Improved Quality of Recovery from Ambulatory Shoulder Surgery After Implementation of a Multimodal Perioperative Pain Management Protocol

Objective To evaluate the efficacy of implementing a standardized multimodal perioperative pain management protocol in reducing opioid prescriptions following otolaryngologic surgery. Study Design Retrospective cohort study. Setting County hospital otolaryngology practice. Methods A perioperative pain management protocol was implemented in adults undergoing otolaryngologic surgery. This protocol included preoperative patient education and a postoperative multimodal pain regimen stratified by pain level: mild, intermediate, and high. Opioid prescriptions were compared between patient cohorts before and after protocol implementation. Patients in the pain protocol were surveyed regarding pain levels and opioid use. Results We analyzed 210 patients (105 preprotocol and 105 postprotocol). Mean ± SD morphine milligram equivalents (MMEs) prescribed decreased from 132.5 ± 117.8 to 53.6 ± 63.9 ( P < .05) following protocol implementation. Mean MMEs prescribed significantly decreased ( P < .05) for each procedure pain tier: mild (107.4 to 40.5), intermediate (112.8 to 48.1), and high (240.4 to 105.0). Mean MMEs prescribed significantly decreased ( P < .05) for each procedure type: endocrine (105.6 to 44.4), facial plastics (225.0 to 50.0), general (160.9 to 105.7), head and neck oncology (138.6 to 77.1), laryngology (53.8 to 12.5), otology (77.5 to 42.9), rhinology (142.2 to 44.4), and trauma (288.0 to 24.5). Protocol patients reported a mean 1-week postoperative pain score of 3.4, used opioids for a mean 3.1 days, and used only 39% of their prescribed opioids. Conclusion Preoperative counseling and standardization of a multimodal perioperative pain regimen for otolaryngology procedures can effectively lower amount of opioid prescriptions while maintaining low levels of postoperative pain.

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Perioperative pain management for shoulder surgery: evolving techniques

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2020.04.049 ◽

2020 ◽

Vol 29 (11) ◽

pp. e416-e433

Author(s):

Manan S. Patel ◽

Joseph A. Abboud ◽

Paul M. Sethi

Keyword(s):

Pain Management ◽

Shoulder Surgery ◽

Perioperative Pain ◽

Perioperative Pain Management

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Age-related differences in cognition and postoperative quality of recovery after beach chair position shoulder surgery

Anaesthesia and Intensive Care ◽

10.1177/0310057x211020319 ◽

2021 ◽

pp. 0310057X2110203

Author(s):

Alwin Chuan ◽

Minh T Tran ◽

Alice X Sun ◽

Tajrian Amin ◽

Yan X Chan ◽

...

Keyword(s):

Older Patients ◽

Shoulder Surgery ◽

Functional Activities ◽

Quality Of Recovery ◽

Beach Chair Position ◽

Management Protocol ◽

Significant Difference ◽

Postoperative Quality ◽

Beach Chair

We examined the influence of age in beach chair position shoulder surgery and postoperative quality of recovery by conducting a single-site, observational, cohort study comparing younger aged (18–40 years) versus older aged (at least 60 years) patients admitted for elective shoulder surgery in the beach chair position. Endpoints were dichotomous return of function to each patient’s individual preoperative baseline as assessed using the postoperative quality of recovery scale; measuring cognition, nociception, physiological, emotional, functional activities and overall perspective. We recruited 112 (41 younger and 71 older aged) patients. There was no statistical difference in cognitive recovery at day three postoperatively (primary outcome): 26/32 younger patients (81%) versus 43/60 (72%) older patients, P=0.45. Rates of recovery were age-dependent on domain and time frame (secondary outcomes), with older patients recovering faster in the nociceptive domain ( P=0.02), slower in the emotional domain ( P=0.02) and not different in the physiological, functional activities and overall perspective domains (all P >0.35). In conclusion, we did not show any statistically significant difference in cognitive outcomes between younger and older patients using our perioperative anaesthesia and analgesia management protocol. Irrespective of age, 70% of patients recovered by three months in all domains.

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Perioperative Pain Management in Primary Bone Tumors

Romanian Journal of Orthopaedic Surgery and Traumatology ◽

10.2478/rojost-2018-0019 ◽

2018 ◽

Vol 1 (Supplement) ◽

pp. 8

Author(s):

A. Bratu ◽

Z. Panti ◽

A. Comanelea ◽

R. Ene ◽

C. Cîrstoiu

Keyword(s):

