scholarly journals Pain and Opioid Consumption and Mobilization after Surgery: Post Hoc Analysis of Two Randomized Trials

2021 ◽  
Author(s):  
Eva Rivas ◽  
Barak Cohen ◽  
Xuan Pu ◽  
Li Xiang ◽  
Wael Saasouh ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Enhanced Recovery ◽  
Early Mobilization ◽  
Opioid Consumption ◽  
Pain Scores ◽  
Unit Increase ◽  
Average Pain ◽  
Lower Pain ◽  
Average Pain Score ◽  
Recovery Pathways

Background Early mobilization is incorporated into many enhanced recovery pathways. Inadequate analgesia or excessive opioids may restrict postoperative mobilization. The authors tested the hypotheses that in adults recovering from abdominal surgery, postoperative pain and opioid consumption are inversely related to postoperative mobilization, and that postoperative mobilization is associated with fewer potentially related complications. Methods The authors conducted a subanalysis of two trials that enrolled adults recovering from abdominal surgery. Posture and movement were continuously monitored for 48 postoperative hours using noninvasive untethered monitors. Mobilization was defined as the fraction of monitored time spent sitting or standing. Results A total of 673 patients spent a median [interquartile range] of 7% [3 to 13%] of monitored time sitting or standing. Mobilization time was 1.9 [1.0 to 3.6] h/day for patients with average pain scores 3 or lower, but only 1.2 [0.5 to 2.6] h/day in those with average scores 6 or greater. Each unit increase in average pain score was associated with a decrease in mobilization time of 0.12 (97.5% CI, 0.02 to 0.24; P = 0.009) h/day. In contrast, there was no association between postoperative opioid consumption and mobilization time. The incidence of the composite of postoperative complications was 6.0% (10 of 168) in the lower mobilization quartile, 4.2% (7 of 168) in the second quartile, and 0% among 337 patients in the highest two quartiles (P = 0.009). Conclusions Patients recovering from abdominal surgery spent only 7% of their time mobilized, which is considerably less than recommended. Lower pain scores are associated with increased mobility, independently of opioid consumption. Complications were more common in patients who mobilized poorly. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

scholarly journals EFFICACY OF QUADRATUS LUMBORUM BLOCKS IN ROBOTIC NEPHRECTOMY- A RETROSPECTIVE REVIEW.

2021 ◽  
Author(s):  
Poonam Pai B.H ◽  
Yan H. Lai ◽  
Abimbola Onayemi ◽  
Hung-Mo Lin
Keyword(s):  
Enhanced Recovery ◽  
Opioid Consumption ◽  
Laparoscopic Nephrectomy ◽  
Control Group ◽  
Pain Scores ◽  
Quadratus Lumborum Block ◽  
Quadratus Lumborum ◽  
Significant Difference ◽  
Enhanced Recovery Pathways ◽  
Recovery Pathways

Abstract Abstract: With the implementation of enhanced recovery pathways (ERAS) in kidney surgeries, regional techniques are being considered an important aspect of multimodal analgesia. Abdominal blocks such as quadratus lumborum block (QLB) have been used as an effective analgesic in abdominal surgeries, however their efficacy in kidney surgery remains unknown. To our best knowledge, there are no clinical studies exploring the relationship between QLBs and post-operative opioid consumption in robotic laparoscopic nephrectomy. Study Objectives: Assess analgesic efficacy between QLB and post-operative opioid consumption in robotic laparoscopic nephrectomy. Design and Setting: A retrospective chart review was conducted by querying the electronic medical record system of 2,200 bed tertiary academic hospital center in New York City. Outcomes: The primary measured outcome was postoperative morphine milli equivalent (MME) consumption for the first 24 hours. Secondary outcomes include intra-operative MME, as well as postoperative pain scores measured on a visual analogue scale (VAS) scale at 2, 6, 12, 18, and 24 hours post-operatively. Results: The mean total post-operative MME in the pQLB group was 11 [4, 18] and 15 [5.6, 28] in the control group (p =.001). There was a significant reduction in intra-operative MME in the QLB group in comparison to the control group. This reduction was not seen in post-operative MME. There was no significant difference in pain scores at any of the measured time points up to 24 hours post-operatively. Conclusion: Our study provides compelling support that ultrasound guided QLB significantly decreased intra operative opioid requirements but did not have the same effect on postoperative opioid requirements following robotic kidney surgeries in the context of an ERAS pathway. Keywords: Kidney surgeries, Robotic laparoscopic nephrectomy, quadratus lumborum block (QLB), enhanced recovery pathways (ERAS)

