PAIIN (Precise Analgesic Instructions Improve Narcotic Usage): A Randomized Trial

2022 ◽  
Author(s):  
Logan Erz ◽  
Brandon Larson ◽  
Shayda Mirhaidari ◽  
Chad Cook ◽  
Doug Wagner
Keyword(s):  
Pain Management ◽  
The United States ◽  
Pain Scale ◽  
Opioid Use ◽  
Breast Reduction Surgery ◽  
Pain Scores ◽  
Subjective Pain ◽  
Group A ◽  
Group B ◽  
New Strategies

Abstract Background Given the ongoing battle with opioid abuse and over-use in the United States new strategies are consistently being implemented in an attempt to reduce opioid use and over prescribing. Objectives The purpose of this study was to determine if a more regulated explicit pain management instruction plan could reduce the number of opioids taken. Methods Blinded randomized prospective study comparing a total of 110 (Group A=55, Group B=55) women undergoing elective outpatient bilateral breast reduction surgery by two different plastic surgeons. Patients were randomly divided into either Group A (control) that received general pain management instructions or Group B (experimental) that received explicit pain management instructions from the surgeons and nurses. Participants were asked to record the number of times they treated their pain with each separate modality. They were also asked to record their average daily pain scale for the days that they were treating their pain. Results Patients in group B took on average 1.5 oxycodone while patients in group A took on average 5.7 oxycodone (p<0.01). Thirty-four patients in group B took no oxycodone. Patients in group B also had statistically significant lower subjective pain scores. Conclusions Based on these results it appears that standardizing how patients are instructed to treat their pain post-operatively may reduce the number of narcotics needed, thus reducing the number of narcotics prescribed without compromising pain control.

scholarly journals Penile nerve block at the base of penis in combination with intravenous ketamin plus midazolam versus general anaesthesia(GA) in children undergoing circumcision for post operative pain management in the Eastern Nepal

2014 ◽  
Vol 4 (1) ◽  
pp. 33-36
Author(s):  
NR Sharma ◽  
P Timalsena ◽  
U Rai
Keyword(s):  
Pain Management ◽  
General Anaesthesia ◽  
Nerve Block ◽  
Randomized Study ◽  
Pain Scale ◽  
Single Shot ◽  
Post Operative Pain ◽  
Analgesia Requirement ◽  
Group A ◽  
Group B

Adequate post operative analgesia in children provides satisfactory psychological objective of this study was to compare the post operative analgesia requirement and child satisfaction between two groups, general anaesthesia(GA) alone and GA in combination with penile nerve block. This prospective randomized study was conducted in 50 children aged 6 to 14 years, who underwent circumcision. The boys were randomly allocated into two groups. Group A (n = 25) received GA with Single shot ketamin 2mg/kg IV plus midazolam 0.1 mg/kg and dorsal penile nerve block at the base of penis prior to circumcision with and Group B (n = 25) received GA with ketamine 2mg/kg IV plus midazolam 0.1 mg/kg plus halothane by laryngeal mask. Severity of pain was assessed quantitatively by children’s hospital eastern Ontario pain scale (CHEOPS). The pain intensity was assessed at one hour A1 in group A and B1 for group B and at two hour A2 for group A and B2 for group B during postoperatively period for two hours. Statistical analysis was done by SPSS method. The post operative analgesia was satisfactory with CHEOPS score 6 or <6 in group A 1. In group A 2 twenty two out of twenty five cases had CHEOPS score <6.Where as in group B1 and B2 it was > 6 .Which was statistically 100% significant. In conclu­sion, combined penile nerve block in combination with intravenous ketamine plus midazolam is the satisfactory method of Post operative pain management in children undergoing circumcision. DOI: http://dx.doi.org/10.3126/jcmc.v4i1.10846 Journal of Chitwan Medical College 2014; 4(1): 33-36

scholarly journals ANALGESIA

2006 ◽  
Vol 13 (03) ◽  
pp. 391-395
Author(s):  
FAYYAZ HUSSAIN ◽  
MOHAMMAD SIDDIQUE ◽  
AMRAN HAFIZ
Keyword(s):  
Mefenamic Acid ◽  
Study Groups ◽  
Pain Scale ◽  
Pain Scores ◽  
Post Operative Pain ◽  
Safe Strategy ◽  
Group A ◽  
Inflammatory Drugs ◽  
C 50 ◽  
Group B

