Pain Management in the Patient with Substance Use Disorder

2018 ◽  
Author(s):  
Thomas Hickey ◽  
Jessica Feinleib
Keyword(s):  
Substance Use ◽  
Pain Management ◽  
Side Effects ◽  
Postoperative Pain ◽  
Respiratory Depression ◽  
Substance Use Disorder ◽  
Multimodal Analgesia ◽  
Surgical Patient ◽  
Acute Postoperative Pain ◽  
Aggressive Communication

Managing pain in the patient with substance use disorder can be challenging. This chapter describes those challenges and provides strategies to address them. Specifically it discusses the prevalence and specific considerations for commonly abused substances, the need for aggressive communication among perioperative clinicians, and a strategy to decrease acute postoperative pain and associated complications using opioid-sparing, multimodal analgesia. It includes a discussion of the concept of equianalgesic opioid doses and management of opioid-related side effects including respiratory depression, with regard to buprenorphine, naltrexone, and methadone. Specific consideration is given to the surgical patient treated with buprenorphine, and a defined clinical plan is outlined.

scholarly journals Continuous Fentanyl Background Infusion Regimen Optimised by Patient-Controlled Analgesia for Acute Postoperative Pain Management: A Randomised Controlled Trial

2020 ◽  
Vol 9 (1) ◽  
pp. 211 ◽  
Author(s):  
Jihoon Hwang ◽  
Sang Kee Min ◽  
Yun Jeong Chae ◽  
Gang Mee Lim ◽  
Han Bum Joe
Keyword(s):  
Pain Management ◽  
Side Effects ◽  
Postoperative Pain ◽  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Postoperative Pain Management ◽  
Patient Controlled Analgesia ◽  
Acute Postoperative Pain ◽  
Background Infusion ◽  
Randomised Controlled

Owing to a lack of studies investigating the effect of adjustments in fentanyl background infusion (BI) with patient-controlled analgesia (PCA) on postoperative analgesia, we evaluated three BI regimens with fentanyl PCA for acute postoperative pain management. This randomised controlled trial enrolled 105 patients, who were assigned to three parallel groups: constant rate BI of 2 mL/h (CRBI group); time-scheduled decremental BI of 6, 2 and 1 mL/h (TDBI group); and BI rates optimised to the demand of PCA (POBI group). The incidence of insufficient analgesia, visual analogue scale (VAS) pain score and side effects were evaluated. The incidence of insufficient analgesia in the post-anaesthesia care unit was lower in the TDBI and POBI groups than the CRBI group. Incidence of insufficient analgesia in the ward was lower in the POBI group than the CRBI group. Postoperative VAS scores were significantly lower in the TDBI and POBI groups for up to 4 h and 24 h, respectively, compared with the CRBI group. Side effects and infused fentanyl dose were highest in the CRBI group. Adjusting BI rate based on time or patient demands could improve postoperative analgesia and reduce side effects. Compared to a constant BI rate, PCA-optimised BI achieved higher patient satisfaction.

scholarly journals Effectiveness of Ketoprofen Suppositoria as Preemptive Analgesia for Postoperative Pain in Patients Undergoing Elective Surgery with General Anesthesia

2020 ◽  
Vol 2 (1) ◽  
pp. 20
Author(s):  
Lupi Lestari ◽  
Elizeus Hanindito ◽  
Arie Utariani
Keyword(s):  
Pain Management ◽  
Side Effects ◽  
Postoperative Pain ◽  
General Anesthesia ◽  
Rating Scale ◽  
Postoperative Pain Management ◽  
Numeric Rating Scale ◽  
Preemptive Analgesia ◽  
Acute Postoperative Pain ◽  
Numeric Rating

Introduction: Effective postoperative pain management provides improved patient comfort and satisfaction, earlier mobilization, fewer pulmonary and cardiac complications, reduced risk deep vein thrombosis, fast recovery, and reduced cost of care. Preemptive analgesia, initiated before the surgical procedure to prevent pain in the early postoperative period, has the potential to be more effective than a similar analgesic treatment initiated after surgery. As a part of multimodal analgesia, the use of NSAIDs should always be considered for acute postoperative pain management. NSAIDs can be used preoperatively as a part of the preemptive regimen and for postoperative pain control to increase the efficacy of opioids and reduce its side effects. Material and Method: This research was experimental research with a case-control design of the study. The samples separated into two groups, the first group got ketoprofen suppository before the induction, and the second group didn’t get the ketoprofen suppository The intensity of pain measured with the Numeric Rating Scale (NRS) or Wong-Baker Faces Pain Scale was the variable studied at different postoperative times (30 min, 60 min, 120 min, 2-6 hours, 6-12 hours). The total amount of rescue analgesics (fentanyl) and side effects were other variables of this study. Result and Discussion: The result is ketoprofen suppository as preemptive analgesia administrations can reduce postoperative pain. Numeric Rating Scale was significantly lower in the ketoprofen group compared to the control group (p < 0,05) at 30 min, 60 min, 230 min, 2-6 hours, 6-12 hours. The number of postoperative analgesics needed in the recovery room was significant differences among both groups (p < 0,05). Conclusion: Preemptive analgesia in patients who underwent an operation with general anesthesia with ketoprofen suppository was effectively in blocking noxious stimuli and central sensitization, with subsequent prevention of acute postoperative pain.

