scholarly journals V-OG04 Paravertebral Catheter Placement In Minimally Invasive Oesophagectomy

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Pooja Prasad ◽  
Jakub Chmelo ◽  
Joshua Brown ◽  
Maziar Navidi ◽  
Shajahan Wahed ◽  
...  
Keyword(s):  
Side Effects ◽  
Pain Control ◽  
Enhanced Recovery ◽  
Rectus Sheath ◽  
Multimodal Analgesia ◽  
Catheter Placement ◽  
Paravertebral Space ◽  
Feasible Option ◽  
Vital Component ◽  
Minimally Invasive Oesophagectomy

Abstract Background Pain control is a vital component of enhanced recovery programmes for patients undergoing an oesophagectomy. Multimodal analgesia using intrathecal diamorphine and local anaesthetic infusion catheters into the paravertebral space and rectus sheath is increasingly utilised. Multimodal analgesia can provide comparable pain relief while potentially reducing side effects associated with thoracic epidurals. This video demonstrates the placement of paravertebral catheters following thoracoscopic oesophagectomy. Methods The video demonstrates the technique for paravertebral catheter placement at the end of the thoracic phase of an oesophagectomy, as practiced at our institution. Results Once the catheter has been placed and flushed, a bolus 15-20mls of 0.25 per cent Levobupivicaine is injected. A 600mls reservoir of Levobupivicaine is attached at the end of the procedure. Conclusions Paravertebral catheters provide a safe and feasible option for pain control following oesophagectomy.

Multimodal analgesia in paediatric palliative care

2021 ◽  
pp. 165-175
Author(s):  
Stefan J. Friedrichsdorf
Keyword(s):  
Bone Marrow ◽  
Palliative Care ◽  
Side Effects ◽  
Pain Control ◽  
Pain Treatment ◽  
Multimodal Analgesia ◽  
Hospitalized Children ◽  
Serious Illness ◽  
Paediatric Palliative Care ◽  
Frequent Exposure

Pain in hospitalized children is very common, under-recognized, and under-treated. In paediatric patients the pain might be not be caused by the underlying serious medical conditions alone, but also by their frequent exposure to painful procedures (e.g. bone marrow aspirations, dressing changes, lumbar punctures, blood draws, injections, etc.). Advanced paediatric pain treatment for children with serious illness usually requires multimodal analgesia, which may include medications from different analgesic classes, procedural interventions, rehabilitation, psychological, and/or integrative (‘non-pharmacological’) therapies that usually act synergistically for more effective paediatric pain control with fewer side effects than any single analgesic or modality.

Perioperative duloxetine for acute postoperative analgesia: a meta-analysis of randomized trials

2019 ◽  
Vol 44 (10) ◽  
pp. 959-965 ◽  
Author(s):  
Andrés Zorrilla-Vaca ◽  
Alexander Stone ◽  
Andres Fabricio Caballero-Lozada ◽  
Stephania Paredes ◽  
Michael Conrad Grant
Keyword(s):  
Side Effects ◽  
Postoperative Pain ◽  
Enhanced Recovery ◽  
Meta Analysis ◽  
Multimodal Analgesia ◽  
Placebo Control ◽  
Acute Postoperative Pain ◽  
Chronic Postsurgical Pain ◽  
Opioid Administration ◽  
Dosing Regimens

BackgroundMultimodal analgesia is a fundamental part of modern surgery and enhanced recovery pathways. Duloxetine, a serotonin and norepinephrine reuptake inhibitor, has been validated for the treatment of chronic neuropathic pain. The evidence for duloxetine as an adjunct for the treatment of acute postoperative pain remains controversial. We conducted a meta-analysis to determine the efficacy of duloxetine in the acute perioperative setting.MethodsA literature search was conducted in the major databases (PubMed, EMBASE and Google Scholar) for randomized controlled trials (RCTs) evaluating duloxetine compared with placebo control for acute postoperative pain. The primary outcome was postoperative pain assessed at 2, 4, 6, 24 and 48 hours time frames. Secondary outcomes included postoperative opioid administration, as well as side effects, such as postoperative nausea/vomiting (PONV), pruritus, dizziness and headache.Results574 patients (n=9 RCTs) were included in the analysis, divided between duloxetine (n=285 patients) and placebo (n=289 patients). Duloxetine use was associated with a significant reduction in pain scores as early as 4 (mean difference (MD) −0.9, 95% CI −1.33 to −0.47) and as late as 48 (MD −0.94, 95% CI −1.56 to −0.33) hours postoperatively compared with placebo. In addition, duloxetine was associated with a significant reduction in opioid administration at 24 (standardized MD (SMD) −2.24, 95% CI −4.28 to −0.19) and 48 (SMD −2.21, 95% CI −4.13 to −0.28) hours as well as a significant reduction in PONV (risk ratio 0.69, 95% CI 0.49 to 0.95, p=0.03) compared with placebo. There was no difference between groups in other side effects.ConclusionDuloxetine, a non-opioid neuromodulator, may provide efficacy for the treatment of acute perioperative pain. Additional prospective studies are required to establish optimal perioperative dosing regimens, role in the setting of a comprehensive multimodal analgesic plan and impact on chronic postsurgical pain.PROSPERO registration numberCRD42019121416

