T4 Impact of Opioid-Minimizing Pain Protocols after Burn Injury

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S3-S4
Author(s):  
Deepanjli Donthula ◽  
Christopher R Conner ◽  
Van Thi Thanh Truong ◽  
Charles Green ◽  
Chuantao Jiang ◽  
...  
Keyword(s):  
Acute Pain ◽  
Posterior Probability ◽  
Linear Models ◽  
Rating Scale ◽  
Burn Injury ◽  
Numeric Rating Scale ◽  
Pain Scale ◽  
Domain Specific ◽  
Lengths Of Stay ◽  
Pain Scores

Abstract Introduction Traditionally, opioids have been the mainstay of treatment for background, breakthrough, procedural, and postoperative pain after burns. However, in addition to an impetus to reduce provider-driven opioid exposure, there is increasing evidence that opioids can worsen acute pain through induction of hyperalgesia. In 2019, we implemented a pill-based, opioid-minimizing pain protocol and protocolized moderate sedation for dressing changes. We hypothesized that these protocols would reduce inpatient opioid exposure without increasing acute pain scores. Methods Two groups of consecutive patients admitted to the burn service were compared: Pre (01/2018 to 07/2019) and Post (01/2020 to 06/2020) implementation of the protocols (08/2019 to 12/2019). Patient demographics, burn characteristics, and lengths of stay were abstracted from the burn registry. Opioid exposure and pain scale scores were obtained from the electronic medical record. The primary outcome was total morphine milligram equivalents (MME). Secondary outcomes included MME/day, pain domain specific MME, pain scores, and lengths of stay. Pain was estimated by creating a normalized pain score (range 0–1) from three different pain scales (Numeric Rating Scale, Behavioral Pain Scale, and Behavioral Pain Assessment Scale). Groups were compared using Wilcoxon Rank Sum and Chi Square. Treatment effect was estimated using Bayesian generalized linear models. Results There were no differences in demographics or burn characteristics between the Pre (n=495) and Post groups (n=174), including TBSA burn (Pre 4% [2, 10] versus Post 5% [2, 10], p=0.898). The Post group had significantly lower total MME (IRR 0.72, 95% CrI 0.57–0.93, posterior probability 99%), MME/day (IRR 0.76, 95% CrI 0.65–0.90, posterior probability 99%), and domain-specific total MME (Table). No difference in average normalized pain scores was seen. The Pre group were hospitalized longer than the Post group (5 days [2, 14] versus 4 days [1, 9], p=0.012). Conclusions Implementation of opioid-minimizing protocols for acute burn pain were associated with a significant reduction in inpatient opioid exposure without increased pain scores. More information is needed to understand the association with reduced hospital days.

Impact of Opioid-Minimizing Pain Protocols after Burn Injury

2021 ◽  
Author(s):  
Deepanjli Donthula ◽  
Christopher R Conner ◽  
Van Thi Thanh Truong ◽  
Charles Green ◽  
Chuantao Jiang ◽  
...  
Keyword(s):  
Rating Scale ◽  
Burn Injury ◽  
Numeric Rating Scale ◽  
Pain Scale ◽  
Chi Square ◽  
Patient Demographics ◽  
Domain Specific ◽  
Pain Scores ◽  
Scale Scores ◽  
Behavioral Pain Scale

