Perioperative Use of Gabapentinoids for the Management of Postoperative Acute Pain

Background Widely used for acute pain management, the clinical benefit from perioperative use of gabapentinoids is uncertain. The aim of this systematic review was to assess the analgesic effect and adverse events with the perioperative use of gabapentinoids in adult patients. Methods Randomized controlled trials studying the use of gabapentinoids in adult patients undergoing surgery were included. The primary outcome was the intensity of postoperative acute pain. Secondary outcomes included the intensity of postoperative subacute pain, incidence of postoperative chronic pain, cumulative opioid use, persistent opioid use, lengths of stay, and adverse events. The clinical significance of the summary estimates was assessed based on established thresholds for minimally important differences. Results In total, 281 trials (N = 24,682 participants) were included in this meta-analysis. Compared with controls, gabapentinoids were associated with a lower postoperative pain intensity (100-point scale) at 6 h (mean difference, −10; 95% CI, −12 to −9), 12 h (mean difference, −9; 95% CI, −10 to −7), 24 h (mean difference, −7; 95% CI, −8 to −6), and 48 h (mean difference, −3; 95% CI, −5 to −1). This effect was not clinically significant ranging below the minimally important difference (10 points out of 100) for each time point. These results were consistent regardless of the type of drug (gabapentin or pregabalin). No effect was observed on pain intensity at 72 h, subacute and chronic pain. The use of gabapentinoids was associated with a lower risk of postoperative nausea and vomiting but with more dizziness and visual disturbance. Conclusions No clinically significant analgesic effect for the perioperative use of gabapentinoids was observed. There was also no effect on the prevention of postoperative chronic pain and a greater risk of adverse events. These results do not support the routine use of pregabalin or gabapentin for the management of postoperative pain in adult patients. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Paravertebral Block Versus Preemptive Ketamine Effect on Pain Intensity after Posterolateral Thoracotomies: A Randomized Controlled Trial

Journal of Clinical Medicine ◽

10.3390/jcm9030793 ◽

2020 ◽

Vol 9 (3) ◽

pp. 793

Author(s):

Michał Borys ◽

Agata Hanych ◽

Mirosław Czuczwar

Keyword(s):

Chronic Pain ◽

Randomized Controlled Trial ◽

Postoperative Pain ◽

Pain Intensity ◽

Acute Pain ◽

Controlled Trial ◽

Pain Syndrome ◽

Paravertebral Block ◽

Posterolateral Thoracotomy ◽

Randomized Controlled

Severe postoperative pain affects most patients after thoracotomy and is a risk factor for post-thoracotomy pain syndrome (PTPS). This randomized controlled trial compared preemptively administered ketamine versus continuous paravertebral block (PVB) versus control in patients undergoing posterolateral thoracotomy. The primary outcome was acute pain intensity on the visual analog scale (VAS) on the first postoperative day. Secondary outcomes included morphine consumption, patient satisfaction, and PTPS assessment with Neuropathic Pain Syndrome Inventory (NPSI). Acute pain intensity was significantly lower with PVB compared to other groups at four out of six time points. Patients in the PVB group used significantly less morphine via a patient-controlled analgesia pump than participants in other groups. Moreover, patients were more satisfied with postoperative pain management after PVB. PVB, but not ketamine, decreased PTPS intensity at 1, 3, and 6 months after posterolateral thoracotomy. Acute pain intensity at hour 8 and PTPS intensity at month 3 correlated positively with PTPS at month 6. Bodyweight was negatively associated with chronic pain at month 6. Thus, PVB but not preemptively administered ketamine decreases both acute and chronic pain intensity following posterolateral thoracotomies.

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Paravertebral Block Versus Preemptive Ketamine Effect on Pain Intensity after Posterolateral Thoracotomies: A Randomized Controlled Trial

10.20944/preprints202002.0093.v1 ◽

2020 ◽

Author(s):

Michał Borys ◽

Agata Hanych ◽

Mirosław Czuczwar

Keyword(s):