A Retrospective Analysis of Gabapentinoid and Opioids to Opioid Monotherapy for Pain Relief in Patients with Chronic Neck and Low Back Pain

Pain Medicine ◽  
2021 ◽  
Author(s):  
Nebojsa Nick Knezevic ◽  
Tabish Aijaz ◽  
Alvaro Ortega-Camacho ◽  
Kenneth D Candido
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pain Score ◽  
Spinal Pain ◽  
Opioid Consumption ◽  
Low Back ◽  
Pain Scores ◽  
Average Pain ◽  
Average Pain Score ◽  
Chronic Spinal Pain

Abstract Objective We compared the reduction in pain and opioid consumption in patients with chronic spinal pain on concomitant gabapentinoids and opioids with patients using opioids only. Design This was a retrospective chart review of patients with chronic neck or low back pain who were on opioids with at least 24-month follow-up. Setting Single-center pain clinic in an urban setting. Subjects 167 patients with chronic spinal pain lasting at least 6 months. Method Patients on gabapentin or pregabalin were included in the gabapentinoid group, while the other patients were included in the non-gabapentinoid group. Primary outcome was assessment of pain scores measured via a numeric rating scale (NRS), and secondary outcomes were response to the treatment (>2 point reduction on NRS) and daily opioid use measured in morphine milliequivalents. Results Pain scores were reduced in the first 6 months and plateaued after that in both groups. At the end of 24 months, the average pain score was 6.71 in the gabapentinoid group, while the average pain score was 7.18 in the non-gabapentinoid group. There was no statistical significance between the groups (p = 0.28). There was no difference in response to treatment in gabapentinoid group (33.3%) when compared to non-gabapentinoid group (32.7%). We also failed to find any significant difference in daily opioid usage between the two groups. Conclusion: Gabapentinoids may not lead to reduction in pain or opioid consumption in patients with chronic spinal pain. A careful approach must be adopted while prescribing gabapentinoids in the chronic spinal pain patient population.

scholarly journals The effectiveness of red ginger extract to decreasemenstrual pain level in adolescent at Al Husna 2 Islamic Boarding School Kediri year 2016

2019 ◽  
Vol 1 (2) ◽  
Author(s):  
Rochmanita Sandya Afindaningrum ◽  
Rahma Kusuma Dewi
Keyword(s):  
Pain Score ◽  
Boarding School ◽  
Wilcoxon Test ◽  
Distribution Data ◽  
P Value ◽  
Menstrual Pain ◽  
Pain Scores ◽  
Average Pain ◽  
Average Pain Score ◽  
Red Ginger

Dismenorea is menstrual problems that is oftenexperienced adolescent and is caused by the occurence of uterine contractions due to increased prostaglandin. The content of gingerol in ginger red can overcome dysmenorrhoea by blocking prostaglandin. The purpose of this study was to know the effect of red ginger drink to the decline in the level of menstrual pain (in adolescent at Boarding school Al Husna 2 Kediri. Pre-experimental research design used by the approach of one group pretest posttest design. The population of this study was all students who experience dismenorea. Sample of adolescents who experience dismenoreawere 17 people with accidental sampling. The average pain score before treatment was 2.53, after treatment average pain score was 1, 59 based on the description, it shows that there was a decrease in pain scores of 0.94 or 37.1%. Normality test is known that the distribution of data in pain scores before being treated distribution is not normal with a p-value of <0.05 while after treated with distribution data is not normal P <0.05, making the results statistically using the Wilcoxon test showed the value of P = 0.000 (p <α = 0,05). There is an influence of red ginger drink to the decline in the level of menstrual pain (dysmenorrhoea) in adolescent at Boarding school Al Husna 2 Kediri. Respondents are advised to drink red ginger when dysmenorrhoea.

