The impact of Enhanced Recovery After Surgery protocol on postoperative pain management in the era of opioid crisis: The post-chemotherapy open RPLND paradigm

2019 ◽  
Vol 18 (1) ◽  
pp. e1365
Author(s):  
K. Dimitropoulos ◽  
L.L. Pisters ◽  
A. Karatzas ◽  
C. Vaiopoulos ◽  
C. Papandreou ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Postoperative Pain Management ◽  
Opioid Crisis ◽  
The Impact

scholarly journals The impact of medical clowns exposure over postoperative pain and anxiety in children and caregivers: An Israeli experience

2019 ◽  
Vol 11 (3) ◽  
Author(s):  
Nitza Newman ◽  
Slava Kogan ◽  
Moshe Stavsky ◽  
Shay Pintov ◽  
Yotam Lior
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Therapy Group ◽  
Postoperative Pain Management ◽  
Serum Cortisol ◽  
Pain Reduction ◽  
Parental Distress ◽  
Post Surgery ◽  
Emotional Outcomes ◽  
The Impact

While postoperative pain management was shown to reduce unwanted physiological and emotional outcomes, pediatric postoperative pain management remains suboptimal. Medical-clowns were shown to be beneficial in many medical contexts including reduction of stress, anxiety and pain. This study was set to assess the effectiveness of medical-clowns on pediatric postoperative pain reduction. Children age 4 or above, planned for elective hernia repair surgery were recruited. Children were randomly divided to a control or medicalclown escorted groups. Demographical and clinical data were collected using questionnaires and electronic sheets. Children escorted by clowns reported lower levels of pain upon admittance, discharge and 12-hours post-surgery. Statistically significant reduction of parental distress and significantly higher serum cortisol levels were observed in the clown-therapy group. Although small, our study supports the possibility that preoperative medical-clown therapy might be a cheap, safe and yet beneficial method for postoperative pain reduction.

scholarly journals The impact of implementing a person-centred pain management intervention on resistance to change and organizational culture

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Eva Angelini ◽  
Axel Wolf ◽  
Helle Wijk ◽  
Helena Brisby ◽  
Adad Baranto
Keyword(s):  
Health Care ◽  
Organizational Culture ◽  
Pain Management ◽  
Postoperative Pain ◽  
Spine Surgery ◽  
Resistance To Change ◽  
Postoperative Pain Management ◽  
Assessment Instrument ◽  
Systematic Change ◽  
The Impact

Abstract Background Resistance to change and organizational culture are essential factors to consider in change management in health care settings. Implementation of structural change remains a challenge. There is a lack of studies providing information on the impact of implementation processes on the organization. The aim of this study was to describe the impact of implementing a systematic change process concerning postoperative person-centred pain management on resistance to change and organizational culture in an orthopaedic spine surgery unit. Methods The study was set in an orthopaedic spine surgery unit at a university hospital. Person-centred bundles of care for postoperative pain management of spine surgery patients were developed in co-creation by a multi-professional expert group and implemented throughout the care pathway. The intervention was underpinned by theories on organizational culture and inspired by principles of person-centred care. Quantitative data were collected using the Resistance to Change Scale and the Organizational Culture Assessment Instrument and analysed using descriptive statistics. Results The findings showed a low resistance to change decreasing during the study. The organizational culture shifted from a result-oriented to a formalized and structured culture after the implementation. The culture preferred by the staff was team-oriented and participation-focused throughout the study. The discrepancy between the current and preferred cultures remained extensive over time. Conclusion It is challenging to describe the influence of the development and implementation of a postoperative pain management program on organizational culture as well as in terms of resistance to change, in a complex health care setting. In the current study the unit was under organizational strain during the implementation. Albeit, the important discrepancy between the current and preferred organizational culture could imply that structural changes aren’t enough when implementing person-centred pain management structures and needs to be combined with relational aspects of change.

scholarly journals Postoperative Pain Management in Enhanced Recovery Pathways

2022 ◽  
Vol Volume 15 ◽  
pp. 123-135
Author(s):  
Christopher K Cheung ◽  
Janet O Adeola ◽  
Sascha S Beutler ◽  
Richard D Urman
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Enhanced Recovery ◽  
Postoperative Pain Management ◽  
Enhanced Recovery Pathways ◽  
Recovery Pathways

scholarly journals Electronic Ordering System Improves Postoperative Pain Management after Total Knee or Hip Arthroplasty

2015 ◽  
Vol 06 (03) ◽  
pp. 591-599 ◽  
Author(s):  
T. Chiu ◽  
S. Wolfe ◽  
S. Magid ◽  
M.K. Urban
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Hip Arthroplasty ◽  
Postoperative Pain Management ◽  
Conventional Group ◽  
Delivery Times ◽  
Pain Scores ◽  
Time To Initiation ◽  
Total Knee ◽  
The Impact

