scholarly journals Nurse-initiated, titrated intravenous opioid analgesia reduces time to analgesia for selected painful conditions

CJEM ◽  
2005 ◽  
Vol 7 (03) ◽  
pp. 149-154 ◽  
Author(s):  
Anne-Maree Kelly ◽  
Catherine Brumby ◽  
Caroline Barnes
Keyword(s):  
Opioid Analgesic ◽  
Data Management System ◽  
Biliary Colic ◽  
Opioid Analgesia ◽  
Narcotic Drug ◽  
Drug Register ◽  
Triage Category ◽  
Analgesic Dose ◽  
Time Of Presentation ◽  
The Impact

ABSTRACTObjectives:Traditionally, patients have to wait until assessed by a physician for opioid analgesia to be administered, which contributes to delays to analgesia. Western Hospital developed a protocol enabling nurses to initiate opioid analgesia prior to medical assessment for selected conditions. The aim of this study was to determine the impact of this protocol on time to first opioid dose in patients presenting to the emergency department (ED) with renal or biliary colic.Methods:This was an explicit medical record review of all adult patients with an ED discharge diagnosis of renal or biliary colic presenting to a metropolitan teaching hospital ED. Patients were identified via the ED data management system. Data collected included demographics, condition, triage category, time of presentation, whether analgesia was nurse-initiated or not, and interval from arrival to first opioid analgesic dose. The narcotic drug register for the relevant period was also searched to cross-check whether opiates were doctor- or nurse-initiated.Results:There were 58 presentations in the nurse-initiated opioid analgesia group and 99 in the non-nurse-initiated analgesia group. Groups were reasonably well matched for gender, triage category and time of presentation, but there was a higher proportion of biliary colic in the non-nurse-initiated analgesia group. Median time to first analgesic dose was 31 minutes in the nurse-initiated group and 57 minutes in the non-nurse-initiated analgesia group (effect size, 26 minutes; 95% confidence interval 16-36 min;p< 0.0001]. There were no major adverse events in either group.Conclusion:A nurse-initiated opioid analgesia protocol reduces delays to opioid analgesia for patients with renal and biliary colic.

scholarly journals The Impact of Pre-emptive Large Dose of Methylprednisolone Combined With Gabapentin on Pain Treatment and Convalescence After Total Knee Arthroplasty in Elderly. A Randomized Control Study

2021 ◽  
Author(s):  
Henryk Liszka ◽  
Małgorzata Zając ◽  
Artur Gądek
Keyword(s):  
Total Knee Arthroplasty ◽  
Single Dose ◽  
Knee Arthroplasty ◽  
Opioid Analgesic ◽  
Control Group ◽  
Study Group ◽  
Intensity Level ◽  
Old Patients ◽  
Total Knee ◽  
The Impact

Abstract Background The aim of the study was to assess whether administration of gabapentin and methylprednisolone as “pre-emptive analgesia” in a group of patients above 65 years of age would be effective in complex pain management therapy following total knee arthroplasty (TKA). Material and Methods One hundred seventy, above 65 years old patients were qualified for the study, and 10 patients were excluded due to clinical situation. One hundred sixty patients were double-blind randomized into two groups: the study (eighty patients) and controls (eighty patients). The study group received as “pre-emptive” analgesia a single dose of 300 mg oral gabapentin and 125 mg intravenous methylprednisolone, while the others placebo. Perioperatively, all the patients received opioid and nonopioid analgesic agents calculated for 1 kg of body weight. We measured the levels of inflammatory markers (leukocytosis, C-reactive protein - CRP), pain intensity level at rest (numerical rating scale - NRS), the life parameters and all complications. Results Following administration of gabapentin and methylprednisolone as “pre-emptive” analgesia CRP values being lower on all postoperative days ( 1, 2 days - p<0,00001, 3 day – p=000538), leukocytosis on day 2 (p<0,0086) and 3 (p<0,00042), the NRS score at rest 6, 12 (p<0,000001), 18 (p<0,00004) and 24 (p=0,005569) hours postoperatively . Methylprednisolone with gabapentin significantly decreased the dose of parenteral opioid preparations (p=0,000006). The duration time of analgesia was significantly longer in study group (p<0,000001). No infectious complications were observed; in the control group, one patient manifested transient ischaemic attack (TIA). Conclusion The use of gabapentin and methylprednisolone at a single dose decreases the level of postoperative pain on the day of surgery, the dose of opioid analgesic preparations, the level of inflammatory parameters without infectious processes.