Abstract In 2019, we implemented a pill-based, opioid-minimizing pain protocol and protocolized moderate sedation for dressing changes in order to decrease opioid exposure in burn patients. We hypothesized that these interventions would reduce inpatient opioid exposure without increasing acute pain scores. Two groups of consecutive patients admitted to the burn service were compared: Pre (01/01/2018 to 07/31/2019) and Post (01/01/2020 to 06/30/2020) implementation of the protocols (08/01/2019 to 12/31/2019). We abstracted patient demographics and burn injury characteristics from the burn registry. We obtained opioid exposure and pain scale scores from the electronic medical record. The primary outcome was total morphine milligram equivalents (MME). Secondary outcomes included MME/day, pain domain-specific MME, and pain scores. Pain was estimated by creating a normalized pain score (range 0-1), which incorporated 3 different pain scales (Numeric Rating Scale, Behavioral Pain Scale, and Behavioral Pain Assessment Scale). Groups were compared using Wilcoxon Rank Sum and Chi Square. Treatment effects were estimated using Bayesian generalized linear models.There were no differences in demographics or burn characteristics between the Pre (n=495) and Post groups (n=174). The Post group had significantly lower total MME (Post 110 MME [32, 325] versus Pre 230 [60, 840], p<0.001), MME/day (Post 33 MME/day [15, 54] versus Pre 52 [27, 80], p<0.001), and domain-specific total MME. No difference in average normalized pain scores was seen.Implementation of opioid-minimizing protocols for acute burn pain was associated with a significant reduction in inpatient opioid exposure without an increase in pain scores.

scholarly journals P030: Acute pain resolution after an emergency department visit: a 14-day trajectory analysis

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S73-S74
Author(s):  
R. Daoust ◽  
J. Paquet ◽  
A. Cournoyer ◽  
E. Piette ◽  
J. Morris ◽  
...  
Keyword(s):  
Pain Intensity ◽  
Acute Pain ◽  
Linear Models ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
The Other ◽  
Future Research ◽  
Intensity Level ◽  
Opioid Prescription ◽  
Mild Pain

Introduction: The objective of the study was to evaluate the acute pain intensity evolution in ED discharged patients using Group-based trajectory modeling (GBTM). This method identified patient groups with similar profiles of change over time without assuming the existence of a particular pattern or number of groups. Methods: This was a prospective cohort study of ED patients aged ≥18 years with an acute pain condition (≤ 2 weeks) and discharged with an opioid prescription. Patients completed a 14-day diary assessing daily pain intensity level (0-10 numeric rating scale) and pain medication use. Results: Among the 372 included patients, six distinct post-ED pain intensity trajectories were identified: two started with severe levels of pain, one remained with severe pain intensity (12.6% of the sample) and the other ended with moderate pain intensity level (26.3%). Two other trajectories had severe initial pain, one decreased to mild pain (21.7%) and the other to no-pain (13.8%). Another trajectory had moderate initial pain which decreased to a mild level (15.9%) and the last one started with mild pain intensity and had no pain at the end of the 14-day (9.7%). The pain trajectory patterns were significantly associated with age, type of painful conditions, pain intensity at ED discharge, and with opioid consumption. Conclusion: Acute pain resolution following an ED visit seems to progress through six different trajectory patterns that are more informative than simple linear models and could be useful to adapt acute pain management in future research.

Evaluation of targeted bupivacaine for reducing acute postoperative pain in cats undergoing routine ovariohysterectomy

2019 ◽  
Vol 22 (2) ◽  
pp. 91-99 ◽  
Author(s):  
James Mack Fudge ◽  
Bernie Page ◽  
Amy Mackrell ◽  
Inhyung Lee
Keyword(s):  
Postoperative Pain ◽  
Acute Pain ◽  
Rating Scale ◽  
High Volume ◽  
Pain Scale ◽  
Placebo Control ◽  
Controlled Clinical Trial ◽  
Colorado State University ◽  
Pain Scores ◽  
Pain Scales