scholarly journals Multimodal Analgesia (MMA) Versus Patient-Controlled Analgesia (PCA) for One or Two-Level Posterior Lumbar Fusion Surgery

2020 ◽  
Vol 9 (4) ◽  
pp. 1087
Author(s):  
Sung-Woo Choi ◽  
Hyeung-Kyu Cho ◽  
Suyeon Park ◽  
Jae Hwa Yoo ◽  
Jae Chul Lee ◽  
...  
Keyword(s):  
Side Effects ◽  
Hospital Stay ◽  
Pain Score ◽  
Pain Control ◽  
Lumbar Fusion ◽  
Length Of Hospital Stay ◽  
Multimodal Analgesia ◽  
Opioid Consumption ◽  
Patient Controlled Analgesia ◽  
Posterior Lumbar Fusion

A multimodal analgesic method was known to avoid the high-dose requirements and dose-dependent adverse events of opioids, and to achieve synergistic effects. The purpose of this study was to compare the efficacy of our multimodal analgesia (MMA) regimen with that of the patient-controlled analgesia (PCA) method for acute postoperative pain management. Patients who underwent one or two-level posterior lumbar fusion (PLF) followed by either MMA or PCA administration at our hospital were compared for pain score, additional opioid and non-opioid consumption, side effects, length of hospital stay, cost of pain control, and patient satisfaction. From 2016 through 2017, a total 146 of patients were screened. After propensity score matching, 66 remained in the PCA and 34 in the MMA group. Compared with the PCA group, the MMA group had a shorter length of hospital stay (median (interquartile range): 7 days (5–8) vs. 8 (7–11); P = 0.001) and lower cost of pain control (70.6 ± 0.9 USD vs. 173.4 ± 3.3, P < 0.001). Baseline data, clinical characteristics, pain score, additional non-opioid consumption, side effects, and patient subjective satisfaction score were similar between the two groups. The MMA seems to be a good alternative to the PCA after one or two-level PLF.

456 PARAVERTEBRAL AND RECTUS SHEATH CATHETERS AS AN ALTERNATIVE TO THORACIC EPIDURAL FOR ANALGESIA POST-ESOPHAGECTOMY

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
J Ng Cheong Chung ◽  
A Mohammed ◽  
M Navidi ◽  
S Wahed ◽  
A Immanuel ◽  
...  
Keyword(s):  
Enhanced Recovery ◽  
Rectus Sheath ◽  
High Volume ◽  
Multimodal Analgesia ◽  
Team Members ◽  
Thoracic Epidural ◽  
Pain Scores ◽  
Significant Difference ◽  
Volume Unit ◽  
Vasopressor Use