Benefits of Enhanced Recovery After Surgery in Patients Undergoing Endoscopic Sinus Surgery

2019 ◽  
Vol 34 (2) ◽  
pp. 280-289 ◽  
Author(s):  
Yunbo Gao ◽  
Chengshuo Wang ◽  
Guyan Wang ◽  
Xu Cui ◽  
Guang Yang ◽  
...  
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Adverse Reactions ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Sinus Surgery ◽  
Self Rating ◽  
Pain Scores ◽  
Lower Pain ◽  
Traditional Care ◽  
Eras Protocol

Background Although enhanced recovery after surgery (ERAS) protocols have been widely applied during perioperative periods for different diseases, there are few reports of ERAS in patients undergoing endoscopic sinus surgery (ESS). This study therefore aimed to evaluate the benefits of ERAS protocol compared to traditional care following ESS. Methods A total of 55 patients with chronic rhinosinusitis undergoing ESS were prospectively assigned to 1 of 5 treatment groups; ERAS groups with postoperative intravenous Flubiprofen Axetil or analgesia pump, traditional care with Flubiprofen Axetil or analgesia pump (NERAS groups), or traditional care without postoperative intravenous analgesia group (control). All patients completed the Kolcaba General Comfort Questionnaire, Medical Outcomes Study Sleep Scale, and Self-rating Anxiety Scale at admission and before discharge. Pain scores were recorded at 2, 6, 24, and 48 hours postsurgery and adverse reactions to analgesics were noted. Results Patients in ERAS group demonstrated significantly higher general comfort scores and lower self-rating anxiety scores compared to patients in NERAS and control groups. Compared to control patients, patients in ERAS group reported significantly lower pain scores at 6, 24, and 48 hours. Moreover, pain alleviated from 6 hours postsurgery in ERAS group compared to 48 hours in NERAS group. Patients using opioids experienced more adverse nausea events than patients using only nonsteroidal anti-inflammatory drugs (NSAIDs). Conclusions The use of patient-tailored ERAS programs following ESS may help to attain higher general comfort and to alleviate perioperative anxiety compared with traditional perioperative care. Adequate postoperative analgesia with NSAIDs in ERAS protocol may alleviate pain earlier with fewer adverse reactions.

Time Series Analysis of the Pain Diary Data Obtained during the Multicenter Study for Hydroxyurea (MSH) Clinical Trial.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 3807-3807 ◽  
Author(s):  
William F. McCarthy ◽  
Robert L. Bauserman ◽  
Bruce A. Barton ◽  
Nan Guo ◽  
Samir K. Ballas ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Time Series ◽  
Pain Score ◽  
Multicenter Study ◽  
Pain Diary ◽  
Diary Data ◽  
Pain Scores ◽  
Average Pain ◽  
Average Pain Score ◽  
Daily Pain

Abstract The Multicenter Study of Hydroxyurea in Sickle Cell Anemia (MSH) was a randomized double-blind placebo-controlled trial to test whether hydroxyurea could reduce the rate of painful crises in adult patients who had at least three painful crises per year. Daily pain diaries were collected biweekly for 299 MSH patients. Patients rated daily pain on a linear scale 0 through 9. The daily pain data was collected to provide useful information regarding the efficacy of hydroxyurea in reducing the rate of painful crises. The objective of this analysis was to determine if there was an underlying time series pattern associated with the MSH pain diary data, especially one indicative of a calendar or seasonal association. An Unobserved Component Model (UCM) was used to determine, based on empirical data, if there was a cycle and/or trend associated with the time series. The times series started on December 1991 and ended on December 1994. The series was equally spaced and univariate. The equal spacing was a monthly interval. The average pain score for each two- week diary period was used to create each unit of analysis. This analysis considered three groupings of patients: all patients, hydroxyurea patients and placebo patients. The results of the modeling indicated that there was indeed both a cycle and a trend associated with the MSH pain diary data. This is the case for each group of patients considered. All three groups had a cycle pattern that seemed to show a seasonal behavior of average pain scores (the changing of the season seemed to show an approximate transition from trough (Spring) to peak (Fall/Winter) and peak to trough). There was a downward trend in average pain scores for both the all patientsgroup and the hydroxyurea patientsgroup. However, there was an upward trend in average pain score for the placebo patientsgroup. This may reflect the result shown in the MSH Clinical Trial, that HU usage reduced the average pain scores reported by patients.

