Craniotomy

2019 ◽  
pp. 221-245
Author(s):  
Roxana Grasu ◽  
Sally Raty
Keyword(s):  
Risk Factors ◽  
Pain Management ◽  
Side Effects ◽  
Respiratory Depression ◽  
Pain Control ◽  
Sensory Nerves ◽  
Current Evidence ◽  
Multimodal Approach ◽  
Perivascular Nerves ◽  
Persistent Headache

This chapter discusses postcraniotomy headache (PCH), a common yet frequently underdiagnosed and undertreated occurrence, with up to 30% of patients experiencing persistent headache after surgery. The chapter identifies risk factors for the development of acute and persistent PCH and describes mechanisms for its development, such as injury to the sensory nerves supplying the scalp and underlying tissues or to the perivascular nerves that supply sensation to the dura mater. Pain management following craniotomy is a balancing act of achieving adequate analgesia while avoiding oversedation, respiratory depression, hypercapnia, nausea, vomiting, and hypertension. Current evidence suggests that a balanced, multimodal approach to the treatment of acute PCH is often required to optimize pain control, minimize undesired side effects, and prevent the development of persistent PCH.

Pain Management

2018 ◽  
Author(s):  
Eelco F. M. Wijdicks ◽  
Sarah L. Clark
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pain Management ◽  
Side Effects ◽  
Pain Control ◽  
Pain Syndrome ◽  
Opioid Analgesics ◽  
Narcotic Analgesics

Adequate pain control has a high priority. In any acute neurologic pain syndrome it must be assumed that pain management is possible, effective, and simple; unfortunately, most patients in pain have been poorly managed. The pharmacopeia of pain management is growing and changing and several trends have been noted. Pain is underreported in the intensive care unit and should be treated when indicated. Acetaminophen is often the first agent used in pain management. Next are weak narcotic analgesics which could have less severe side effects than stronger opioid analgesics. This chapter discusses types of pain in the neurosciences intensive care unit and specific pharmacologic approaches.

Pain Management for the Obese Sleep Apnea Patient

ICU Director ◽  
2012 ◽  
Vol 3 (2) ◽  
pp. 80-84 ◽  
Author(s):  
Mark A. Schumacher
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Pain Management ◽  
Side Effects ◽  
Respiratory Depression ◽  
Adult Population ◽  
Opioid Analgesic ◽  
Sleep Apnea Syndromes ◽  
Obese Patients ◽  
Obstructive Sleep

Currently, one third of the US adult population is considered obese. As such, obese patients are a rapidly growing population of patients being admitted to ICU. The problems in managing pain for these patients, primarily perioperative and hospital-associated respiratory depression, are becoming increasingly apparent. New approaches for pain management are intended to minimize the life-threatening side effects of traditional pain control drugs (opioids) and to increase the therapeutic options with nonopioid agents. This article ( a) reviews the pathophysiology of obstructive sleep apnea and other related sleep apnea syndromes, ( b) describes risk factors for perioperative and hospital-associated respiratory depression, ( c) reviews other significant side effects of opioid analgesic agents, and finally ( d) summarizes the emerging consensus for the use of multimodal analgesia for managing pain in obese patients with obstructive sleep apnea.

Management of patients with pain and severe side effects while on intrathecal morphine therapy: A case study

2017 ◽  
Vol 17 (1) ◽  
pp. 37-40 ◽  
Author(s):  
Kehua Zhou ◽  
Sen Sheng ◽  
Gary G. Wang
Keyword(s):  
Pain Management ◽  
Side Effects ◽  
Pain Control ◽  
Intrathecal Morphine ◽  
Management Approach ◽  
Intractable Pain ◽  
Pump Therapy ◽  
Pump Implantation ◽  
Morphine Therapy

AbstractBackground and aimsThe use of intrathecal morphine therapy has been increasing. Intrathecal morphine therapy is deemed the last resort for patients with intractable chronic non-cancer pain (CNCP) who failed other treatments including surgery and pharmaceutical interventions. However, effective treatments for patients with CNCP who “failed” this last resort because of severe side effects and lack of optimal pain control remain unclear.Methods and resultsHere we report two successfully managed patients (Ms. S and Mr. T) who had intractable pain and significant complications years after the start of intrathecal morphine therapy. The two patients had intrathecal morphine pump implantation due to chronic consistent pain and multiple failed surgical operations in the spine. Years after morphine pump implantation, both patients had significant chronic pain and compromised function for activities of daily living. Additionally, Ms. S also had four episodes of small bowel obstruction while Mr. T was diagnosed with end stage severe “dementia”. The successful management of these two patients included the simultaneous multidisciplinary approach for pain management, opioids tapering and discontinuation.ConclusionThe case study indicates that for patients who fail to respond to intrathecal morphine pump therapy due to side effects and lack of optimal pain control, the simultaneous multidisciplinary pain management approach and opioids tapering seem appropriate.

scholarly journals Non-Allopathic Interventions for the Management of Acute and Chronic Pain: A Brief Review