Pain following tonsillectomy in childrenis a significant problem that tends to be underestimated. Nonsteroidal anti-inflammatory drugs are effective in themanagement of mild to moderate post-operative pain in children. They can decrease or even eliminate the need foropioid analgesia, thus reducing the opioid-induced side effects. In this study, I used paracetamol alone and acombination of paracetamol with either mefenamic acid or ibuprofen and examined the analgesia produced by all thesethree regimens by using Wong and Baker facial pain scale. Patients and method: The study comprised of three groupsA, B, and C (50 patients in each group selected by non probability convenient method and randomly divided). Analgesiawas achieved in group A with paracetamol 20mg/kg, with paracetamol 20mg/kg plus mefenamic acid 10mg/kg in groupB and paracetamol 20mg/kg plus ibuprofen 5mg/kg in group C orally in syrup form. Post-operative pain was assessedby Wong & Baker faces pain scale at recovery, 4, 8, 12 and 24 hours. Supplementary analgesia was given with oralmefenamic acid (10 mg/kg) in-group B and ibuprofen (5mg/kg) in-group C; otherwise regular oral paracetamol (20mg/kg-6 hourly) was given routinely in all three-study groups post-operatively. Results: Pain score was significantlyhigher in paracetamol group as compared to mefenamic acid or ibuprofen groups (P<0.05), however there was nosignificant difference in pain scores between mefenamic acid and ibuprofen groups. Conclusion: Although there is stillneed for improving analgesia for tonsillectomy pain in children but I can acclaim that a combination of mefenamic acidor ibuprofen with paracetamol is still the most useful, cheap and safe strategy in children, which avoids all opioids sideeffects.

Does laryngopharyngeal reflux affect healing and recovery after tonsillectomy?

2007 ◽  
Vol 122 (6) ◽  
pp. 603-608 ◽  
Author(s):  
S Elwany ◽  
Y A Nour ◽  
E A Magdy
Keyword(s):  
Wound Healing ◽  
Laryngopharyngeal Reflux ◽  
Ph Monitoring ◽  
Control Group ◽  
Study Group ◽  
Pain Scores ◽  
Blinded Study ◽  
Group A ◽  
Group B ◽  
Control Group Group

AbstractIntroduction:Laryngopharyngeal reflux is increasingly being implicated in several otolaryngological disorders.Aims:To study a potential correlation between pre-operative laryngopharyngeal reflux and wound healing and recovery after tonsillectomy, based on subjective and objective findings.Materials and methods:A prospective, blinded study was undertaken, including 60 patients scheduled for tonsillectomy, divided into two equal groups: a study group (group A) with pre-operative laryngopharyngeal reflux documented using ambulatory 24-hour pH monitoring; and a control group (group B) without laryngopharyngeal reflux.Results:Group A had significantly higher pain scores on the seventh and 14th post-operative days (p = 0.022 and p = 0.000, respectively) and took a significantly longer time to return to normal eating (p = 0.013), compared with group B. Group A also showed significantly slower healing on the seventh and 14th post-operative days, as estimated by assessing the grade of post-operative slough formation (p = 0.016 and p = 0.029, respectively). A significant correlation between the number of pharyngeal reflux episodes and the degree of post-operative slough was also found.Conclusions:Laryngopharyngeal reflux can significantly decrease wound healing following tonsillectomy. Therefore, pre-operative recognition and management of this condition is desirable in order to eliminate its negative post-operative effect.

Comparison of stent related symptoms in patients taking mirabegron, solifenacin, or tamsulosin: A double blinded randomized clinical trial

2021 ◽  
pp. 039156032110481
Author(s):  
Abhishek Chandna ◽  
Santosh Kumar ◽  
Kalpesh M Parmar ◽  
Aditya P Sharma ◽  
Sudheer K Devana ◽  
...  
Keyword(s):  
General Health ◽  
Bodily Pain ◽  
Ureteroscopic Lithotripsy ◽  
Health Indices ◽  
Pain Scores ◽  
Robotic Pyeloplasty ◽  
Group A ◽  
Group B ◽  
Double Blinded ◽  
To Receive