scholarly journals Oral Oxycodone for Acute Postoperative Pain: A Review of Clinical Trials

2017 ◽  
Vol 2 (20;2) ◽  
pp. sE33-sE52 ◽  
Author(s):  
Chi-Wai Cheung
Keyword(s):  
Clinical Trials ◽  
Pain Management ◽  
Side Effects ◽  
Postoperative Pain ◽  
Pain Relief ◽  
Hospital Stay ◽  
Spine Surgery ◽  
Analgesic Efficacy ◽  
Postoperative Pain Management ◽  
Acute Postoperative Pain

Background: Opioids are the mainstay of pain management for acute postsurgical pain. Oral oxycodone is an opioid that can provide effective acute postoperative pain relief. Objectives: To evaluate the use of oral oxycodone for acute postoperative pain management. Study Design: This is a narrative review based on published articles searched in PubMed and Medline from 2003 to 2015 on oral oxycodone for acute postoperative pain management. Methods: Clinical trials related to the use of oral oxycodone for acute postoperative pain management were searched via PubMed and Medline from 2003 to 2015. The search terms used were “oral strong opioids,” “postsurgical,” “postoperative,” “post-surgical,” and “postoperative.” Treatment interventions were compared for analgesic efficacy, rescue medication use, side effects, recovery, length of hospital stay, and patient satisfaction. Results: There were 26 clinical trials included in the review. Oral oxycodone showed superior postoperative analgesic efficacy compared with placebo in patients undergoing laparoscopic cholecystectomy, abdominal or pelvic surgery, bunionectomy, breast surgery, and spine surgery. When compared with intravenous opioids, oral oxycodone provided better or comparable pain relief following knee arthroplasty, spine surgery, caesarean section, laparoscopic colorectal surgery, and cardiac surgery. One study of dental postsurgery pain reported inferior pain control with oral oxycodone versus rofecoxib. (withdrawn from the US market due to cardiac safety concerns). In many studies, the demand for rescue analgesia and total opioid consumption were reduced in the oxycodone treatment arm. Patients receiving oral oxycodone experienced fewer opioid-related side effects than those on other opioids, and had a similar occurrence of postoperative nausea and vomiting as patients on placebo. Furthermore, oral oxycodone did not prolong hospital stay and was associated with lower drug costs compared with epidural and intravenous analgesics. Oxycodone administered as part of a multimodal analgesic regimen produced superior pain relief with fewer side effects and a reduced hospital stay. Limitation: There is a limited number of randomized double blinded studies in individual surgical operations, thus making it more difficult to come up with definitive conclusions. Conclusion: Oral oxycodone appears to offer safe and effective postoperative analgesia, and is a well-accepted and reasonable alternative to standard intravenous opioid analgesics. Key words: Postoperative, pain, analgesia, oral oxycodone, opioid

scholarly journals Acute postoperative pain

2016 ◽  
Vol 11 (3) ◽  
pp. 231-233
Author(s):  
Adriana Alexandra BRĂDIŞ ◽  
◽  
Adrian Daniel TULIN ◽  
Erick NESTIANU ◽  
Ioana Anca BĂDĂRĂU ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Postoperative Pain ◽  
Postoperative Morbidity ◽  
Emotional Experience ◽  
Multimodal Analgesia ◽  
Postoperative Recovery ◽  
Psychological Effects ◽  
Acute Postoperative Pain ◽  
Pain Scales

Acute postoperative pain is a personal unpleasant sensory and emotional experience with negative physiological and psychological effects. Severe acute pain may increase postoperative morbidity and mortality and is a risk factor for chronic pain incidence. We evaluate pain intensity using pain scales. Pain management includes preventive analgesia who interacts and modulates central sensitization response and multimodal analgesia which uses two or more different analgesic mechanisms agents for a superior analgesic effect. Effective pain management provide early postoperative recovery and decrease the incidence of chronic pain.

Acute Pain

2019 ◽  
pp. 241-258
Author(s):  
Nantthasorn Zinboonyahgoon ◽  
Kristin Schreiber
Keyword(s):  
Substance Use ◽  
Pain Management ◽  
Side Effects ◽  
Acute Pain ◽  
Multimodal Treatment ◽  
Treatment Plan ◽  
Multimodal Analgesia ◽  
Management Plan ◽  
Pain Pathways ◽  
Pain Care

Chapter 14 covers the essentials of acute pain care in the hospital and procedural setting. The chapter begins with an overview of the negative physiologic impacts of uncontrolled acute pain. Based on a foundational understanding of pain pathways and nociceptive signaling, it is possible to construct an acute pain management plan incorporating nonpharmacologic, systemic, and focal pharmacologic elements for an effective multimodal treatment plan. Acute opioid management, including analgesic equivalence, is discussed in detail. Benefits, precautions, side effects, and toxicities of opioids are addressed. Naloxone administration is described in detail. Obstetric, regional, nerve blockade, and multimodal analgesia are described. Adjustments to therapy for patients with substance use disorder are addressed in detail.