Survivor pain: Experience at an oncology palliative care clinic.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 260-260
Author(s):  
Cristian Zanartu ◽  
Lisa Emond ◽  
Ann Wojtaszczyk
Keyword(s):  
Palliative Care ◽  
Cancer Survivors ◽  
Risk Mitigation ◽  
Opioid Analgesics ◽  
The United States ◽  
Care Clinic ◽  
Pain Scores ◽  
Average Pain ◽  
Average Pain Score ◽  
Opioid Medications

260 Background: As of January 2014 there are an estimated 14.5 million cancer survivors in the United States. In observational studies of cancer survivors up to 40% report chronic pain. Opioids remain an important and effective treatment for active cancer pain. For survivors, however, we must take into account the paucity of data supporting long term benefits of opioids on pain and functional outcomes, and extensive evidence of potential harms. We present data from our palliative care clinic where we have established a nuanced approach to pain management in this population, which includes risk mitigation, consistent education, emphasis on non-pharmacological and non-opiate medications, and attempts to down-taper opioid analgesics when feasible. Methods: Retrospective, observational chart review of 62 patients identified as cancer survivors, who have been managed for pain, at an academically affiliated palliative care clinic embedded in the oncology department. Demographic information, baseline and latest visit pain scores and functional assessments, as well as pain regimen data were collected. Means for pain and functionality scores were compared for those patient’s with differing opioid regimens and nonpharmacological treatments. Results: Of the 62 patients reviewed, 48 were tapered off opioid medication. In the patients who were tapered off opioid medications, 8 (16%) showed an increase in average pain scores, 11 (22%) showed no change in average pain scores, and 29 (60%) showed improvement in average pain score. Conclusions: In 82% of the patients whose opioid medications were decreased, average pain scores either remained the same or actually improved over time. This is encouraging data to support the theory that decreasing opioids in cancer survivors does not worsen pain control in the majority of that population.

scholarly journals Programmed Intermittent Epidural Bolus versus Continuous Epidural Infusion in Major Upper Abdominal Surgery: A Retrospective Comparative Study

2021 ◽  
Vol 10 (22) ◽  
pp. 5382
Author(s):  
Yeon-Ju Kim ◽  
Do-Kyeong Lee ◽  
Hyun-Jung Kwon ◽  
Hye-Mee Kwon ◽  
Jong-Hyuk Lee ◽  
...  
Keyword(s):  
Adverse Events ◽  
Abdominal Surgery ◽  
Local Anesthetic ◽  
Opioid Consumption ◽  
Epidural Infusion ◽  
Continuous Epidural Infusion ◽  
Pain Scores ◽  
Upper Abdominal Surgery ◽  
Significant Difference ◽  
Upper Abdominal

Although recent evidence shows that the programmed intermittent epidural bolus can provide improved analgesia compared to continuous epidural infusion during labor, its usefulness in major upper abdominal surgery remains unclear. We evaluated the effect of programmed intermittent epidural bolus versus continuous epidural infusion on the consumption of postoperative rescue opioids, pain intensity, and consumption of local anesthetic by retrospective analysis of data of patients who underwent major upper abdominal surgery under ultrasound-assisted thoracic epidural analgesia between July 2018 and October 2020. The primary outcome was total opioid consumption up to 72 h after surgery. The data of postoperative pain scores, epidural local anesthetic consumption, and adverse events from 193 patients were analyzed (continuous epidural infusion: n = 124, programmed intermittent epidural bolus: n = 69). There was no significant difference in the rescue opioid consumption in the 72-h postoperative period between the groups (33.3 mg [20.0–43.3] vs. 28.3 mg [18.3–43.3], p = 0.375). There were also no significant differences in the pain scores, epidural local anesthetic consumption, and incidence of adverse events. Our findings suggest that the quality of postoperative analgesia and safety following major upper abdominal surgery were comparable between the groups. However, the use of programmed intermittent epidural bolus requires further evaluation.