Background: The present study aims to assess the efficacy of mirabegron, a novel beta-3 agonist for ameliorating stent related symptoms (SRSs) as compared to tamsulosin and solifenacin. Methods: Total of 150 patients undergoing ureteral stent placement following ureteroscopic lithotripsy, percutaneous nephrolithotomy, or laparoscopic/robotic pyeloplasty were randomized in 1:1:1 fashion to receive mirabegron 50 mg (group A), solifenacin 5 mg (group B), and tamsulosin 0.4 mg (group C) OD respectively. Patients were followed at POD10 (I visit), 4 weeks (II visit) after surgery, and 2 weeks post-stent removal. Validated vernacular version of ureteric stent symptoms questionnaire (USSQ) was administered to the patients at each visit. Results: Out of 150 patients randomized, 123 patients (A; n = 41, B; n = 40, and C; n = 42) completed the study. The groups were comparable in terms of urinary index score of USSQ at I and II visits ( p = 0.119 and 0.076, respectively). A lower proportion of patients in group B experiencing bodily pain at II visit ( p = 0.039), however, pain scores were comparable. Significantly lower general health index scores were observed in group A at I visit and over 4 weeks ( p = 0.007). No significant differences were observed in other domains of USSQ. Age, sex, and surgical procedure undertaken did not significantly impact the scores in various USSQ domains. Conclusion: Mirabegron demonstrates comparable benefit in alleviating SRSs with better general health indices and may be an effective alternative for SRSs, especially when tamsulosin or solifenacin are contra-indicated or poorly tolerated.

scholarly journals Role of Prophylactic Antibiotics in the Management of Postoperative Endodontic Pain

2015 ◽  
Vol 16 (12) ◽  
pp. 939-943 ◽  
Author(s):  
Leena Alsomadi ◽  
Riyad Al Habahbeh
Keyword(s):  
Pain Scale ◽  
Prophylactic Antibiotics ◽  
Post Treatment ◽  
Endodontic Treatment ◽  
Significant Difference ◽  
Group A ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Group B

ABSTRACT Aim To investigate the efficacy of using antibiotics in post endodontic treatment as a method to alleviate post-treatment pain. Materials and methods After completion of endodontic treatment 129 patients were randomly divided into two groups: Group A (65 patients) received Ibuprofen 400 mg one tablet before procedure and one tablet every 8 hours for the first day, then one tablet once indicated by pain. Group B (64 patients) received the same regimen as group A in addition to amoxicillin, clavulanic acid tablets (one tablet before the procedure, and then one tablet twice daily for a total of 3 days). Intensity of pain at 8 hours interval using visual analog scale (VAS) and total number of Ibuprofen tablets used was recorded by patients. Results Peak postoperative pain occurred at 16 hours posttreatment in both groups, there was a significant difference in the pain scale between the two groups in favor for group B over group A (3.8 vs 2.1 respectively). Pain scale was significantly lower in group B at 24, 32, 40, and 48 hours post-treatment with a p-value of < 0.05. The pain scale at 56, 64 and 72 hours were also less in group B, although could not show up as statistical difference. Patients in group A used statistically significant more Ibuprofen than patients in group B (486 vs 402). Conclusion Antibiotic prescription to manage post endodontic treatment pain results in less pain with less consumption of Ibuprofens. Clinical significance Pain management in endodontics is a real challenge, nonsteroidal anti-inflammatory drugs (NSAIDS) are used effectively in many patients to alleviate post endodontic pain. Nonsteroidal anti-inflammatory drugs may have adverse reactions or may be contraindicated. Short-term use of antibiotics to alleviate pain can be of clinical benefits in these patients. How to cite this article Alsomadi L, Al Habahbeh R. Role of Prophylactic Antibiotics in the Management of Postoperative Endodontic Pain. J Contemp Dent Pract 2015;16(12):939-943.

scholarly journals ELECTIVE MIDLINE LAPAROTOMY

2011 ◽  
Vol 18 (01) ◽  
pp. 106-111
Author(s):  
ARSALAN SIRAJ ◽  
ATHAR ABBAS SHAH GILANI ◽  
MUHAMMAD FAROOQ DAR ◽  
Sohail Raziq
Keyword(s):  
Postoperative Pain ◽  
Blood Loss ◽  
Wound Infection ◽  
Visual Analogue Score ◽  
P Value ◽  
Midline Laparotomy ◽  
Pain Scores ◽  
Group A ◽  
Insignificant Difference ◽  
Group B