Opioid analgesic dose and the risk of misuse, overdose, and death: A narrative review

2017 ◽  
Vol 27 (5) ◽  
pp. 464-472 ◽  
Author(s):  
David Tyler Coyle ◽  
Chih-Ying Pratt ◽  
Josephine Ocran-Appiah ◽  
Alex Secora ◽  
Cynthia Kornegay ◽  
...  
Keyword(s):  
Opioid Analgesic ◽  
Narrative Review ◽  
Analgesic Dose

scholarly journals Clinical and environmental factors are not associated with establishment of pre-hospital intravenous access.

2019 ◽  
Vol 2 (3) ◽  
pp. 43
Author(s):  
Rasmus Lyngby
Keyword(s):  
Environmental Factors ◽  
Hospital Setting ◽  
Light Conditions ◽  
Success Rates ◽  
Chi Square ◽  
Triage Category ◽  
The Social ◽  
Chi Square Test ◽  
Level Of Difficulty ◽  
The Impact

Background: Establishing intravenous (IV) access is part of the paramedic scope of practice and in critically ill patients the procedure is essential to administer fluids and/or drugs. However, in the unique pre-hospital setting clinical and environmental factors may challenge the procedure. Previous studies have investigated IV procedure time and overall success-rates with little or no attention to the impact of challenging factors. The aim of this study was to investigate clinical and environmental factors associated with the first attempt of IV access establishment. Methods: Data containing information on IV procedure characteristics, patient condition and environmental factors were obtained by paramedics operating in the Capital Region of Denmark. Data was collected during three non-consecutive months in 2017 and 2018. Data was exported to IBM’s Statistical Package for the Social Sciences (SPSS) for analysis. A chi-square test for independence (with Yates’ Continuity Correction for 2x2 tables and likelihood ratio for expected count violations) was applied to test for association between first attempt of IV access establishment, patient condition and environmental factors. Results: A total of 259 datasets were available. Statistical analysis revealed a significant association between first attempt of IV access establishment and assessed level of difficulty (p=0.00). No significant association was found between first attempt of IV access establishment and presence of radial pulse (p=0.21), patient triage category (p=0.35), size of catheter (p=0.80), site of catheter insertion (p=0.11), light conditions (p=0.26) and procedure location (p=0.31). Conclusion: This study concludes that first-attempt IV access establishment was significantly associated with assessed level of difficulty, and non-significantly associated with the investigated clinical end environmental factors. Based on the findings, paramedics should reconsider IV access for patients where the procedure is considered difficult, and consider other available administration options. On the contrary, paramedics should not refrain from attempting IV access establishment based on present clinical and environmental factors thought to challenge the procedure.

scholarly journals Effects of Relaxed Lockdown on Pediatric ER Visits during SARS-CoV-2 Pandemic in Italy

2021 ◽  
Vol 18 (18) ◽  
pp. 9547
Author(s):  
Luigi Matera ◽  
Raffaella Nenna ◽  
Francesca Ardenti Morini ◽  
Giuseppe Banderali ◽  
Mauro Calvani ◽  
...  
Keyword(s):  
Emergency Room ◽  
Multicenter Study ◽  
Preventive Measures ◽  
Pediatric Emergency ◽  
Communicable Diseases ◽  
Social Activities ◽  
Triage Category ◽  
The Impact ◽  
Retrospective Multicenter Study