Abstract   Thoracic epidural (TE) analgesia has been the gold standard for pain management post-esophagectomy and is still being widely used. While it offers excellent analgesia, it can negatively impact on recovery due to hypotension. An alternative is multimodal analgesia using intrathecal-diamorphine, paravertebral and rectus sheaths local anaesthetic infusion-catheters (LAC) and intravenous opioids (PCA). The aim of this study was to compare the effectiveness of TE analgesia and multimodal LAC analgesia and the associated incidence of hypotension. Methods Data were collected over a three-year period for patients who underwent trans-thoracic (Ivor Lewis) esophagectomy from a single high volume unit. Multimodal analgesia was integrated into the patient pathway in early 2016 and adopted by all team members. All patients were treated post operatively with a standardised enhanced recovery pathway. Pain scores using a visual analogue scale (VAS) at rest and movement, episodes of hypotension (systolic BP &lt; 90 mmHg) and vasopressor requirements for post-operative days 0 to 4 (POD 0–4) were recorded for both groups. Results Overall 239 patients were included in this study, 104 patients received TE analgesia and 135 patients received multimodal analgesia. There was no statistically significant difference in the mean VAS pain scores between both cohorts on all post-operative days. (p = 0.06–0.89). In comparison to TE analgesia, the multimodal patient group had significantly fewer episodes of hypotension (multimodal: 21% vs TE: 38%, p = 0.01) and significantly less vasopressor infusion requirements to maintain their blood pressure (multimodal: 30% vs TE: 55%, p = 0.01). Conclusion Multimodal analgesia using intrathecal diamorphine with combined paravertebral and rectus sheath catheters is not inferior to TE in providing pain control post esophagectomy. In addition there are significantly fewer episodes of hypotension and significantly less need for vasopressor use. This may confer a postoperative advantage permitting better patient mobilisation and recovery in the immediate post operative period.

Opioid-free anaesthesia for the surgical correction of abnormalities associated with brachycephalic obstructive airway syndrome in five dogs

2021 ◽  
Vol 26 (3) ◽  
pp. 57-61
Author(s):  
María Isabel Gómez Martínez ◽  
Miguel Ángel Martínez Fernández
Keyword(s):  
Side Effects ◽  
Nerve Block ◽  
Opioid Analgesic ◽  
Multimodal Analgesia ◽  
Human Medicine ◽  
Surgical Correction ◽  
Analgesic Drugs ◽  
Maxillary Nerve ◽  
Nociceptive Pathways ◽  
Maxillary Nerve Block

Opioid-free anaesthesia is currently becoming more popular in human medicine, as it provides multimodal analgesia, affecting multiple nociceptive pathways without the use of opioids, in order to minimise opioid-related side effects. This article presents the cases of five dogs undergoing surgical correction of abnormalities associated with brachycephalic obstructive airway syndrome, all of whom received opioid-free anaesthesia for surgery. All dogs received a bilateral maxillary nerve block with bupivacaine 0.5% and a combination of non-opioid analgesic drugs. Buprenorphine was allowed during the postoperative period, based on pain assessment. Three out of five dogs received buprenorphine 6–7 hours after the nerve block was performed. Opioid-free anaesthesia provided adequate conditions for surgery and no adverse effects were reported. Prospective controlled studies comparing opioid-free anaesthesia with opioid-based techniques are required to elucidate whether or not opioid-free anaesthesia confers objective advantages.

scholarly journals The impact of multimodal analgesia based enhanced recovery protocol on quality of recovery after laparoscopic gynecological surgery: a randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhiyu Geng ◽  
Hui Bi ◽  
Dai Zhang ◽  
Changji Xiao ◽  
Han Song ◽  
...  
Keyword(s):  
Enhanced Recovery ◽  
Controlled Trial ◽  
Bowel Function ◽  
Multimodal Analgesia ◽  
Study Group ◽  
Gynecological Surgery ◽  
Quality Of Recovery ◽  
Enhanced Recovery Protocol ◽  
The Impact