Objectives: To compare the diathermy incision with scalpel incision in patients undergoing midline elective laparotomy. Design of Study: A prospective, experimental comparative study. Place and Duration: Department of surgery, PNS Shifa Karachi, from March 2007 to June 2008. Patients and Methods: A total of 100 patients were included in the study, and equally divided into 2 groups. Group A received scalpel incision while in group B diathermy was employed to incise all layers. Peroperative parameters including, incision time and blood loss were calculated. Postoperatively, pain was assessed by visual analogue score and wound infection documented. Results: Both groups included fifty patients each out of the total 44 females and 56 were males, with similar gender preposition in both the groups. Mean age of patients in scalpel group was 48.78 (±14.47) while it was 44.92 (±15.87) in diathermy group. The mean incision related blood loss in Scalpel group was 1.53 (±0.20) ml/cm2 and in Diathermy group was 1.43 (±0.20) ml/cm2, showing significantly less bleeding in diathermy group (p-value= 0.014). Diathermy group, with incision related time of 6.20 sec/cm2 (±0.97 sec/cm2), was significantly quicker (p-value= 0.003) than scalpel incision, with incision time of 6.76 sec/cm2 (±0.84 sec/cm2). Postoperative pain scores, recorded daily over five days, showed insignificant difference between the two groups. Conclusions: Diathermy, employed for midline laparotomy, is quicker and hemostatic, compared to the scalpel. The two are, however, similar in terms of wound infection and postoperative pain.

scholarly journals Comparison between intravenous injectable diclofenac and per rectal diclofenac suppository as analgesics in operated per anal and perianal benign pathologies

2019 ◽  
Vol 7 (1) ◽  
pp. 263
Author(s):  
Juthikaa Abhijit Deherkar
Keyword(s):  
Pain Relief ◽  
Hospital Stay ◽  
Pain Score ◽  
Pain Scale ◽  
Group A ◽  
Group B ◽  
At Home

Background: Per anal and perianal surgeries are one of the bread and butter surgeries in a surgeons life, and satisfaction of patient matters a lot. Early miraculous recovery has always been patient’s expectations hence we decided to study standard IV method of diclofenac as analgesic with diclofenac suppository and compared their effects on patients with the help of pain scale of 0 to 10.Methods: 200 common per anal surgeries were considered in the study, and were divided in two groups group A post operatively IV diclofenac was given 12 hourly and in group B cases diclofenac suppository 100 mg was started daily twice and the pain score was noted for a week.Results: Diclofenac suppositories resulted in early pain relief and thus early discharges of these patients. The pain score had decreased to a larger extent by day 3 and was almost negligible by day 5 and a few cases to day 7. The hospital stay reduced as patient could manage suppository at home by themselves. IV site complications like thrombophlebitis leading to pain and fever could be easily avoided.Conclusions: Thus diclofenac suppositories proved to be an effective way to give a pain free satisfaction compared to intravenous painful analgesics, thus decreased their hospital stay and also it was a patient friendly.

scholarly journals A prospective study of lornoxicam as pre-emptive analgesic in abdominal surgeries in tertiary care hospital in Salem, India

2017 ◽  
Vol 6 (7) ◽  
pp. 1778
Author(s):  
Mohammed Ziauddin Sarkhil ◽  
Hemant Kumar Dutt ◽  
Rajaram S.
Keyword(s):  
Rating Scale ◽  
Tertiary Care ◽  
Open Appendectomy ◽  
Care Hospital ◽  
Pain Rating ◽  
Pain Scores ◽  
Analgesic Regimen ◽  
Group A ◽  
Group B ◽  
Pain Rating Scale

Background: Preemptive analgesia, involves the introduction of an analgesic regimen before the onset of noxious stimuli, with the goal of preventing sensitization of the nervous system to subsequent stimuli that could amplify pain.Methods: To determine the efficacy and safety of Lornoxicam when administered preemptively by using Wong-Baker FACES Pain Rating scale. The patients undergoing abdominal surgery were randomly categorized into group A and B of 25 each. Group A- Received Lornoxicam 8mg (1ml) one hour before surgery. Group B- Not received any analgesic before surgery. Primary measurement of the efficacy was done by using Wong-Baker Faces Pain Rating Scale at 2, 4, 8, 12 and 24 hour. All parameters were analyzed by using student t test.Results: Surgeries which were included in the study are hernia repair, open appendectomy, laparoscopic (appendectomy, cholecystectomy). Reduction in pain scores at 12th hourly and 24th hourly pain scores (<0.05) was significant. Tramadol usage decreased significantly with laparoscopic surgeries.Conclusions: In this study we could demonstrate that lornoxicam when used preemptively reduces the pain score slightly and reduces the requirement of post-operative analgesics significantly.