2020 ◽  
Vol 25 (2) ◽  
Author(s):  
Linda Cole
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Pain Control ◽  
Nursing Practice ◽  
Healthcare Providers ◽  
Allopathic Medicine ◽  
Management Approach ◽  
Historical Overview ◽  
Multimodal Approach ◽  
Effective Interventions

With increased regulation and scrutiny, healthcare providers may be reluctant to prescribe medications, especially opioids, for patients with pain, and particularly chronic pain. However, nurses, as the frontline resource for patients, must advocate for effective interventions to address pain. Sound knowledge of non-allopathic approaches (including non-conventional, complementary, alternative, and integrative strategies) for acute, chronic, and cancer-related pain control supports a holistic pain management approach for patient care. In this article I discuss the clinical relevance of pain management and provide an historical overview of non-allopathic medicine. The discussion considers the five domains of non-allopathic medicine along with negative aspects associated with these interventions and the need for a multimodal approach. The article conclusion offers implications for nursing practice that include resources for non-allopathic pain management for both providers and patients.

Postoperative Management and Radiography

2015 ◽  
Author(s):  
John Goodfellow ◽  
John O'Connor ◽  
Hemant Pandit ◽  
Christopher Dodd ◽  
David Murray
Keyword(s):  
Total Knee Arthroplasty ◽  
Pain Management ◽  
Pain Control ◽  
Postoperative Management ◽  
Early Postoperative Period ◽  
Multimodal Approach ◽  
Invasive Approach ◽  
Opiate Use ◽  
Total Knee ◽  
Good Pain Control

In the early postoperative period, good pain control is essential. Regimes of pain management appropriate for total knee arthroplasty may not be suited to the very rapid mobilisation that is possible after UKA through a minimally invasive approach. A multimodal approach is best with minimal opiate use. Different regimes are used successfully in different institutions.

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.

Barriers to Optimal Pain Management in the General Surgery Population

2018 ◽  
Author(s):  
Anand C. Thakur
Keyword(s):  
Pain Management ◽  
Pain Control ◽  
Pain Perception ◽  
Evidence Based ◽  
Multimodal Approach ◽  
Short List ◽  
Acute Pain Management ◽  
Physiological Factors ◽  
Physician Knowledge ◽  
Perception Management

Barriers to the implementation of adequate pain control are multifactorial and encompass all caregivers. A complete list of barriers to adequate pain control would involve biopsychosocial factors, physiological factors, pharmacological concerns, and medical legal concerns. A short list of barriers to adequate pain control can be separated into physician knowledge, expectations and perceptions, nurses’ and other ancillary providers’ knowledge, expectations and perceptions, patient expectations and perception, management of acute pain, management of chronic pain, discrepancies of pain perception and different population groups, and both regulatory and formulary issues. To have an understanding of up-to-date recommendations and standards regarding evidence-based pain management requires a multimodal approach with a team of physicians.

Patient-controlled Epidural Analgesia with Bupivacaine and Fentanyl on Hospital Wards 

1998 ◽  
Vol 88 (3) ◽  
pp. 688-695 ◽  
Author(s):  
Spencer S. Liu ◽  
Hugh W. Allen ◽  
Gayle L. Olsson
Keyword(s):  
Risk Factors ◽  
Side Effects ◽  
Epidural Analgesia ◽  
Respiratory Depression ◽  
Postoperative Analgesia ◽  
Motor Block ◽  
Management Service ◽  
Pain Scores ◽  
Epidural Catheters ◽  
Hospital Wards

Background The efficacy and safety of patient-controlled epidural analgesia (PCEA) for postoperative analgesia on hospital wards was studied. Methods Postoperative analgesia was provided for 1,030 patients with PCEA using 0.05% bupivacaine and fentanyl, 4 microg/ml, in a standardized manner. Patients were seen at least twice a day by the staff of the anesthesia pain management service. Prospectively gathered data included verbal pain scores at rest and activity (0-10); consumption of bupivacaine and fentanyl; and incidences of pruritus, nausea, sedation, hypotension, motor block, and respiratory depression. Descriptive statistics were used. Risk factors for side effects were determined using logistic regression. Results The study included 552 women and 477 men who underwent a median (mode) of 3 (2) days of PCEA. Their mean age was 59 +/- 16 yr and their mean weight was 76 +/- 19 kg. There were 454 abdominal, 165 gynecologic, 126 urologic, 108 vascular, 90 thoracic, 83 orthopedic, and 4 plastic surgical procedures. Median (mode) pain scores were 1 (0) at rest and 4 (5) with activity on postoperative day 1. Incidences of side effects were 16.7% (pruritus), 14.8% (nausea), 13.2% (sedation), 6.8% (hypotension), 2% (motor block), and 0.3% (respiratory depression). Reasons for termination of PCEA were elective (82%), displaced epidural catheter (12%), anticoagulation (3%), infection (1%), side effects (1%), inadequate analgesia (1%), and other (<1%). Risk factors for side effects were female sex, patient weight <73 kg, patient age <58 yr, bupivacaine and fentanyl consumption >9 ml/h, use of analgesic adjuncts, and lumbar placement of epidural catheters. Conclusion Patient-controlled epidural analgesia provides effective and safe postoperative analgesia on hospital wards.