Abstract Background Our objective was to evaluate the impact of multimodal analgesia based enhanced recovery protocol on quality of recovery after laparoscopic gynecological surgery. Methods One hundred forty female patients scheduled for laparoscopic gynecological surgery were enrolled in this prospective, randomized controlled trial. Participants were randomized to receive either multimodal analgesia (Study group) or conventional opioid-based analgesia (Control group). The multimodal analgesic protocol consists of pre-operative acetaminophen and gabapentin, intra-operative flurbiprofen and ropivacaine, and post-operative acetaminophen and celecoxib. Both groups received an on-demand mode patient-controlled analgesia pump containing morphine for rescue analgesia. The primary outcome was Quality of Recovery-40 score at postoperative day (POD) 2. Secondary outcomes included numeric pain scores (NRS), opioid consumption, clinical recovery, C-reactive protein, and adverse events. Results One hundred thirty-eight patients completed the study. The global QoR-40 scores at POD 2 were not significantly different between groups, although scores in the pain dimension were higher in Study group (32.1 ± 3.0 vs. 31.0 ± 3.2, P = 0.033). In the Study group, NRS pain scores, morphine consumption, and rescue analgesics in PACU (5.8% vs. 27.5%; P = 0.0006) were lower, time to ambulation [5.0 (3.3–7.0) h vs. 6.5 (5.0–14.8) h; P = 0.003] and time to bowel function recovery [14.5 (9.5–19.5) h vs.17 (13–23.5) h; P = 0.008] were shorter, C-reactive protein values at POD 2 was lower [4(3–6) ng/ml vs. 5 (3–10.5) ng/ml; P = 0.022] and patient satisfaction was higher (9.8 ± 0.5 vs. 8.8 ± 1.2, P = 0.000). Conclusion For minimally invasive laparoscopic gynecological surgery, multimodal analgesia based enhanced recovery protocol offered better pain relief, lower opioid use, earlier ambulation, faster bowel function recovery and higher patient satisfaction, while no improvement in QoR-40 score was found. Trial registration ChiCTR1900026194; Date registered: Sep 26,2019.

scholarly journals The Association between Implementation an Enhanced Recovery after Cesarean Pathway with Standardized Discharge Prescriptions and Opioid Use and Pain Experience after Cesarean Delivery

2021 ◽  
Author(s):  
Jennifer A. McCoy ◽  
Sarah Gutman ◽  
Rebecca F. Hamm ◽  
Sindhu K. Srinivas
Keyword(s):  
Cesarean Delivery ◽  
Pain Control ◽  
Enhanced Recovery ◽  
Median Number ◽  
Baseline Survey ◽  
Quality Improvement Initiative ◽  
Opioid Use ◽  
Pain Scores ◽  
Patient Reported ◽  
Hospital Patients

Objective This study was aimed to evaluate opioid use after cesarean delivery (CD) and to assess implementation of an enhanced recovery after CD (ERAS-CD) pathway and its association with inpatient and postdischarge pain control and opioid use. Study Design We conducted a baseline survey of women who underwent CD from January to March 2017 at a single, urban academic hospital. Patients were called 5 to 8 days after discharge and asked about their pain and postdischarge opioid use. An ERAS-CD pathway was implemented as a quality improvement initiative, including use of nonopioid analgesia and standardization of opioid discharge prescriptions to ≤25 tablets of oxycodone of 5 mg. From November to January 2019, a postimplementation survey was conducted to assess the association between this initiative and patients' pain control and postoperative opioid use, both inpatient and postdischarge. Results Data were obtained from 152 women preimplementation (PRE) and 137 women post-implementation (POST); complete survey data were obtained from 102 women PRE and 98 women POST. The median inpatient morphine milligram equivalents consumed per patient decreased significantly from 141 [range: 90–195] PRE to 114 [range: 45–168] POST (p = 0.002). On a 0- to 10-point scale, median patient-reported pain scores at discharge decreased significantly (PRE: 7 [range: 5–8] vs. POST 5 [range: 3–7], p < 0.001). The median number of pills consumed after discharge also decreased significantly (PRE: 25 [range: 16–30] vs. POST 17.5 [range: 4–25], p = 0.001). The number of pills consumed was significantly associated with number prescribed (p < 0.001). The median number of leftover pills and number of refills did not significantly differ between groups. Median patient-reported pain scores at the week after discharge were lower in the POST group (PRE: 4 [range: 2–6] vs. POST 3[range: 1–5], p = 0.03). Conclusion Implementing an ERAS-CD pathway was associated with a significant decrease in inpatient and postdischarge opioid consumption while improving pain control. Our data suggest that even fewer pills could be prescribed for some patients. Key Points

scholarly journals Bilateral posterior Quadratus Lumborum block for pain relief after cesarean delivery: a randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Pawinee Pangthipampai ◽  
Sukanya Dejarkom ◽  
Suppachai Poolsuppasit ◽  
Choopong Luansritisakul ◽  
Suwida Tangchittam
Keyword(s):  
Side Effects ◽  
Cesarean Delivery ◽  
Pain Control ◽  
Spinal Block ◽  
Side Group ◽  
Link Type ◽  
Quadratus Lumborum Block ◽  
Analgesic Regimen ◽  
Quadratus Lumborum ◽  
Median Pain