Opioid Requirements in Laparoscopic Colectomies: Do Enhanced Recovery After Surgery Protocols Make a Difference?

2020 ◽  
pp. 000313482095631
Author(s):  
Samer Kawak ◽  
Joanna F. Wasvary ◽  
Matthew A. Ziegler
Keyword(s):  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Tertiary Care ◽  
Patient Characteristics ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Care Hospital ◽  
Pain Scores ◽  
Enhanced Recovery Pathways ◽  
Recovery Pathways

Background With the growing opioid epidemic and recent focus on the quantity of opioids prescribed at discharge after surgery, enhanced recovery pathways provide another tool to counteract this epidemic. The aim of this current study is to analyze the differences in opioid requirements and pain scores in the immediate postoperative period for patients who underwent laparoscopic colectomies before and after the implementation of enhanced recovery after surgery (ERAS) protocols. Materials and Methods This study is a retrospective review of patients and was conducted at an academically affiliated tertiary care hospital. In patients undergoing elective laparoscopic colectomies before December 1, 2013-July 31, 2015 and after September 1, 2015-May 31, 2018, the implementation of enhanced recovery pathways was included. The primary end point was opioid consumption from the end of surgery until 48 hours after surgery. Secondary end points included pain scores, surgery length of time, and hospital length of stay after surgery. Results A total of 242 patients (122 pre- and 120 postimplementation) were analyzed. Patient characteristics were similar between groups. Pain scores were higher in the preimplementation patients for postoperative day (POD) 0 scores ( P = .019). There was a decrease in the morphine milligram equivalents (MME) on POD 0-2 for the postimplementation patients. This decrease resulted in a 61% reduction in opioid requirements after implementation of ERAS protocols (32 vs. 12.5 MME, P < .0001). Discussion Enhanced recovery after surgery protocols can reduce opioid requirements after elective laparoscopic colectomies without negatively affecting pain scores.

scholarly journals The Efficacy of Adding a Continuous Intravenous Morphine Infusion to Patient-Controlled Analgesia (PCA) in Abdominal Surgery

1995 ◽  
Vol 23 (4) ◽  
pp. 453-458 ◽  
Author(s):  
P. J. Dawson ◽  
F. C. Libreri ◽  
D. J. Jones ◽  
G. Libreri ◽  
A. R. Bjorkstein ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Continuous Infusion ◽  
Delivery Ratio ◽  
Double Blind ◽  
Morphine Infusion ◽  
Pain Scores ◽  
Significant Difference ◽  
Intravenous Morphine ◽  
Lower Pain ◽  
Intravenous Analgesia

The effect of adding a continuous infusion of morphine 1 mg/hr to patient-controlled intravenous analgesia was studied in a randomized double-blind trial. Ninety-six patients scheduled for abdominal surgery were enrolled; 38 received PCA and continuous infusion (PCA + C), 45 received PCA alone and 13 were excluded because of protocol violations. PCA was delivered via an ABBOTT 4200 pump with settings of morphine 1 mg bolus and five-minute lockout in both groups. A separate pump delivered a continuous infusion of morphine 1 mg/ml (PCA + C) or 9% normal saline (PCA) at 1 ml/hr for three postoperative days. Pain was assessed by hourly verbal pain scores (VPS) and daily visual analog pain scores at rest and on movement (VASrest, VASmove). PCA delivered morphine and the demand to delivery ratio (D/D ratio) were used as indirect indicators of pain. These were assessed during daytime (0800–2200 hours), sleep (2200–0500 hours) and on first waking (0500–0800 hours). Patient demographics were similar. Patients receiving a continuous infusion had lower pain scores during the first 24 hours but not thereafter (VPS P=0.04, VASmove P=0.02). The PCA group delivered more PCA morphine during 0500–0800 hours and 0800–2200 hours on the first day only. There was no significant difference in the D/D ratio for any time period during the three days. Total morphine delivery was greater in the PCA + C group on the second and third postoperative days (P= 0.009 and P=0.0001 respectively). The incidence of respiratory depression and the total number of complications were significantly higher in those receiving continuous infusion (P=0.04 and P=0.011 respectively.) Adding a continuous morphine infusion of 1 mg/hr to the described PCA settings for three days following abdominal surgery improved analgesia during the first 24 hours but was associated with a greater incidence of complications.

