Neuraxial Anesthesia Is Associated With Decreased Pain Scores and Post-Anesthesia Care Unit Opioid Requirement Compared With General Anesthesia in Hip Arthroscopy

2021 ◽  
Vol 37 (1) ◽  
pp. 139-146 ◽  
Author(s):  
Elizabeth H.G. Turner ◽  
Christopher J. Whalen ◽  
Matthew A. Beilfuss ◽  
Scott J. Hetzel ◽  
Kristopher M. Schroeder ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Hip Arthroscopy ◽  
Neuraxial Anesthesia ◽  
Anesthesia Care ◽  
Post Anesthesia Care Unit ◽  
Pain Scores

scholarly journals NEURAXIAL ANESTHESIA FOR HIP ARTHROSCOPY IS ASSOCIATED WITH DECREASED IMMEDIATE POSTOPERATIVE PAIN SCORES AND OPIOID REQUIREMENTS COMPARED TO GENERAL ANESTHESIA

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0003
Author(s):  
Elizabeth H. G. Turner ◽  
Christopher J. Whalen ◽  
Matthew A. Beilfuss ◽  
Scott J. Hetzel ◽  
Kristopher M. Schroeder ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Adverse Events ◽  
General Anesthesia ◽  
Hip Arthroscopy ◽  
Neuraxial Anesthesia ◽  
Pain Scores ◽  
Significant Difference ◽  
Opioid Administration ◽  
Spinal Epidural ◽  
Major Adverse Events

Background: Hip arthroscopy is most commonly performed utilizing general anesthesia. Studies in hip and knee arthroplasty have shown an association between neuraxial anesthesia and lower rates of perioperative adverse events, lower post-operative pain scores, and lower dosing of postoperative systemic analgesics when compared to general anesthesia. A direct comparison between neuraxial and general anesthesia in hip arthroscopy has not previously been investigated. Hypothesis/Purpose: We sought to identify the immediate post-operative differences in opioid use, pain scores, and post-anesthesia care unit (PACU) length of stay (LOS) after hip arthroscopy related to the type of anesthesia used for the surgical procedure. Methods: Patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS) with labral tears by a single surgeon at an academic center between October 2017 and July 2019 were retrospectively reviewed. The primary outcome was PACU opioid administration, measured by morphine equivalents (MEQ). Secondary parameters included total LOS, post-incision LOS, PACU LOS and PACU arrival/discharge pain scores. Analyses conducted were t-tests, Wilcoxon rank sum tests, or chi-square tests. Results: A total of 129 patients met inclusion criteria for this study; 54 males and 75 females, with an average age of 28 (±10.1) years. 52 (40.3%) had general anesthesia and 77 (59.7%) had neuraxial anesthesia, including spinal, epidural, and combined spinal-epidural anesthesia which were intermixed throughout the study period. Intraoperative and PACU opioid administration demonstrated a significant difference in medians. Neuraxial methods required a lower MEQ in both the operating room (30.0 vs 53.9, p = 0.001) and PACU (18.2 vs 31.2, p = 0.002). Neuraxial anesthesia had lower median PACU arrival and discharge pain scores (0.0 vs. 5.0, p = 0.001, 3.0 vs. 4.0, p = 0.013). There was no statistically significant difference in post-incision LOS, or traction time. General anesthesia was associated with a longer PACU phase 1 time (1.0 vs. 1.3 hrs, p = 0.005). No major adverse events such as death, disability, or prolonged hospitalization occurred in either group. Conclusion: Neuraxial anesthesia use in routine hip arthroscopy was associated with lower immediate postoperative pain scores, lower intraoperative and immediate postoperative opioid requirements, and may be associated with shorter anesthesia recovery time without any major adverse events when compared to general anesthesia. Tables [Table: see text][Table: see text]

scholarly journals Risk Factors of Postoperative Shivering at Post Anesthesia Care Unit in Normothermic Patients Underwent General Anesthesia