Objectives This study sought to determine if bupivacaine targeted at specific, potentially painful sites could enhance postoperative analgesia in routine feline ovariohysterectomies. A secondary objective was to assess the utility of multiple acute pain scales for cats in a high-volume surgery setting. Methods Two hundred and twelve cats were included in a prospective, randomized, double-blinded, placebo-controlled clinical trial. Anesthesia included buprenorphine, ketamine, dexmedetomidine and isoflurane. A ventral midline ovariohysterectomy was performed and cats were administered bupivacaine (2 mg/kg), placebo control (0.9% saline) or sham control (observation only) intraoperatively at the ovarian suspensory ligaments and vessels, uterine body and incisional subcutaneous tissues. Two pain scales were used to assess cats postoperatively. Initially, a multidimensional composite pain scale (MCPS) and a 0–10 numeric pain rating scale (NRS) were used. Subsequently, the MCPS was replaced with a modified Colorado State University Feline Acute Pain Scale (mCSU). Pain scores for the test groups were compared using a one-way ANOVA and a Holm–Bonferroni post hoc analysis when a difference was found ( P <0.05). Results Pain for the bupivacaine group was lower than the control groups at 1 h post-recovery and discharge, attaining significance with higher body weights. The P values were 0.008 and 0.004 for 1 h post-recovery and discharge, respectively. Pain scores between evaluators for the MCPS and NRS correlated poorly with r values for 1 h post-recovery and discharge of −0.08 and 0.22, respectively. Additionally, the MCPS proved difficult to use and time consuming, especially for feral and fractious patients, and was replaced with the mCSU. Conclusions and relevance Targeted bupivacaine reduced early postoperative pain scores following routine feline ovariohysterectomies. The technique used was simple, requiring just over a minute to perform at minimal additional cost. The MCPS was not ideal for use in a high-volume spay setting.

Postoperative Pain After Endoscopic vs Microscopic Otologic Surgery: A Systematic Review and Meta-analysis

2021 ◽  
pp. 019459982110419
Author(s):  
Sara Toulouie ◽  
Nikolas R. Block-Wheeler ◽  
Alexander Rivero
Keyword(s):  
Systematic Review ◽  
Postoperative Pain ◽  
Rating Scale ◽  
Meta Analysis ◽  
Case Series ◽  
Original Data ◽  
Numeric Rating Scale ◽  
Pain Scale ◽  
Ear Surgery ◽  
Pain Scores

Objective Equivalent outcomes, such as procedural safety and audiometry, have been reported between endoscopic ear surgery (EES) and microscopic ear surgery (MES). This study aims to determine if EES leads to decreased postoperative pain when compared with MES. Data Sources PubMed, OVID MEDLINE, Scopus, Web of Science, and Cochrane Central from 2000 to 2020. Review Methods A systematic review in accordance with the PRISMA guidelines and standardized bias assessment was performed. Studies containing original data on postoperative pain following EES and MES were included. Results Fourteen studies fulfilled eligibility: 7 retrospective studies, 6 randomized controlled trials, and 1 case series. Studies included surgery for cholesteatoma (n = 3), tympanoplasty/myringoplasty (n = 6), and stapedotomy (n = 5), pooling data from 974 patients. Postoperative pain was quantitatively described through a variety of numeric pain scores. Meta-analysis was performed on 11 studies. Among the 7 studies utilizing the numeric rating scale or visual analog scale, postoperative pain in the EES cohort was significantly lower than that of the MES cohort (standardized mean difference = −1.45 [95% CI, −2.05 to −0.85], P < .001). Similarly, pain scores were lower in the EES cohort among the 4 studies utilizing the Three Grades Pain Scale (odds ratio = 0.2 [95% CI, 0.09-0.45], P < .001). Additional qualitative strengths identified in EES included significant improvements in visualization, operative time, postoperative complications, and decreased need for canalplasty. Quality assessment indicated low to moderate risk of bias for all studies. Conclusion Meta-analysis confirms that EES results in significantly less postoperative pain when compared with MES. This surgical approach should be considered in the armamentarium of otologic surgeons, allowing for improved outcomes.

scholarly journals PERBANDINGAN INTERPRETASI SKALA NYERI ANTARA NRS-VAS-WBFS OLEH PASIEN PASCA OPERASI ELEKTIF ORTHOPEDI DI RSUD Dr. SOETOMO

2020 ◽  
Vol 8 (3) ◽  
pp. 447
Author(s):  
Ginong Pratitdya ◽  
Nancy M. Rehatta ◽  
Dedi Susila
Keyword(s):  
Rating Scale ◽  
Health Management ◽  
Numeric Rating Scale ◽  
Cross Sectional Study ◽  
Pain Scale ◽  
Primary Data ◽  
Research Subjects ◽  
Cross Sectional ◽  
Pain Scores ◽  
Significant Difference