Evaluation of a novel chemokine receptor 2 (CCR2)-antagonist in painful diabetic polyneuropathy

2013 ◽  
Vol 4 (2) ◽  
pp. 77-83 ◽  
Author(s):  
Jarkko Kalliomäki ◽  
Bror Jonzon ◽  
Karin Huizar ◽  
Michael O’Malley ◽  
Anita Andersson ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Pain Score ◽  
Chemokine Receptor ◽  
Plasma Levels ◽  
Analgesic Efficacy ◽  
Treatment Groups ◽  
Pain Scores ◽  
Average Pain ◽  
Average Pain Score ◽  
Ccr2 Antagonist

AbstractBackground and aimsPreclinical data suggest that the chemokine receptor 2 (CCR2) is involved in the pathophysiology of neuropathic pain through modulation of neuronal excitability, synaptic transmission and activation of spinal cord microglia. CCR2-antagonists have shown to be effective in preclinical models of neuropathic pain. The aim of this study was to evaluate the analgesic efficacy, safety and tolerability of a novel CCR2-antagonist, AZD2423, in patients with painful diabetic neuropathy (PDN).MethodsThis was a double-blind, randomized, parallel-group, multi-center study in patients with symmetric distal sensory polyneuropathy due to type 1 or 2 diabetes and duration of neuropathic pain between 3 months and 5 years. Concomitant treatment with neuropathic pain medications (e.g. anticonvulsants, tricyclic antidepressants, serotonin-noradrenaline uptake inhibitors, opioids, topical lidocaine or capsaicin) was not allowed. 134 patients with PDN were equally randomized to 28 days oral administration of 20 mg AZD2423,150 mg AZD2423, or placebo. The primary efficacy variable was the change of average pain score from 5-days baseline to the last 5 days of treatment, measured with numerical rating scale (NRS, 0–10). The secondary efficacy measures included NRS worst pain scores, patient global impression of change, pain interference on sleep and activity, and neuropathic pain symptom inventory (NPSI).ResultsThe change of NRS average pain score was not significantly different between treatment groups (AZD2423 20mg: –1.50; AZD2423 150 mg: –1.35; placebo: –1.61). The NPSI total score and three out of five subscores (evoked pain, pressing/deep pain and paresthesia/dysesthesia) tended to be reduced more by AZD2423 150 mg than by placebo. No other secondary efficacy variables differed between treatment groups. The frequency and type of adverse events for AZD2423 were similar to placebo. The achieved plasma levels of AZD2423 in the two dose groups were in line with predictions from pharmacokinetic data previously obtained in healthy volunteers. Dose-dependent increase of plasma levels of the ligand of CCR2 (CCL2; chemokine ligand 2) and decrease of the mean levels of monocytes (–27% by AZD2423 150 mg) suggested that the administrated doses of AZD2423 interacted with the CCR2 target.ConclusionThe CCR2-antagonist AZD2423 showed no analgesic efficacy in PDN based on NRS average pain scores and global and functional pain outcome measures. The NPSI data suggested possible effects on certain sensory components of pain. There were no major safety or tolerability concerns.ImplicationsTreatment with a CCR2-antagonist does not have a clinically important analgesic effect in an overall PDN population.

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