Summary Objectives: The authors investigated the impact of computerized provider order entry (CPOE) on the delivery times of analgesia and subsequent patient outcomes. We hypothesized that patients would report less pain and use less pain medications compared with the previous paper-based system. Methods: Two groups of patients after a total hip (THA) or knee arthroplasty (TKA) were retrospectively compared: one comprising 106 patients when the paper-based ordering system was in effect (conventional group), and one comprising 96 patients after CPOE was installed (electronic group). All patients received a regional anaesthetic at surgery (combined spinal-epidural). TKA patients also received a single-injection femoral nerve block. After transfer to the postoperative anaesthesia care unit (PACU), a patient-controlled epidural analgesia (PCEA) infusion was initiated. The following data was collected from the PACU record: time to initiation of analgesia, visual analog scale (VAS) pain scores at initiation of analgesia and hourly for the first postoperative day (POD), volume of pain medication used, length of stay (LOS) in the PACU and the hospital. Results: The time to initiation of analgesia from arrival in the PACU was significantly lower in the electronic group compared to the conventional group (24.5 ± 28.3 minutes vs. 51.1 ± 26.2 minutes; mean ± SD, p < 0.001), as were VAS pain scores (0.82 ± 1.08 vs. 1.5 ± 1.52, p < 0.001) and the volume of PCEA needed to control pain (27.9 ± 20.2 ml vs. 34.8 ± 20.3 ml, p = 0.001) at 4 hours postoperatively. PACU LOS and hospital LOS did not significantly differ in the two groups. Conclusions: After implementation of CPOE, patients received their postoperative analgesia faster, had less pain, and required less medication. Citation: Urban M,Chiu T, Wolfe S, Magid S. Electronic Ordering System Improves Postoperative Pain Management after Total Knee or Hip Arthroplasty. Appl Clin Inform 2015;6: 591–599http://dx.doi.org/10.4338/ACI-2014-12-RA-0114

scholarly journals Role of Multimodal Analgesia in the Evolving Enhanced Recovery after Surgery Pathways

Medicina ◽  
2018 ◽  
Vol 54 (2) ◽  
pp. 20 ◽  
Author(s):  
David Gelman ◽  
Arūnas Gelmanas ◽  
Dalia Urbanaitė ◽  
Ramūnas Tamošiūnas ◽  
Saulius Sadauskas ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Recovery Period ◽  
Postoperative Pain Management ◽  
Multimodal Analgesia ◽  
Postoperative Recovery ◽  
Surgical Trauma ◽  
Surgical Interventions ◽  
Inflammatory Drugs

Enhanced recovery after surgery (ERAS) are specially designed multimodal perioperative care pathways which are intended to attain and improve rapid recovery after surgical interventions by supporting preoperative organ function and attenuating the stress response caused by surgical trauma, allowing patients to get back to normal activities as soon as possible. Evidence-based protocols are prepared and published to implement the conception of ERAS. Although they vary amongst health care institutions, the main three elements (preoperative, perioperative, and postoperative components) remain the cornerstones. Postoperative pain influences the quality and length of the postoperative recovery period, and later, the quality of life. Therefore, the optimal postoperative pain management (PPM) applying multimodal analgesia (MA) is one of the most important components of ERAS. The main purpose of this article is to discuss the concept of MA in PPM, particularly reviewing the use of opioid-sparing measures such as paracetamol, nonsteroid anti-inflammatory drugs (NSAIDs), other adjuvants, and regional techniques.

scholarly journals SP1.1.14Future Insights on Virtual Reality Potential Uses as a Care Package for Colorectal Patients

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
A Gendia ◽  
H Rottenburg ◽  
M Hutton ◽  
A Cota ◽  
J Clark
Keyword(s):  
Virtual Reality ◽  
Pain Management ◽  
Postoperative Pain ◽  
Enhanced Recovery ◽  
Postoperative Pain Management ◽  
Immersive Virtual Reality ◽  
Educational Tool ◽  
Care Package ◽  
Three Stages ◽  
Areas Of Interest

Abstract Aim To provide an insight on current applications of immersive virtual reality (VR) on patients undergoing surgery and to project the potential uses of these applications on colorectal population. Methods A non-systematic literature search of PubMed using key subject “Virtual Reality and Surgery” to identify relative articles. On reviewing applications of VR in surgery we identified four main areas of interest: preoperative education, perioperative support, postoperative pain management and rehabilitation. Results VR technology showed promising results in all three stages of patient’s journey ; In pre-surgery, VR was used as a powerful educational tool for vascular patients. Intraoperatively, it showed promising results as a distraction method to relief stress and discomfort in patients undergoing colonoscopy and gynaecology procedures. Postoperatively, VR was utilized in pain management in orthopaedics, cardiothoracic populations with acceptable results. Moreover, physical rehabilitation showed a strong outlet of the technology due to its engaging properties. Conclusion VR has been showing applicable benefits in different stages of patient’s care undergoing surgery. With proper future development of Its applications, VR potentials in colorectal population could be numerous; education on stoma and type of surgery with help of 3D environment, distraction tool for colonoscopy screening and postoperative pain. In addition, VR could help with enhanced recovery inform of physical and mental rehabilitation. Future uses of VR in colorectal population could be a key in improving outcomes and overall satisfactions. However, formulated studies and validated applications should be tackled to apply the technology safely in the standard care of colorectal patients.

A new postoperative pain management (intravenous acetaminophen: Acelio®) leads to enhanced recovery after esophagectomy: a propensity score-matched analysis

Surgery Today ◽  
2017 ◽  
Vol 48 (5) ◽  
pp. 502-509 ◽  
Author(s):  
Yu Ohkura ◽  
Junichi Shindoh ◽  
Masaki Ueno ◽  
Toshiro Iizuka ◽  
Shusuke Haruta ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Propensity Score ◽  
Enhanced Recovery ◽  
Postoperative Pain Management ◽  
Intravenous Acetaminophen
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