Health management is still a challenge in health services. An instrument that can cure pain is easy, easy, with accurate interpretation and can be used by every party involved in pain management. The purpose of this study was to analyze the Numeric Rating Scale (NRS), Visual Analogue Scale (VAS), and Wong Baker Faces Scale (WBFS), which can be interpreted well by postoperative care patients. The research method used was an observational analytic study with a cross-sectional study design that analyzed the scale application (NRS, VAS, WBFS) in patients after elective orthopedic surgery at RSUD Dr. Soetomo Surabaya. This study analyzed primary data of postoperative patients which contained socio-demographic characteristics, type of anesthesia given, pain scores and patient interpretation of pain scales through special instruments. The results showed that 102 research subjects were needed. The pain scale interpretation instrument was declared valid and reliable (Cronbach Alpha> 0.60). Mean pain scores from the VAS scale (4.29), NRS (4.82) and WBFS (4.81). No significant difference was obtained NRS scale and WBFS scale (Sig> 0.05). Mean interpretation of pain scale from the VAS scale (13.62), NRS (17.14) and WBFS (21.33). There was a significant difference in the pain score of the VAS scale against the NRS scale, also the WBFS scale (Sig

28 Assessment of Pain and Provision of Non-Pharmacologic Analgesia to Children by Prehospital Providers in Southwestern Ontario: A Cross-Sectional Study

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e21-e21
Author(s):  
Karina Burke ◽  
Branka Vujcic ◽  
Jonathan Hamilton ◽  
Charlotte Mace ◽  
John Teefy ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Rating Scale ◽  
A Priori ◽  
Numeric Rating Scale ◽  
Cross Sectional Study ◽  
Subject Area ◽  
Stepwise Logistic Regression ◽  
Tertiary Referral Centre ◽  
Cross Sectional ◽  
Pain Scores

Abstract Primary Subject area Emergency Medicine - Paediatric Background There is abundant evidence that provision of pharmacologic analgesia by prehospital providers to children is suboptimal. Most paediatric calls are performed by primary care paramedics (PCPs) who are unable to administer pharmacologic analgesia to children but can administer non-pharmacologic therapies. Objectives Our objective was to describe the provision of non-pharmacologic analgesia to children by prehospital providers. Design/Methods We reviewed all ambulance call reports (ACRs) of children 0-17 years with acutely painful conditions (headache, abdominal pain, injury, head/ears/eyes/nose/throat pain, and back pain) who were transported to a paediatric tertiary referral centre serving a catchment of &gt; 1 million from 2017-2019. Data collection was recorded by two blinded assessors using a study-specific Excel™ sheet. The primary outcome was the proportion of children offered non-pharmacologic analgesia. We performed a stepwise logistic regression on the primary outcome using covariates defined a priori: age, sex, visible deformity, type of crew, complaint, pain score, call time, and prior analgesia. Results All 11,084 ACRs from January 1, 2017 to December 31, 2019 were reviewed. The sample included 5887/11084 (53.1%) males, ranging from 1 month to 17 years, with a mean (SD) age of 10.5 (5.6) years. Calls involved mainly PCPs [8576/11084 (77.4%)]. Non-trauma-related musculoskeletal injuries were most common, comprising 2743/11,084 (24.7%) of calls. Pain scores were documented in 6947/11084 (62.7%) of calls. The verbal numeric rating scale (0-10) was used in 5022/6947 (72.3%) of calls, with a mean (SD) score of 5.2 (3.2). Non-pharmacologic analgesia was provided in 2926/11084 (26.4%) of calls, most commonly splint (1115/2926, 38.1%) and ice (931/2926, 31.8%). Pharmacologic analgesia was provided in 458/11084 (4.1%) of calls. In the multivariate model, mild (OR: 3.2; 95% CI 2.3-4.4; p &lt; 0 .001) and moderate pain (OR: 1.7; 95% CI 1.3-2.2) (versus no pain) were significant predictors of non-pharmacologic analgesia, whereas visible deformity (OR: 0.5; 95% CI 0.3-0.6; p &lt; 0 .001) was a significant negative predictor. Conclusion The provision of non-pharmacologic analgesia to children in Southwestern Ontario by prehospital providers is suboptimal, despite moderate to severe pain. There is a clear need for education surrounding approaches to non-pharmacologic analgesia in children among prehospital providers.