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 Pain management in obstetrics and gynecology

Pain medicine ◽  
2018 ◽  
Vol 3 (3) ◽  
pp. 69-73
Author(s):  
Ye V Grigimalsky ◽  
A Y Garga
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Pain Control ◽  
Surgical Intervention ◽  
Opioid Analgesics ◽  
Multimodal Analgesia ◽  
Obstetrics And Gynecology ◽  
Negative Consequences ◽  
Acute Postoperative Pain ◽  
Regional Analgesia

The problem of acute postoperative pain is present throughout the lifetime of surgery and, unfortunately, does not lose its relevance today. Inadequate pain control in the postoperative period leads to negative consequences. Multimodal analgesia is currently the method of choice for postoperative anesthesia. The basis is the prescription of paracetamol (Infulgan®) in combination or without NSAIDs with the addition of methods of regional analgesia and, in case of insufficient effect, the use of opioid analgesics lies in the basisi of this method. Choosing one or another scheme of multimodal analgesia is determined, above all, is due to the invasiveness of the surgical intervention performed.

scholarly journals Comparative Study in the Management of Postoperative Pain with High Dose Intravenous Paracetamol versus Tramadol

2021 ◽  
Vol 5 (4) ◽  
pp. 1-6
Author(s):  
Tanudeep Kaur ◽  
Keyword(s):  
Pain Management ◽  
Side Effects ◽  
Postoperative Pain ◽  
Pain Relief ◽  
Emotional Experience ◽  
Postoperative Pain Management ◽  
Economic Benefits ◽  
High Dose ◽  
Postoperative Patient ◽  
Intravenous Paracetamol

Pain is an unpleasant sensory and emotional experience causing agony and several side effects in a postoperative patient. Thus effective postoperative pain management has a humanitarian role with additional medical and economic benefits Paracetamol (PCM) has been widely used as an effective analgesic and antipyretic for over a century with an established safety profile, and Tramadol is a commonly used intravenous drug for postoperative pain relief.

Comparison of post-operative analgesic effect between Pregabalin and Gabapentin given as premedication drugs for patients undergoing laproscopic cholecystectomy

2021 ◽  
Vol 8 (2) ◽  
pp. 179-184
Author(s):  
Arun Kumar Balasubramanian ◽  
Rasikapriya Madhanagopal ◽  
Priyanka S Gowda ◽  
Brindha Rathnasabapathy ◽  
R Shankar
Keyword(s):  
Placebo Group ◽  
Side Effects ◽  
Postoperative Pain ◽  
Adverse Events ◽  
Multimodal Analgesia ◽  
Dose Requirement ◽  
College Hospital ◽  
Rescue Analgesia ◽  
Entire Study ◽  
The Difference

Currently most of the anesthetist prefer the usage of multimodal analgesia technique to improve the degree of pain relief without inducing any side effects. Pregabalin and gabapentin when given in higher doses reduces the preoperative anxiety and induce sedation without causing undesirable side effects.To compare and evaluate the effects of premedication drugs Pregabalin or Gabapentin versus placebo for attenuation of postoperative pain among patients undergoing laparoscopic cholecystectomy under general anaesthesia.A prospective comparative study was conducted for a period of 6 months in the department of anesthesiology of our medical college hospital. A total of 90 patients posted for elective laproscopic cholecystectomy in the age group between 20 and 60 years were taken as our study subjects. The entire study subjects were randomized into three groups of 30 each. Group B subjects received 3 tablets of Beplex forte (as placebo), Group G subjects received 3 tablets of Gabapentin 300mg (total 900mg) and Group P subjects received 3 tablets of Pregabalin 50mg (total 150mg). Post-operatively degree of pain, requirement for rescue analgesia, sedation score and adverse events occurred was monitored and analysed between the three groups. Pain score was less in the pregabalin group at all intervals compared to gabapentin and placebo group and the difference was found to be statistically significant. Maximum amount of tramadol requirement as a part of rescue analgesia was seen in the placebo group followed by gabapentin group and minimal dose requirement was needed for pregabalin group and the difference was found to be statistically significant. The occurrence of adverse events such as somnolence and dizziness was almost similar in all the three groups whereas the incidence of nausea and vomiting was less in pregabalin group compared to gabapentin and placebo group. Pregabalin can be effectively used as a part of the multimodal analgesic to prevent acute postoperative pain among patients undergoing elective laproscopic cholecystectomy.

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