Previously, we demonstrated an 81% reduction in pediatric Emergency Room (ER) visits in Italy during the strict lockdown due to the SARS-CoV-2 pandemic. Since May 2020, lockdown measures were relaxed until 6 November 2020, when a strict lockdown was patchily reintroduced. Our aim was to evaluate the impact of the relaxed lockdown on pediatric ER visits in Italy. We performed a retrospective multicenter study involving 14 Italian pediatric ERs. We compared total ER visits from 24 September 2020 to 6 November 2020 with those during the corresponding timeframe in 2019. We evaluated 17 ER specific diagnoses grouped in air communicable and non-air communicable diseases. We recognized four different triage categories: white, green, yellow and red. In 2020 total ER visits were reduced by 51% compared to 2019 (16,088 vs. 32,568, respectively). The decrease in air communicable diseases was significantly higher if compared to non-air communicable diseases (−64% vs. −42%, respectively). ER visits in each triage category decreased in 2020 compared to 2019, but in percentage, white and red codes remained stable, while yellow codes slightly increased and green codes slightly decreased. Our results suggest that preventive measures drastically reduced the circulation of air communicable diseases even during the reopening of social activities but to a lesser extent with regard to the strict lockdown period (March–May 2020).

scholarly journals Methods for constructing treatment episodes and impact on exposure-outcome associations

2019 ◽  
Vol 76 (2) ◽  
pp. 267-275
Author(s):  
Laura Pazzagli ◽  
Lena Brandt ◽  
Marie Linder ◽  
David Myers ◽  
Panagiotis Mavros ◽  
...  
Keyword(s):  
Exposure Time ◽  
Clinical Relevance ◽  
Alternative Methods ◽  
Treatment Episode ◽  
Outpatient Visits ◽  
Drug Register ◽  
The Impact ◽  
Efficacy Profile

Abstract Purpose To assess the impact on exposure time and outcome misclassifications, and consequent impact on exposure-outcome associations from treatment episode construction. We investigated the dosage assumptions of 1 unit per day, and 1 DDD per day, versus actual prescribed dosage under different handling of gaps and overlaps of prescriptions. Methods Data on mirtazapine and citalopram exposure (years 2006–2014) from the Swedish Prescribed Drug register were used. Via a within individuals design we compared method A, based on actual dosage, with methods B and C based on 1 unit of drug per day and 1 DDD per day assumptions, respectively, including consideration of gaps and overlaps. Four outcomes were used, hospitalizations and outpatient visits for all and for psychiatric causes. Results Relative to method A, both alternative methods lead to misclassification of exposure time. With regard to outcome misclassifications, method B overestimates the effect of the exposure on the outcome in 77% and 100% of exposure definition comparisons for mirtazapine and citalopram respectively, while 23% of the comparisons for mirtazapine results in underestimation of exposure-outcome associations. Conversely, treatment episodes based on DDD (method C) result in underestimation of the exposure-outcome association in 100% and 87.5% of exposure definition comparisons for mirtazapine and citalopram respectively, while 12.5% of the comparisons for citalopram results in overestimation of the exposure-outcome associations. Conclusions The study provides results that have consistent clinical relevance. We have showed that a non-accurate construction of exposure time may lead to errors on outcome detection during exposed time, and consequently affect conclusions on safety or efficacy profile of a treatment.

Role of multimodal anaesthetic in post-operative analgesic requirement for robotic assisted radical prostatectomy

2021 ◽  
pp. 039156032110318
Author(s):  
Murugu Kalai Selvan Masilamani ◽  
Aiswarya Sukumar ◽  
Pete William Cooke ◽  
Chandrashekar Rangaswamy
Keyword(s):  
Pain Management ◽  
Radical Prostatectomy ◽  
Opioid Analgesic ◽  
Length Of Hospital Stay ◽  
Anaesthetic Technique ◽  
Analgesic Requirement ◽  
Robotic Assisted ◽  
Visual Analogue Pain ◽  
Management Protocol ◽  
The Impact

Purpose: Robotic assisted laparoscopic radical prostatectomy (RARP) is considered as standard of care for surgical management of localised prostate cancer. Procedure specific postoperative pain management (PROSPECT) guidelines are available for open radical prostatectomy. There is a lack of evidence for optimal pain management protocol in patients undergoing robotic radical prostatectomy. This study investigates the impact of multimodal anaesthetic on post-operative analgesic requirements. Methods and materials: In our Institute, RARP is performed with a multimodal anaesthetic technique. Forty-one consecutive cases from October 2018 to March 2019 operated on by the same surgeon and anaesthetised by the same anaesthetic consultant were included in the study. All the patients received standardised multimodal anaesthetic technique. Data from visual analogue pain scores, nausea, vomiting and requirement of analgesics were collected from hospital records and results were analysed. Results: Our results showed that 60% of patients reported either no pain or mild pain. None of the patients required stronger opioids or parenteral analgesic. Only three patients required antiemetic. Length of hospital stay was 1.19 days which is comparable to published outcomes from high volume centres performing RARP. Conclusion: Our study adds to the currently published literature that RARP when combined with the multimodal anaesthetic technique can significantly reduce stronger opioid analgesic requirement in the post-operative period without compromising LOS.