Oral paracetamol versus zolmitriptan to treat acute migraine attack in the emergency department

2021 ◽  
Keyword(s):  
Emergency Department ◽  
Rating Scale ◽  
Rescue Therapy ◽  
Tertiary Care ◽  
Numeric Rating Scale ◽  
Controlled Study ◽  
Care Hospital ◽  
Acute Migraine ◽  
Pain Scores ◽  
Significant Difference

Background: Treatment provided in an emergency department is aimed at alleviating pain immediately with minimized adverse effects as well as warding off further migraine attacks. The primary aim of this article is to compare the effectiveness of oral paracetamol versus zolmitriptan in treating acute migraine attacks. Methods: This prospective, randomized, and controlled study was carried out at a tertiary care hospital visited by 95,000 patients annually. The study recruited 200 participants who were randomized into two groups. One group received 1000 mg paracetamol while the other group received 2.5 mg zolmitriptan orally. Baseline pain scores were recorded using the Visual Analogue Scale (VAS) and Numeric Rating Scale (NRS) at 15, 30 and at 60 min following administration of the study drugs. Patients requiring further treatment were provided fentanyl at a dosage of 1 µg/kg as a rescue therapy. Results: A significant decrease was evident in VAS and NRS scores following the administration of the study drugs in both groups (P < 0.001). The change in VAS pain scores after 15, 30 and 60 min was calculated as 17.0 ± 13.9, 41.2 ± 16.3 and 61.2 ± 17.5 mm, respectively, in the paracetamol group and 14.2 ± 11.7, 39.2 ± 17.9 and 59.2± 19.3 mm, respectively, in the zolmitriptan group, which did not indicate significant differences (P = 0.103, P = 0.425, P = 0.483, respectively). Likewise, NRS pain scores showed a downward trend in line with VAS pain scores and did not yield a significant difference (P = 0.422). No significant difference concerning rescue therapy was noted between the two groups (P = 0.596). Conclusion: Oral paracetamol and zolmitriptan prove to be similarly effective and have low incidence of acute side effects in treating acute migraine cases without aura.

Differences in calculated percentage improvement versus patient-reported percentage improvement in pain scores: a review of spinal cord stimulation trials

2021 ◽  
pp. rapm-2020-102238
Author(s):  
Jonathan M Hagedorn ◽  
Timothy R Deer ◽  
Nicholas C Canzanello ◽  
Stephen M Covington ◽  
Darrell R Schroeder ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Pain Scale ◽  
Concordance Correlation ◽  
Percentage Improvement ◽  
Patient Reported ◽  
The Mean ◽  
Numeric Rating