Abstract Background Achieving optimal analgesia with few side effects is the goal of pain management after cesarean delivery. Intrathecal (IT) morphine is the current standard but ultrasound-guided quadratus lumborum block (QLB) may offer superior pain control with fewer side effects. This study compared the pain-free period after cesarean delivery among parturients who received spinal block with IT morphine, with IT morphine and bilateral QLB, or only bilateral QLB. Methods Parturients having elective cesarean delivery under spinal block were randomized and allocated into IT morphine 0.2 mg with sham QLB (Group IT), IT morphine 0.2 mg and bilateral QLB with 0.25% bupivacaine 25 ml in each side (Group IT+QLB), or bilateral QLB with 0.25% bupivacaine 25 ml in each side (Group QLB). A PCA pump was connected after completion of the QLB or sham block. The first time to PCA morphine requirement was recorded and compared. Results Eighty parturients were included. Analysis of Group QLB was terminated early because at the second interim analysis, median pain-free period was significantly shorter in Group QLB [hours (95%CI): 2.50 (1.04–3.96) in Group IT vs. 7.75 (5.67–9.83) in IT+QLB vs. 1.75 (0.75–2.75) in QLB (p < 0.001)]. The median (min, max) amount of morphine required during 24 h was 5.5 (0–25) in Group IT vs. 5.0 (0–36) in IT+QLB vs. 17.5 (1–40) mg in Group QLB (p < 0.001). In the final analysis the median pain-free period was 2.50 (1.23–3.77) hours (95%CI) in Group IT (n = 27) vs. 8.02 (5.96–10.07) in IT+QLB (n = 28). (p = 0.027). Conclusion US-QLB used in conjunction with IT morphine yielded a statistically significant longer median pain-free period compared with standard IT morphine alone. However, QLB alone provided inferior pain control compared with standard IT morphine. When combined with IT morphine, QLB could provide additional analgesic benefit as a part of multimodal analgesic regimen, especially during the early postoperative period. Trial registration ClinicalTrials.gov no. NCT03199170 Date registered on June 22, 2017. Prospectively registered.

scholarly journals Sufentanil sublingual tablet system versus oral oxycodone for management of postoperative pain in enhanced recovery after surgery pathway for total knee arthroplasty: a randomized controlled study

2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Emmanuel Noel ◽  
Luca Miglionico ◽  
Mickael Leclercq ◽  
Harold Jennart ◽  
Jean-François Fils ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Multimodal Analgesia ◽  
Sublingual Tablet ◽  
Randomized Controlled ◽  
Total Knee ◽  
Median Pain

Abstract Purpose Effectiveness of sufentanil sublingual tablet system (SSTS) compared to oral oxycodone in the management of postoperative pain after total knee arthroplasty (TKA) within an enhanced recovery after surgery (ERAS) protocol. Methods This pragmatic, parallel, open label, randomized controlled, trial enrolled 72 adult patients scheduled for TKA under spinal anesthesia following ERAS pathway. In addition to multimodal analgesia, patients received SSTS 15 mcg (SSTS group) or oral oxycodone extended release 10 mg twice daily and oral oxycodone immediate-release 5 mg up to four times daily on demand (Oxy group) to control pain during 48 h postoperatively. The primary endpoint was pain measured using a numeric rating scale at 24 h postoperatively. Time to first mobilization, side effects and patient satisfaction were also recorded. Results Median pain score at 24 h at rest was 3 [2–4] for Oxy group vs 2 [1.75–3] for SSTS group (p = 0.272) whereas median pain score on movement was 4 [3–6] vs 3 [2–5] respectively (p = 0.059). No difference in time to first mobilization was found between the two groups. The method of pain control was judged good/excellent for 83.9% of patients in the SSTS group compared with 52.9% in the Oxy group (p = 0.007). The incidence of nausea was 33% in SSTS group and 9% in Oxy group (p = 0.181). Conclusions In complement to ERAS multimodal analgesia, sublingual sufentanil 15 mcg tablet system did not show clinically significant pain improvement compared to oral oxycodone after total knee arthroplasty. Trial registration Clinical Trials: NCT04448457; retrospectively registered on June 24, 2020. https://clinicaltrials.gov/ct2/show/NCT04448457?cond=sublingual+sufentanil&cntry=BE&draw=2&rank=3

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