Improvements in data collection through physician use of a computer-based chemotherapy treatment consultant.

1985 ◽  
Vol 3 (10) ◽  
pp. 1409-1417 ◽  
Author(s):  
D L Kent ◽  
E H Shortliffe ◽  
R W Carlson ◽  
M B Bischoff ◽  
C D Jacobs
Keyword(s):  
Data Collection ◽  
Disease Activity ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Clinical Trial Data ◽  
Data Management System ◽  
Before And After ◽  
Computer Based ◽  
Physical Findings ◽  
The Impact

The impact of a computer-based data management system on the completeness of clinical trial data was studied before and after the system's introduction in an oncology clinic. Physicians use the system, termed ONCOCIN, to record data during patient visits and to receive advice about treatment and tests required by experimental cancer protocols. Although ONCOCIN does not force the user to enter all data expected by the protocol, after its introduction there was improvement in the recording frequency of such data. The percentage of expected physical findings recorded increased from 74% to 91% (P less than .05), toxicity history from less than 1% to 45% (P less than .01), general chemistry results from 36% to 82% (P less than .01), x-ray results from 44% to 73% (P less than .01), and physicians' assessments of overall disease activity and Karnofsky performance status from 73% to 91% (P less than .05). Analysis of the steps in data collection and their contribution to loss of data suggests that observations or test ordering which are dependent on the physician are most improved by the system. Furthermore, analysis of post-ONCOCIN visits when the system was unavailable suggests that the recording of physician-dependent data (physical findings and assessments of disease activity and performance status) is likely to revert to pre-ONCOCIN levels if the system is not used routinely. The results show that ONCOCIN can greatly enhance recovery of those data expected for chemotherapy protocol patients. The program's interaction with the physician is central to its effectiveness in data collection, especially for data that arise directly from the patient-physician encounter.

Creating an Opioid Recommendation Card for Trainees: Methods, Use, and Impact

2020 ◽  
pp. 000313482094062
Author(s):  
Mollie R. Freedman-Weiss ◽  
Alexander S. Chiu ◽  
Erin M. White ◽  
Peter S. Yoo
Keyword(s):  
Postoperative Analgesia ◽  
Opioid Analgesic ◽  
Junior Resident ◽  
Evidence Based ◽  
Prescribing Practices ◽  
Opioid Prescribing ◽  
Surgical Residents ◽  
Surgical Trainees ◽  
Wide Variability ◽  
The Impact

Background In academic hospitals, surgical residents write most of the postoperative prescriptions; yet, few residents are trained on postoperative analgesia. This leads to wide variability in practices and often excess opioid prescribing. We sought to create an opioid guideline pocket card for surgical residents to access when prescribing opioids postoperatively and to evaluate the impact of this initiative. Methods A comprehensive literature review was conducted to generate evidence-based procedure-specific opioid recommendations; additional recommendations were formulated via consensus opinion from surgical divisions at an academic institution. A pocket-sized guideline card was developed to include these procedure-specific recommendations as well as opioid guidelines for discharges after inpatient stays, non-opioid analgesic recommendations, access to opioid safety and disposal instructions for patients discharge, an equianalgesic dosing chart, and instructions for naloxone use. The card was distributed to all General Surgery house staff at a university-affiliated hospital in the spring of 2018. Following the distribution, trainees were surveyed on their use of the card. Descriptive statistics were used to analyze the survey. Results Of 85 trainees, 62 (72.9%) responded to the survey in full; 58% use the card regularly. Of the 27 junior resident respondents, 70.4% use the card at least monthly including 48.1% who use the card daily-to-weekly. Overall, 81.6% of residents changed their opioid-prescribing practices because of this initiative and 89.8% believe the card should continue to be distributed and used. Discussion An evidence-based guideline card for postoperative analgesia is highly valued and utilized by surgical trainees, especially those most junior in their training.