scholarly journals Multimodal Pain Management in Older Elective Arthroplasty Patients

2017 ◽  
Vol 8 (3) ◽  
pp. 151-154 ◽  
Author(s):  
Elaine Brooks ◽  
Susan H. Freter ◽  
Susan K. Bowles ◽  
David Amirault
Keyword(s):  
Older Adults ◽  
Pain Management ◽  
Postoperative Analgesia ◽  
Pain Control ◽  
Postoperative Delirium ◽  
Tertiary Care ◽  
Opioid Analgesics ◽  
Multimodal Approach ◽  
Pain Scores ◽  
Significant Difference

Background: Pain management after elective arthroplasty in older adults is complicated due to the risk of undertreatment of postoperative pain and potential adverse effects from analgesics, notably opioids. Using combinations of analgesics has been proposed as potentially beneficial to achieve pain control with lower opioid doses. Objective: We compared a multimodal pain protocol with a traditional one, in older elective arthroplasty patients, measuring self-rated pain, incidence of postoperative delirium, quantity and cost of opioid analgesics consumed. Methods: One hundred fifty-eight patients, 70 years and older, admitted to tertiary care for elective arthroplasty were prospectively assessed postoperative days 1–3. Patients received either traditional postoperative analgesia (acetaminophen plus opioids) or a multimodal pain protocol (acetaminophen, opioids, gabapentin, celecoxib), depending on surgeon preference. Self-rated pain, postoperative delirium, and time to achieve standby-assist ambulation were compared, as were total opioid doses and analgesic costs. Results: Despite receiving significantly more opioid analgesics (traditional: 166.4 mg morphine-equivalents; multimodal: 442 mg morphine equivalents; t = 10.64, P < .0001), there was no difference in self-rated pain, delirium, or mobility on postoperative days 1–3. Costs were significantly higher in the multimodal group ( t = 9.15, P < .0001). Knee arthroplasty was associated with higher pain scores than hip arthroplasty, with no significant difference in opioid usage. Conclusion: A multimodal approach to pain control demonstrated no benefit over traditional postoperative analgesia in elective arthroplasty patients, but with significantly higher amounts of opioid consumed. This poses a potential risk regarding tolerability in frail older adults and results in increased drug costs.

scholarly journals The Use of Conditioning Open-Label Placebo in Opioid Dose Reduction: A Case Report and Literature Review

2021 ◽  
Vol 2 ◽  
Author(s):  
Maria A. Estudillo-Guerra ◽  
Ines Mesia-Toledo ◽  
Jeffrey C. Schneider ◽  
Leon Morales-Quezada
Keyword(s):  
Case Report ◽  
Pain Management ◽  
Side Effects ◽  
Literature Review ◽  
Behavioral Intervention ◽  
Pain Control ◽  
Inpatient Rehabilitation ◽  
Trial Participation ◽  
Open Label ◽  
Cord Injury

Introduction: Adequate pain management for inpatients in rehabilitation units is essential for achieving therapeutic goals. Opioid treatments are commonly prescribed, but these are associated with numerous adverse effects, including the risk of addiction and decreased quality of life. Conditioning an open-label placebo is a promising approach to extend the analgesic effect of the opioid while reducing its overall dosage.Objectives: To describe a patient's experience in using conditioning open-label placebo (COLP) as a pharmaco-behavioral intervention to decrease opioid intake and its side effects after inpatient rehabilitation discharge, and to perform a literature review about the use of open-label placebo in pain.Methods: This case study has been extracted from a clinical trial initiated in 2018. A 61-year-old male was recruited at a tertiary rehabilitation hospital after suffering a traumatic sport-related injury and orthopedic surgery. Pain management included prescription of non-steroidal anti-inflammatory drugs (NSAIDs) and short-acting oxycodone. After trial participation, the patient requested off-label COLP treatment to help him decrease outpatient opioid utilization.Results: After COLP treatment, the patient could discontinue oxycodone intake (a reduction from 15 morphine equivalents/day) after rehabilitation discharge. Moreover, opioid side effects decreased from 46 to 9 points on the numerical opioid side-effects scale. A literature review identified five clinical trials using “honest” open-label placebo (OLP) or COLP as an experimental intervention for pain control. From these studies, two were in the area of chronic lower back pain, one in post spine surgery, one in irritable bowel syndrome, and another in spinal cord injury and polytrauma. Four studies reported positive outcomes related to pain control, while one study showed no significant differences in pain management between treatment-as-usual and the COLP group.Conclusion: The case report illustrates how a pharmaco-behavioral intervention can facilitate downward opioid titration safely after inpatient rehabilitation. It initiates a discussion about new approaches for opioid management using conditioning and the patient's expectation of pain relief.

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