Percutaneous vertebroplasty with high- versus low-viscosity bone cement for osteoporotic vertebral compression fractures

2020 ◽  
Author(s):  
Feng Miao ◽  
Xiaojun Zeng ◽  
Wei Wang ◽  
Zhou Zhao
Keyword(s):  
Percutaneous Vertebroplasty ◽  
Body Height ◽  
Cement Leakage ◽  
High Viscosity ◽  
Vertebral Compression Fractures ◽  
Vertebral Body Height ◽  
Low Viscosity ◽  
Pain Scores ◽  
Group A ◽  
Group B

Abstract Background: There is no consensus on the best choice between high- and low-viscosity bone cement for percutaneous vertebroplasty (PVP). This study aimed to compare the clinical outcomes and leakage between three cements with different viscosities in treating osteoporotic vertebral compression fractures.Methods: This is a prospective study comparing patients who were treated with PVP: group A (n = 99, 107 vertebrae) with high-viscosity OSTEOPAL V cement, group B (n = 79, 100 vertebrae) with low-viscosity OSTEOPAL V cement, and group C (n = 88, 102 vertebrae) with low-viscosity Eurofix VTP cement. Postoperative pain severity was evaluated using the visual analog scale. Cement leakage was evaluated using radiography and computed tomography.Results: There was no significant difference in the incidence of cement leakage between the three groups (group A 20.6%, group B 24.2%, group C 20.6%, P = 0.767). All three groups showed significant reduction in postoperative pain scores but did not differ significantly in pain scores at postoperative 2 days (group A 2.01 ± 0.62, group B 2.15 ± 0.33, group C 1.92 ± 0.71, P = 0.646). During the 6 months after cement implantation, significantly less reduction in the fractured vertebral body height was noticed in group B and group C than in group A (group A 19.0%, group B 8.1%, group C 7.3%, P = 0.009).Conclusions: Low-viscosity cement has comparable incidence of leakage compared to high-viscosity cement in PVP for osteoporotic vertebral compression fractures. It also can better prevent postoperative loss of vertebral body height.

scholarly journals Postoperative Pain and Opioid Use Following Surgical Treatment of Ankle Fractures

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0033
Author(s):  
Matthew Pate ◽  
Jacob Hall ◽  
John Anderson ◽  
Donald Bohay ◽  
John Maskill ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Ankle Fracture ◽  
Management Practices ◽  
Opioid Analgesic ◽  
The United States ◽  
Ankle Fractures ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Opioid Medication

Category: Ankle, Bunion, Trauma Introduction/Purpose: Chronic opioid abuse is one of the greatest public health challenges in the United States. The most common first exposure to opioids comes from acute care prescriptions, such as those after surgery. Moreover, opioids are often prescribed excessively, with current estimates suggesting ˜75% of the pills prescribed are unused. Ankle fractures are the most common operatively treated fracture in orthopaedic surgery, and management of acute pain following surgery is challenging. The optimal perioperative pain regimen is still a point of controversy, as there is limited data available regarding appropriate amount of opioid to prescribe. This study evaluates opioid prescribing techniques of multiple foot and ankle surgeons, and associated patient outcomes. We aim to help surgeons improve their pain management practices and to limit opioid overprescription. Methods: Chart review and phone survey were performed on forty two adult patients within three to six months of ankle fracture fixation at our institution. These patients were offered to voluntarily participate in a standardized questionnaire regarding pain scores, opioid use, non-opioid analgesic use, pain management satisfaction, and patient prescription education. Results: 57% of patients reported that they were given “more” or ”much more” opioid medication than needed, 38% stated that they were given the “right amount”, and 5% reported that they were given ”less” or “much less” than needed. 40.0% were on opioids prior to operation. 53.5% did not require refill of discharge opioid prescriptions, 30.2% of patients did not fill any posteroperative opioid prescription. 16.3% of patients filled their discharge prescription and at least one additionall refill (mean refill = 2.22). Mean number of reported opioid pills taken after surgery was 17.4. Mean satisfaction with overall pain management at phone follow up was 8.6/10. Conclusion: While postoperative pain and management vary substantially, a majority of patients feel that they are given more opioid medication than necessary following ankle fracture repair, and a majority of opioid prescriptions are not completely used. Going forward, it is likely that a majority of patients could experience the same beneficial results with less prescription opioid pain medication, which would reduce overpresciption and potential misuse.

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