Pain Predicts Overall Survival in Men With Metastatic Castration-Refractory Prostate Cancer

2008 ◽  
Vol 26 (15) ◽  
pp. 2544-2549 ◽  
Author(s):  
Susan Halabi ◽  
Nicholas J. Vogelzang ◽  
Alice B. Kornblith ◽  
San-San Ou ◽  
Philip W. Kantoff ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Group Performance ◽  
Opioid Analgesic ◽  
Objective Response ◽  
Pain Interference ◽  
Phase Iii ◽  
Risk Of Death ◽  
Pain Scores ◽  
The Impact

PurposePain from castration-refractory prostate cancer (CRPC) bone metastases is a common event. Although it is assumed that pain represents an adverse prognostic factor, this variable has not been extensively evaluated. The objective of this study was to determine whether men with CRPC who had higher pain interference scores at baseline had worse clinical outcomes compared with men who had lower pain scores.Patients and MethodsData from three randomized phase III multicenter trials conducted by the Cancer and Leukemia Group B from 1992 to 1998 were combined. Eligible patients had progressive CRPC adenocarcinoma of the prostate, an Eastern Cooperative Oncology Group performance status of 0 to 2, and adequate hematologic, renal, and hepatic functions. Seven items from the Brief Pain Inventory were used to assess the impact of pain on a range of daily activities and quality of life, each rated on a scale from 0 to 10.ResultsIn 599 men, the median pain interference scores was 17 (interquartile range, 4 to 34), and 38% of the men had opioid analgesic use at baseline. There was a statistically significant association between pain interference scores and risk of death. The median survival times were 17.6 months (95% CI, 16.1 to 19.1 months) and 10.2 months (95% CI, 8.6 to 11.3 months; P < .001) in men with low (< 17) and high (≥ 17) pain scores, respectively. Pain was inversely associated with likelihood of prostate-specific antigen decline, objective response, and time to bone progression.ConclusionThis analysis demonstrates that pain is a statistically significant predictor of overall survival in men with metastatic CRPC. These results need to be validated prospectively in future phase III trials.

scholarly journals Harnessing endogenous opioids for pain relief: Fantasy vs reality

2020 ◽  
Vol 16 (1) ◽  
pp. 67-72
Author(s):  
Alan R. Gintzler, PhD ◽  
Nai-Jiang Liu, MD, PhD
Keyword(s):  
Pain Relief ◽  
Opioid Analgesic ◽  
Endogenous Opioids ◽  
Opioid Analgesia ◽  
Opioid Overdose ◽  
Endogenous Opioid ◽  
Current Crisis ◽  
Novel Approach ◽  
Clinical Pain ◽  
Opioid Antinociception

Objective: To review evidence demonstrating efficacy and feasibility of harnessing the activity of endogenous opioid analgesic systems for pain management.Methods: The authors sought to summarize a wealth of data that establish proof of concept that the analgesic activity of endogenous opioids can be exploited to clinically benefit from the enormous pain-relieving abilities of these peptides without contributing to the current crisis of death by synthetic opioid overdose.Results: There is a plethora of studies demonstrating that not only can endogenous opioids mediate placebo-induced antinociception but they are also active in modulating clinical pain. Earlier studies convincingly demonstrate the effectiveness of psychological strategies to coopt endogenous opioid analgesic systems to produce pain relief. The challenge is to define pharmacological targets for activating endogenous opioid analgesia reliably in a clinical setting. Based on insights gleaned from mechanisms underlying the ebb and flow of analgesic responsiveness to the spinal application of endomorphin 2, multiple signaling proteins were identified that activate endogenous spinal opioid analgesia. Notably, this was achieved in the absence of any exogenous synthetic opioid.Conclusions: Utilization of drugs that harness endogenous opioid antinociception in accordance with varying physiological states represents a novel approach for effective pain management while mitigating the present epidemic of death by synthetic opioid overdose.

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