Quality Of Life ◽

Pain Management ◽

Epidural Catheter ◽

Bone Tumors ◽

Tumor Resection ◽

Perioperative Pain ◽

Before And After ◽

Perioperative Pain Management ◽

Primary Bone

Abstract Introduction. The increasing number of tumor prosthesis in the last decade shows the advance in musculoskeletal oncology. Limb sparing surgery nowadays has to be the focus in surgery, maintaining the patient’s quality of life. Prognosis depends on the histological type of tumor, size, and local extension. Pain is present in almost any cases of bone tumors and can vary in intensity and character. Being the leading symptom is strongly correlated to the quality of life. The purpose of this study was to evaluate pain in patients with primary bone sarcomas before and after surgery. Material and methods. 11 patients were involved in this study over a period of 4 years (2014-2017) from the Orthopedics and Traumatology Department in the University Emergency Hospital in Bucharest. Tumor resection and reconstruction with modular prosthesis was performed in 4 cases, and tumor resection was necessary in 3 cases and amputation in 4 cases. Pain was evaluated before and after surgery using the Visual Analog Scale (VAS). Early postoperative pain control was achieved with epidural catheter, followed by opioid therapy, NSAIDs and Paracetamol in the early stages of mobilization. Results. Surface sarcomas and tumors close to the periosteum, or periosteal involvement has shown a localized and increased pain. Multimodal-analgesia was used for pain management. Within the first 48 hours, analgesia was performed with an epidural catheter by continuous infusion of ropivacaine 0.2% and fentanyl 2mcg/ ml at a rate ranging between 3-6 ml/ h, obtaining a VAS score between 0 and 3. Conclusions. Perioperative pain management has to be individualized to the localization and local soft tissue involvement of the tumor. In late stages of sarcomas or local recurrence, conventional analgesics can be inefficient. Early diagnosis and surgical removal of these tumors is the most important objective for a good prognosis.

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Impact of perioperative pain management protocol on opioid prescribing patterns

The Laryngoscope ◽

10.1002/lary.28133 ◽

2019 ◽

Vol 130 (5) ◽

pp. 1180-1185 ◽

Cited By ~ 3

Author(s):

Jason E. Thuener ◽

Kate Clancy ◽

Maxwell Scher ◽

Mustafa Ascha ◽

Katrina Harrill ◽

...

Keyword(s):

Pain Management ◽

Prescribing Patterns ◽

Opioid Prescribing ◽

Perioperative Pain ◽

Management Protocol ◽

Perioperative Pain Management

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Pre-Emptive and Multi-Modal Perioperative Pain Management May Improve Quality of Life in Patients Undergoing Spinal Surgery

January 2018 - Pain Physician ◽

10.36076/ppj.2013/16/e217 ◽

2013 ◽

Vol 3;16 (3;5) ◽

pp. E217-E226

Author(s):

Seong-Hwan Moon

Keyword(s):

Quality Of Life ◽

Pain Management ◽

Postoperative Pain ◽

Spinal Surgery ◽

Degenerative Spine ◽

Perioperative Pain ◽

Related Quality ◽

Tertiary Hospitals ◽

Perioperative Pain Management

Background: Compared to an abundance of data on surgical techniques for degenerative spine conditions and the outcomes thereof, little is available to guide optimal perioperative pain management after spinal surgery. The aim of this study was to survey patterns of perioperative pain management after spinal surgery and to investigate the effects of perioperative pain management, such as pre-emptive analgesia and multi-modal postoperative pain management, on acute postoperative satisfaction, pain reduction, and health-related quality of life in patients undergoing spinal surgery. Study design: Non-blind multicenter prospective observational clinical series. Setting: Seventeen tertiary hospitals (14 hospitals attached to medical colleges and 3 general hospitals). Methods: Pain management protocols of 393 patients (153 men, 240 women; mean age of 67 years, ranging from 21 to 91 years) from 17 tertiary hospitals after spinal surgery for degenerative spine disease were evaluated using a self-administered questionnaire. Results: A total of 79 (20%) patients received pre-emptive analgesics, which included cyclooxygenase-2 (COX-2) inhibitors, with or without administration of anticonvulsants, immediately before surgery at the time of antibiotic prophylaxis. Postoperative pain was managed mainly by multi-modal therapy (363 cases, 92%), along with various combinations of patient controlled anesthesia (PCA), conventional nonsteroidal anti-inflammatory drugs (NSAIDs), COX2 inhibitors, and narcotics. Self-reported levels of pain were not significantly different among postoperative multiple modalities of pain management, but were different significantly for preemptive pain management regimens (P < 0.05, independent t-test). The number of patients that reported the self-administrative use of PCA was higher in the no pre-emptive pain management group compared to the pre-emptive group (P < 0.05). In regards to EQ-5D usual activity, depression/ anxiety and self-care improved significantly in the pre-emptive pain management group when measured at 2 weeks postoperative (P < 0.05). Limitations: The limitation of our study is that it is not a randomized controlled observational study. Conclusions: Pre-emptive analgesia and multi-modal pain management after spinal surgery may lead to better health-related quality of life, greater patient satisfaction, and less postoperative pain. Key words: Degenerative spine, surgery, pre-emptive, pain, management

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