Chronic Pain ◽

Randomized Controlled Trial ◽

Postoperative Pain ◽

Pain Intensity ◽

Acute Pain ◽

Controlled Trial ◽

Pain Syndrome ◽

Paravertebral Block ◽

Posterolateral Thoracotomy ◽

Randomized Controlled

Severe postoperative pain affects most patients after thoracotomy and is a risk factor for post-thoracotomy pain syndrome (PTPS). This randomized controlled trial compared preemptively administered ketamine versus paravertebral block (PVB) versus control in patients undergoing posterolateral thoracotomy. The primary outcome was acute pain intensity on the visual analog scale (VAS) on the first postoperative day. Secondary outcomes included morphine consumption, patient satisfaction, and PTPS assessment with Neuropathic Pain Syndrome Inventory (NPSI). Acute pain intensity was significantly lower with PVB compared to other groups at four out of six time points. Patients in the PVB group used significantly less morphine via a patient-controlled analgesia pump than participants in other groups. Moreover, patients were more satisfied with postoperative pain management after PVB. PVB, but not ketamine, decreased PTPS intensity at 1, 3, and 6 months after posterolateral thoracotomy. Acute pain intensity at hour 8 and PTPS intensity at month 3 correlated positively with PTPS at month 6. Bodyweight was negatively associated with chronic pain at month 6. Thus, PVB but not preemptively administered ketamine decreases both acute and chronic pain intensity following posterolateral thoracotomies. The trial was prospectively registered at the Australian New Zealand Clinical Trial Registry (https://www.anzctr.org.au/; ACTRN12616000900415; 07 July 2016).

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Pain therapy to reduce perioperative complications

Innovative Surgical Sciences ◽

10.1515/iss-2019-0008 ◽

2019 ◽

Vol 4 (4) ◽

pp. 158-166

Author(s):

Stephan M. Freys ◽

Esther Pogatzki-Zahn

Keyword(s):

Postoperative Pain ◽

Postoperative Complications ◽

Adverse Events ◽

Acute Pain ◽

Surgical Procedure ◽

Pain Therapy ◽

Recovery Period ◽

Acute Pain Therapy

AbstractThe incidence rates of adverse events secondary to any operation are a well-known problem in any surgical field. One outstanding example of such adverse events is postoperative pain. Thus, the incidence of acute postoperative pain following any surgical procedure and its treatment are central issues for every surgeon. In the times of Enhanced Recovery After Surgery (ERAS) programs, acute pain therapy became an increasingly well investigated and accepted aspect in almost all surgical subspecialties. However, if it comes to the reduction of postoperative complications, in the actual context of postoperative pain, surgeons tend to focus on the operative process rather than on the perioperative procedures. Undoubtedly, postoperative pain became an important factor with regard to the quality of surgical care: both, the extent and the quality of the surgical procedure and the extent and the quality of the analgesic technique are decisive issues for a successful pain management. There is growing evidence that supports the role of acute pain therapy in reducing postoperative morbidity, and it has been demonstrated that high pain scores postoperatively may contribute to a complicated postoperative course. This overview comprises the current knowledge on the role of acute pain therapy with regard to the occurrence of postoperative complications. Most of the knowledge is derived from studies that primarily focus on the type and quality of postoperative pain therapy in relation to specific surgical procedures and only secondary on complications. As far as existent, data that report on the recovery period after surgery, on the rehabilitation status, on perioperative morbidity, on the development of chronic pain after surgery, and on possible solutions of the latter problem with the institution of transitional pain services will be presented.

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Analgesic Effect of Dexamethasone after Arthroscopic Knee Surgery: A Randomized Controlled Trial

Pain Research and Management ◽

10.1155/2016/4216469 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6

Author(s):

Jairo Moyano ◽

Maria García ◽

Maria Caicedo

Keyword(s):

Postoperative Pain ◽

Pain Intensity ◽

Knee Surgery ◽

Controlled Study ◽

Opioid Use ◽

Arthroscopic Knee Surgery ◽

Randomized Controlled ◽

Significant Difference ◽

Intraoperative Period ◽

Arthroscopic Knee

Background.Dexamethasone is sometimes used as a coanalgesic because of its anti-inflammatory properties.Objective. To evaluate opioid use, postoperative pain intensity, and side effects after a single dose of dexamethasone in patients undergoing arthroscopic knee surgery.Methods. In this randomized controlled study patients were randomized to receive either 10 mg of intravenous dexamethasone (DM group) or 0.9% normal saline (NS group) during the intraoperative period. Primary outcomes were pain intensity and total morphine and codeine use after surgery.Results. Seventy-eight patients were included in the study. The DM group showed statistically significant higher pain intensity at the fourth postoperative hour (DM: 3.96/10, standard deviation [SD] 0.54; NS: 2.46/10, SD 0.45;p=0.036). No statistically significant difference in total opioid use (morphine plus codeine) was identified with 15.9 (SD 1.97) codeine tablets used in DM group and 20 (SD 2.14) in NS group (p=0.25).Discussion. Pain intensity tended to decrease in both groups suggesting morphine as the main source of analgesia.Conclusions. Intravenous dexamethasone during the intraoperative period has no clinical impact on postoperative pain intensity during the first 48 h after arthroscopic knee surgery. This trial is registered withR000020892.

