scholarly journals The Impact of Preventative Multimodal Analgesia on Postoperative Opioid Requirement and Pain Control in Patients Undergoing Lumbar Fusions

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Sharad Rajpal ◽  
Steven L Hobbs ◽  
Ewell Lee Nelson ◽  
Alan T Villavicencio ◽  
Christopher Zielenski ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Patient Group ◽  
Pain Control ◽  
Reference Group ◽  
Intrathecal Morphine ◽  
Lumbar Fusion ◽  
Multimodal Analgesia ◽  
Duration Of Surgery ◽  
The Impact

Abstract INTRODUCTION Preventive multimodal analgesia (PMA) addresses multiple sources and pathways of acute and chronic pain by interfering with peripheral and central sensitization and should provide a way to achieve safer and more effective pain management with reduced opioid medication use. The main objectives of this study were to determine the impact of PMA on postoperative opioid requirements and analgesic effectiveness in patients undergoing lumbar fusion surgery. METHODS A prospective observational study with a historical reference group was performed. The study compared the postoperative opioid requirement and analgesic effect in a total of 103 patients undergoing elective, one- or two-level transforaminal lumbar interbody fusion (TLIF) surgeries for symptomatic lumbar degenerative disc diseases. The PMA patient group included 52 consecutive patients who received 1000 mg of acetaminophen, 300 consecutive patients receiving 900 mg of gabapentin, and 200 consecutive patients receiving 400 mg of celecoxib 1 h before the procedure. The reference group included 51 patients who received 15 mg of morphine-equivalent dose (MED) preoperatively. Multiple linear regression was used to evaluate the influence of PMA on pain, MED, and acetaminophen use over 4 postoperative days (PODs), while controlling for all variables likely to influence these outcomes, including age, gender, baseline opioid use, duration of surgery, postoperative intrathecal morphine use, and administration of muscle relaxants and anticonvulsants. RESULTS The differences in opioid requirement and postoperative pain scores were statistically significant on all 4 postoperative days. The effect size varied from –0.54 to –0.99 for the postoperative opioid requirement and from –0.59 to –1.16 for postoperative pain, indicating that these measures were reduced by about ½ to 1 standard deviation in the PMA patient group. CONCLUSION PMA is a highly effective method for postoperative pain management in patients undergoing lumbar fusion surgeries, which not only improves pain control, but also reduces the opioid requirement.

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.

The impact of an educational pain management booklet intervention on postoperative pain control after cardiac surgery

2016 ◽  
Vol 16 (1) ◽  
pp. 18-27 ◽  
Author(s):  
Ann Kristin Bjørnnes ◽  
Monica Parry ◽  
Irene Lie ◽  
Morten Wang Fagerland ◽  
Judy Watt-Watson ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Pain Management ◽  
Postoperative Pain ◽  
Pain Control ◽  
Postoperative Pain Control ◽  
The Impact

scholarly journals Does Subcutaneous Infiltration of Liposomal Bupivacaine Following Single-Level Transforaminal Lumbar Interbody Fusion Surgery Improve Immediate Postoperative Pain Control?

2018 ◽  
Vol 12 (1) ◽  
pp. 85-93 ◽  
Author(s):  
Marko Tomov ◽  
Kevin Tou ◽  
Rose Winkel ◽  
Ross Puffer ◽  
Mohamad Bydon ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Control ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Control Group ◽  
Lumbar Interbody Fusion ◽  
Control Cohort ◽  
Liposomal Bupivacaine ◽  
Single Level ◽  
The Impact

<sec><title>Study Design</title><p>Retrospective case-control study using prospectively collected data.</p></sec><sec><title>Purpose</title><p>Evaluate the impact of liposomal bupivacaine (LB) on postoperative pain management and narcotic use following standardized single-level low lumbar transforaminal lumbar interbody fusion (TLIF).</p></sec><sec><title>Overview of Literature</title><p>Poor pain control after surgery has been linked with decreased pain satisfaction and increased economic burden. Unfortunately, opioids have many limitations and side effects despite being the primary treatment of postoperative pain. LB may be a form of pre-emptive analgesia used to reduce the use of postoperative narcotics as evidence in other studies evaluating its use in single-level microdiskectomies.</p></sec><sec><title>Methods</title><p>The infiltration of LB subcutaneously during wound closure was performed by a single surgeon beginning in July 2014 for all single-level lumbar TLIF spinal surgeries at Landstuhl Regional Medical Center. This cohort was compared against a control cohort of patients who underwent the same surgery by the same surgeon in the preceding 6 months. Statistical analysis was performed on relevant variables including: morphine equivalents of narcotic medication used (primary outcome), length of hospitalization, Visual Analog Scale pain scores, and total time spent on a patient-controlled analgesia (PCA) pump.</p></sec><sec><title>Results</title><p>A total of 30 patients were included in this study; 16 were in the intervention cohort and 14 were in the control cohort. The morphine equivalents of intravenous narcotic use postoperatively were significantly less in the LB cohort from day of surgery to postoperative day 3. Although the differences lost their statistical significance, the trend remained for total (oral and intravenous) narcotic consumption to be lower in the LB group. The patients who received the study intervention required an acute pain service consult less frequently (62.5% in LB cohort vs. 78.6% in control cohort). The amount of time spent on a PCA pump in the LB group was 31 hours versus 47 hours in the control group (<italic>p</italic>=0.1506).</p></sec><sec><title>Conclusions</title><p>Local infiltration of LB postoperatively to the subcutaneous tissues during closure following TLIF significantly decreased the amount of intravenous narcotic medication required by patients. Well-powered prospective studies are still needed to determine optimal dosing and confirm benefits of LB on total narcotic consumption and other measures of pain control following major spinal surgery.</p></sec>