2021 ◽  
Author(s):  
Laortip Rattanapittayaporn ◽  
Maliwan Oofuvong
Keyword(s):  
Risk Factors ◽  
General Anesthesia ◽  
Core Temperature ◽  
Conditional Logistic Regression ◽  
Control Group ◽  
Anesthesia Care ◽  
Post Anesthesia Care Unit ◽  
Emergency Case ◽  
Increased Risk ◽  
Duration Of Surgery

Objective: The aim of study was to identify risk factors that can be modified to reduce incidence of postoperative shivering in normothermic patient who underwent general anesthesia.Material and Methods: A retrospective case control study was conducted between January 2017 and August 2018 by assessing the anesthetic records of normothermic patients at a post anesthesia care unit who underwent general anesthesia. A control group of 201 patients was randomly matched with 201 cases by age (±5 years) and site of surgery. Medical records were reviewed for data including patient demographics, operative time, anesthetic medication, type of fluid, core temperature at the end of surgery and occurrence of postoperative shivering. Conditional logistic regression analysis was performed to assess the association between potential risk factors and postoperative shivering.Results: Higher body mass index (BMI) [odds ratio (OR) 0.91, 95% confidence interval (CI) 0.87-0.96] and higher core temperature at end of surgery (OR 0.33 95% CI 0.18-0.63) are associated with reduced risk of postoperative shivering. Whereas emergency case compared with elective case (OR 3.06 95% CI 1.63-5.72) and longer duration every 10 minutes (OR 1.05 95% CI 1.03-1.08) are associated with an increased risk of postoperative shivering.Conclusion: Emergency case, longer duration of surgery, lower BMI and lower core temperature at end of surgery were significantly associated with postoperative shivering.

Emergence From General Anesthesia and Evolution of Delirium Signs in the Post-Anesthesia Care Unit

2016 ◽  
Vol 60 (2) ◽  
pp. 75-76
Author(s):  
E. Card ◽  
P. Panharipande ◽  
C. Tomes ◽  
C. Lee ◽  
J. Wood ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Anesthesia Care ◽  
Post Anesthesia Care Unit

scholarly journals Of Rough Starts and Smooth Finishes: Correlations Between Post-Anesthesia Care Unit and Postoperative Days 1-5 Pain Scores

Pain Medicine ◽  
2013 ◽  
Vol 15 (2) ◽  
pp. 306-315 ◽  
Author(s):  
Patrick James Tighe ◽  
Christopher A. Harle ◽  
Andre Pierre Boezaart ◽  
Haldun Aytug ◽  
Roger Fillingim
Keyword(s):  
Anesthesia Care ◽  
Post Anesthesia Care Unit ◽  
Pain Scores

scholarly journals The clinical application of preoperative self-anticipated pain score and the correlation with surgical pain after elective surgery - a prospective observational study

2020 ◽  
Author(s):  
Wei-Shu Chang ◽  
Yi-Ting Hsieh ◽  
Moa-Chu Chen ◽  
Shu-Ching Chang ◽  
Tzu-Shan Chen ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Observational Study ◽  
Pain Intensity ◽  
Prospective Observational Study ◽  
Elective Surgery ◽  
Perioperative Period ◽  
Anesthesia Care ◽  
Post Anesthesia Care Unit ◽  
Pain Scores