IntroductionSpinal cord stimulation is frequently used for the treatment of intractable chronic pain conditions. Trialing of the spinal cord stimulator device is recommended to assess the patient’s response to neurostimulation before permanent implantation. The trial response is often assessed by Numeric Rating Scale changes and patient-reported percentage pain improvement. Using number rating scale changes between prespinal and postspinal cord stimulation trial, a calculated percentage pain improvement can be obtained. The aim of this study was to assess the difference between calculated and patient-reported percentage improvement in pain scale during spinal cord stimulation trials.MethodsThis study was a retrospective single center review of all spinal cord stimulation trials from January 1 2017 to July 1 2019. A total of 174 patients were included. The paired t-test was used to compare numeric pain scores obtained prestimulation versus poststimulation. The mean difference between methods (patient-reported minus calculated) was compared with zero using the 1-sample t-test. Lin’s concordance correlation coefficient was computed with a 95% CI, calculated using Fisher z-transformation; and a bootstrapping approach was used to compare the concordance correlation coefficient between groups. In all cases, two-tailed tests were used with p<0.05 considered statistically significant.ResultsBased on prestimulation and poststimulation numeric rating scale scores, the mean±SD calculated percentage improvement in pain scale was 54±28. The mean±SD patient-reported percentage improvement in pain scale was 59±25. The overall 95% limits of agreement for the two methods are −30% to +41%. The overall concordance correlation coefficient was 0.76 (95% CI 0.69 to 0.81).ConclusionAlthough the two methods are highly correlated, there is substantial lack of agreement between patient-reported and calculated percentage improvement in pain scale, suggesting that these measures should not be used interchangeably for spinal cord stimulator trial outcome assessment. This emphasizes the need for improved metrics to better measure patient response to neuromodulation therapies. Additionally, patient-reported percentage improvement in pain was found to be higher than calculated percentage improvement in pain, potentially highlighting the multidimensional experience of pain and the unpredictability of solely using Numeric Rating Scale scores to assess patient outcomes.

Correlation between quality of pain and depression: A post-operative assessment of pain after caesarian section among women in Ghana

2017 ◽  
Vol 16 (1) ◽  
pp. 165-165
Author(s):  
V.A. Adzika ◽  
F.N. Glozah ◽  
D. Ayim-Aboagye ◽  
C.S.K. Ahorlu ◽  
M. Ekuban
Keyword(s):  
Acute Pain ◽  
Rating Scale ◽  
Depression Scale ◽  
Pain Scale ◽  
Pilot Studies ◽  
King David ◽  
Purposeful Sampling ◽  
Post Operative Pain ◽  
Operative Assessment

Abstract Background and aims Post-operative pain after caesarean operation remains one of the major complains after delivery. With the rising rate of caesarean deliveries, the assessment and management of acute pain has become a major concern for medical professionals in Ghana. The aim was to determine the association between the neuroplasticity of pain and depression using a postoperative pain assessment among women after caesarean section in Ghana. Methods A descriptive pilot studies consisting of 54 women who have undergone caesarean operations and reported of acute pain after three months were conducted in King David Hospital and Neptune Medical centre. A purposeful sampling was used to complete the Numeric Pain Scale (NPS) and the Wong-Baker FACES Pain Rating Scale to justify the inclusion criteria. While the Pain Quality Assessment Scale (PQAS) and the Beck Depression Inventory (BDI) were completed by participant. Results On the characteristics of their pain respondents scored above 7, on average, for hot pains (7.04 ±2.028, minimum of 5 and maximum of 10), unpleasant pains (7.33±1.907, minimum of 5 and maximum of 10), intense and deep pain (7.35 ±1.825, minimum of 5 and maximum of 10) and intense but surface (7.38 ±1.784, minimum of 5 and maximum of 10), each with a minimum of 5 and a maximum of 10. This implies that for each of those types of pain, respondents scored very high levels of intensity. Similarly, on intensity of pain sensation (6.43 ±1.814, minimum of 5 and maximum of 10), sharpness of pain (6.53±1.772, minimum of 5 and maximum of 10), how dull their pains felt (6.38 ±2.603, minimum of 0 and maximum of 10) sensitiveness of their skins (6.75 ±1.9, minimum of 4 and maximum of 10) and how itchy (6.98±2.137, minimum of 4 and maximum of 10) their skins felt with their respective standard deviations. On the depression scale, more than half of the respondents (51.9%) captured in this study had moderate depression. Conclusions We ultimately sought to conduct a test of association between ten indicators of quality of pain and depression. There turned out to be significant association between intensity of pain and depression (χ2 = 21.507; p < 0.001) simply implying that where there is a rise in intensity of pain, there is likely going to be depression. There was also a significant association between sharp sensation and depression (χ2 =31.256).

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