scholarly journals Study of Pain Level Control Targets After Arthroscopic Surgery

2021 ◽  
Author(s):  
Wang Xin ◽  
Liu Congying ◽  
Zhang Xiaole ◽  
Wang Hong ◽  
Xu Yan ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Score ◽  
Pain Control ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Arthroscopic Surgery ◽  
Daily Activities ◽  
Pain Level ◽  
Convenience Sampling ◽  
The Impact

Abstract Objective: To explore the goal of pain control in patients after arthroscopic surgery.Design: Investigation. Postoperative pain, pain control satisfaction and the effect of pain on daily activities were investigated and evaluated.Setting: Department of Sports Medicine,Peking University 3rd Hospital,Beijing, P.R.ChinaSubjects: 514 patients selected by convenience sampling from patients hospitalized in a level A hospital in Beijing from 2020.06-2020.11. The patient inclusion criteria were an age of at least 18 years, no history of diagnosis of mental illness, the ability to clearly express his or her pain and an agreement to voluntarily cooperate with the investigators. The exclusion criteria were patients who were unable to complete follow-up.Methods: Postoperative pain, pain control satisfaction and the effect of pain on daily activities were investigated and evaluated by administering a homemade questionnaire to 514 patients selected by convenience sampling from patients hospitalized in a level A hospital in Beijing from 2020.06-2020.11. Pain was assessed using a digital pain numerical rating scale (NRS) (0-10), and a digital score ranging from 0 to 10 was used for satisfaction with pain control and the impact of pain on aspects of daily living.Results: The pain level was most severe in patients 6-24 hours after arthroscopic surgery, during which pain control satisfaction was at its worst. The pain score was significantly related to the effects of pain on aspects of daily life, and the degree of these effects changed significantly for pain scores greater than 2 points.Conclusion: Pain control 6 to 24 hours after surgery is not satisfactory. It is recommended that a pain score of 2 points is used as the goal for pain control after arthroscopic surgery to guide both doctors and patients to effectively control postoperative pain.

The Impact of Preventative Multimodal Analgesia on Postoperative Opioid Requirement and Pain Control in Patients Undergoing Lumbar Fusions

2020 ◽  
Vol 33 (3) ◽  
pp. E135-E140
Author(s):  
Sharad Rajpal ◽  
Steven L. Hobbs ◽  
E. Lee Nelson ◽  
Alan Villavicencio ◽  
Christopher Zielenski ◽  
...  
Keyword(s):  
Pain Control ◽  
Multimodal Analgesia ◽  
The Impact

scholarly journals The efficacy of pre-emptive analgesia on pain management in total knee arthroplasty: a mini-review

Arthroplasty ◽  
2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Jianda Xu ◽  
Huan Li ◽  
Chong Zheng ◽  
Bin Wang ◽  
Pengfei Shen ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Pain Management ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Physiological Mechanism ◽  
Cost Effective ◽  
Postoperative Pain Management ◽  
Multimodal Analgesia ◽  
Total Knee ◽  
End Stage

Abstract Total knee arthroplasty (TKA) is considered a cost-effective and efficacious treatment for patients with end-stage knee arthritis. Meanwhile, TKA has been regarded as one of the most painful orthopaedic surgeries. Pain control after TKA remains a challenging task. Many analgesic innovations are used to reduce the level of pain, but none has been proven to be the optimum choice till now. Multimodal analgesia incorporates the use of analgesic adjuncts with different mechanisms of action to enhance postoperative pain management. This approach is a preferable choice in relieving postoperative pain with minimum side effects. This paper aims to review pre-emptive analgesia for pain management in TKA. We reviewed the application of pre-emptive analgesia, its physiological mechanism, and the techniques.

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