Abstract Background: Current principles of postoperative pain management are primarily based on the types and extent of surgical intervention. This clinical study measured patient’s self-anticipated pain score before surgery, and correlated the scores with the pain levels and analgesic requirements after surgery.Methods: This prospective observational study recruited consecutive patients who received elective surgery in the E-Da Hospital, Taiwan from June to August 2018. Patients were asked to subjectively rate their highest anticipated pain level (numerical rating scale, 0-10) for the scheduled surgical interventions during their preoperative anesthesia assessment. After the operation, the actual pain intensity (NRS 0-10) experienced by the patient in the post-anesthesia care unit and the total dose of opioids administered during the perioperative period were recorded. Pain scores ³4 on NRS were regarded as being unacceptable levels for anticipated or postoperative pain.Results: A total of 996 patients were included in the study. Most of the patients (86%) received general anesthesia and 73.9% of them had a history of previous operation. Female anticipated significantly higher overall pain intensities than the male patients (adjusted odd ratio 1.532, 95% confidence interval 1.125-2.086; P=0.007). Patients who took regular benzodiazepine at bedtime (P=0.040) and those scheduled to receive more invasive surgical procedures were most likely to anticipate for higher pain intensity at the preoperative period (P<0.001). Although higher anticipated pain scores (NRS³4) were associated with higher postoperative pain levels (P=0.021) and higher total equivalent opioid dose (P=0.001) for acute pain management during the perioperative period, these surgical patients actually experienced less pain than they anticipated at the post-anesthesia care unit.Conclusion: This observational study found that patients who are female, use regular benzodiazepines at bedtime and scheduled for more invasive surgeries anticipate significantly higher surgery-related pain. Therefore, appropriate preoperative counseling for analgesic control and the management of exaggerated pain expectation in these patients is necessary to improve the quality of anesthesia delivered and patient’s satisfaction.

scholarly journals A comprehensive three-phase opiate sparing multimodal pain protocol for hip arthroscopy: a retrospective review

2020 ◽  
Author(s):  
Jensen G Kolaczko ◽  
Derrick M Knapik ◽  
Elisabeth Kroneberger ◽  
Amrita Chadha ◽  
Michael J Salata
Keyword(s):  
Hospital Admission ◽  
Hip Arthroscopy ◽  
Hospital Admissions ◽  
Peripheral Nerve Block ◽  
Post Anesthesia Care Unit ◽  
Pain Scores ◽  
Time Period ◽  
Three Phase ◽  
Baseline Characteristics ◽  
Mean Time

Abstract The aim of this study is to assess the efficacy of a three-phase, multimodal, perioperative pain protocol for primary hip arthroscopy based on pain scores, narcotic use, time to discharge, hospital admission and complications. A retrospective study of patients undergoing primary hip arthroscopy over a 48-month time period was conducted. Patients were separated into a multimodal group consisting of non-narcotic medication, local analgesia and a peripheral nerve block (PNB) versus patients receiving only a PNB. Differences in post-anesthesia care unit (PACU) visual analog scores, PACU time to discharge, PACU opioid consumption, hospital admission and complications between protocols were recorded and analyzed. There were 422 patients who underwent 484 surgeries, with 15 patients crossing over pain protocol groups for surgery on the contralateral hip. One hundred and ninety-six patients underwent 213 procedures in the multimodal group and 241 patients underwent 271 procedures in the PNB group. No differences in baseline characteristics were appreciated between groups. Mean time to discharge was significantly shorter in the multimodal group (137.4 ± 49.3 min versus 176.3 ± 6.5 min; P &lt; 0.001) which also had less post-operative admissions (0 versus 9; P = 0.006) than the PNB group. In patients who crossed over protocol groups, a statistically shorter time to discharge was appreciated with the multimodal protocol compared with the PNB protocol (119.9 ± 32.1 min versus 187.9 ± 9.2; P = 0.012). The three-phase, multimodal pain protocol led to significantly faster discharge times and fewer hospital admissions when compared with isolated PNB in patients undergoing primary hip arthroscopy.

Capnography Monitoring to Reduce Adverse Events in the Pediatric Post-Anesthesia Care Unit

PEDIATRICS ◽  
2016 ◽  
Vol 137 (Supplement 3) ◽  
pp. 189A-189A
Author(s):  
Melissa L. Langhan ◽  
Fangyong Li ◽  
Lance Lichtor
Keyword(s):  
Adverse Events ◽  
Anesthesia Care ◽  
Post Anesthesia Care Unit
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