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Impact of Perioperative Pain Intensity, Pain Qualities, and Opioid Use on Chronic Pain After Surgery

Regional Anesthesia and Pain Medicine ◽

10.1097/aap.0b013e318237516e ◽

2012 ◽

Vol 37 (1) ◽

pp. 19-27 ◽

Cited By ~ 82

Author(s):

Elizabeth G. VanDenKerkhof ◽

Wilma M. Hopman ◽

David H. Goldstein ◽

Rosemary A. Wilson ◽

Tanveer E. Towheed ◽

...

Keyword(s):

Chronic Pain ◽

Pain Intensity ◽

Opioid Use ◽

Perioperative Pain

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Pain intensity as a moderator of the association between opioid use and insomnia symptoms among adults with chronic pain

Sleep Medicine ◽

10.1016/j.sleep.2018.08.015 ◽

2018 ◽

Vol 52 ◽

pp. 98-102 ◽

Cited By ~ 4

Author(s):

Mary Beth Miller ◽

Wai Sze Chan ◽

Ashley F. Curtis ◽

Jeff Boissoneault ◽

Michael Robinson ◽

...

Keyword(s):

Chronic Pain ◽

Pain Intensity ◽

Opioid Use ◽

Insomnia Symptoms

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Postoperative Pain, Adverse Events (Associated with Acute Pain Management)

Encyclopedia of Pain ◽

10.1007/978-3-642-28753-4_3427 ◽

2013 ◽

pp. 2982-2985

Author(s):

Stephan A. Schug

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Adverse Events ◽

Acute Pain ◽

Acute Pain Management

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The changing face of acute pain services

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2017.04.072 ◽

2017 ◽

Vol 16 (1) ◽

pp. 204-210 ◽

Cited By ~ 2

Author(s):

Adriana Miclescu ◽

Stephen Butler ◽

Rolf Karlsten

Keyword(s):

Chronic Pain ◽

Pain Intensity ◽

Acute Pain ◽

Severe Pain ◽

Care Hospital ◽

Opioid Dependency ◽

Number Of Patients ◽

History Of ◽

Number Of Visits ◽

Pain Services

AbstractBackground and AimsAcute Pain Services have been implemented initially to treat inadequate postoperative pain. This study was undertaken to prospectively review the current challenges of the APS team in an academic hospital assessing the effects of its activity on both surgical and medical pain intensity. It also define the characteristics of the patients and the risk factors influencing the multiple visits from the APS team.MethodThis prospective cohort study was conducted at Uppsala University Hospital (a Swedish tertiary and quaternary care hospital) during one year. All the patients referred to the APS team were enrolled. A standardized data collection template of demographic data, medical history, pain diagnosis, associated diseases, duration of treatment, number of visits by the APS team and type of treatment was employed. The primary outcomes were pain scores before, after treatment and the number of follow-ups. The patients were visited by APS at regular intervals and divided by the number of visits by APS team into several groups: group 1 (one visit and up to 2 follow ups); group 2 (3 to 4 follow-ups); group 3 (5 to 9 follow-ups); group 4 (10 to 19 follow-ups); group 5 (>20 followups). The difference between groups were analyzed with ordinal logistic regression analyses.ResultsPatients (n = 730) (mean age 56±4, female 58%, men 42%) were distributed by service to medical (41%) and surgical (58%). Of these, 48% of patients reported a pain score of moderate to severe pain and 27% reported severe pain on the first assessment. On the last examination before discharge, they reported 25–30% less pain (P = 0.002). The median NRS (numerical rating scores) decreased significantly from 9.6 (95% confidence interval, 8.7–9.9) to 6.3 (6.1–7.4) for the severe pain (P < 0.0001), from 3.8 (3.2–4.3) to 2.4 (1.8–2.9) for the moderate pain. The odds ratio for frequent follow-ups of the patients between 18 and 85 years (n = 609) was 2.33 (95% CI: 1.35–4.02) if the patient had a history of chronic neuropathic pain, 1.80(1.25–2.60) in case the patient had a history of chronic nociceptive pain, 2.06(1.30–3.26) if he had mental diseases, and 3.35(2.21–5.08) if he had opioid dependency at the time of consultation from APS. Strong predictors of frequent visits included female gender (P = 0.04).ConclusionsBeside the benefits of APS in reducing pain intensity, this study demonstrates that the focus of APS has been shifted from the traditional treatment of acute surgical pain to the clinical challenges of treating hospitalized patients with a high comorbidity of psychiatric diseases, opioid dependency and chronic pain.ImplicationsThe concept of an APS will ultimately be redefined according to the new clinical variables. In the light of the increasing number of patients with complex pain states and chronic pain, opioid dependency and psychiatric comorbidities it is mandatory that the interdisciplinary APS team should include other specialties besides the “classical interdisciplinary APS team”, as psychiatry, psychology, rehabilitation and physiotherapy with experience in treating chronic pain patients.

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