scholarly journals Survey Criteria for Fibromyalgia Independently Predict Increased Postoperative Opioid Consumption after Lower-extremity Joint Arthroplasty

2013 ◽  
Vol 119 (6) ◽  
pp. 1434-1443 ◽  
Author(s):  
Chad M. Brummett ◽  
Allison M. Janda ◽  
Christa M. Schueller ◽  
Alex Tsodikov ◽  
Michelle Morris ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Lower Extremity ◽  
Pain Control ◽  
Joint Arthroplasty ◽  
Opioid Consumption ◽  
Self Report ◽  
Pain Severity ◽  
Anesthetic Technique ◽  
Opioid Use ◽  
Postoperative Pain Control

Abstract Background: Variance in pain after total knee and hip arthroplasty may be due to a number of procedural and peripheral factors but also, in some individuals, to aberrant central pain processing as is described in conditions like fibromyalgia. To test this hypothesis, the authors conducted a prospective, observational cohort study of patients undergoing lower-extremity joint arthroplasty. Methods: Five hundred nineteen patients were preoperatively phenotyped using validated self-reported pain questionnaires, psychological measures, and health information. In addition to being assessed for factors previously found to be associated with poor outcomes in arthroplasty, participants also completed the American College of Rheumatology survey criteria for fibromyalgia. Previous studies have suggested that rather than being “present” or “absent,” features of fibromyalgia as measured by this instrument, occur over a wide continuum. Postoperative pain control was assessed by total postoperative opioid consumption. Results: Preoperatively, patients with higher fibromyalgia survey scores were younger, more likely to be female, taking more opioids, reported higher pain severity, and had a more negative psychological profile. In the multivariate analysis, the fibromyalgia survey score, younger age, preoperative opioid use, knee (vs. hip), pain severity at baseline, and the anesthetic technique were all predictive of increased postoperative opioid consumption. Conclusions: The use of the survey criteria for fibromyalgia led to the finding of distinct phenotypic differences, and the measure was independently predictive of opioid consumption. This self-report measure may provide an additional simple means of predicting postoperative pain outcomes and analgesic requirements. Future studies are needed to determine whether tailored therapies can improve postoperative pain control in this population.

Liposomal Bupivacaine Versus Immediate-Release Bupivacaine for Postoperative Pain Control

2021 ◽  
pp. 106002802110435
Author(s):  
Atul Dilawri ◽  
Marcia Wyman ◽  
Sneha Shah
Keyword(s):  
Postoperative Pain ◽  
Pain Control ◽  
Tertiary Care ◽  
Immediate Release ◽  
Opioid Consumption ◽  
Surgical Patients ◽  
Matched Cohort ◽  
Postoperative Pain Control ◽  
Liposomal Bupivacaine ◽  
Analgesic Use

Background Liposomal bupivacaine (LB) is increasingly being used for postoperative pain control, but there are conflicting efficacy data when compared with immediate-release bupivacaine (IRB). Objective To evaluate the comparative efficacies of LB and IRB for postoperative pain control in order to assess the formulary status of LB at our institution. Methods A single-center, retrospective, institutional review board–approved, noninferiority matched cohort study at a tertiary care academic medical center. Adult surgical patients admitted for >24 hours who received LB or IRB were included. The primary outcome was total opioid consumption within 24 hours postoperatively. Secondary outcomes included total opioid consumption within 72 hours postoperatively, nonopioid analgesic use within 24 and 72 hours postoperatively, time to rescue analgesic use, and postoperative length of stay (LOS). Results A total of 326 patients were included in the matched cohort. Median 24-hour opioid consumption was significantly lower in the IRB group compared with the LB group (81 mg [30, 153] vs 103 mg [46, 241]; P = 0.01). Patients receiving IRB compared with LB also had a decrease in total opioid consumption 72 hours postoperatively (110 mg [45, 258] vs 165 mg [68, 402]; P = 0.005) and shorter postoperative LOS (2.8 days [1.7, 4] vs 3.3 days [2, 5.1]; P < 0.001). There was no difference in time to rescue analgesic use. Conclusion and Relevance Across a variety of surgical procedures, administration of IRB compared with LB was associated with a reduction in total opioid consumption within 24 and 72 hours postoperatively and shorter LOS in adult surgical patients.

scholarly journals Comparison of Continuous Epidural and Intravenous Analgesia for Postoperative Pain Control in Pediatric Lower Extremity Surgery

2004 ◽  
Vol 45 (5) ◽  
pp. 789 ◽  
Author(s):  
Sun Joon Bai ◽  
Bon Nyeo Koo ◽  
Jong Hoon Kim ◽  
Philip S. Doh ◽  
Ki Hwan Kim ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Lower Extremity ◽  
Pain Control ◽  
Postoperative Pain Control ◽  
Intravenous Analgesia

scholarly journals Perioperative Management of a Patient Taking Suboxone® at the Time of Ambulatory Surgery

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Shawn H. Malan ◽  
Christopher H. Bailey ◽  
Narjeet Khurmi
Keyword(s):  
Postoperative Pain ◽  
Minimally Invasive ◽  
Pain Control ◽  
Perioperative Management ◽  
Ambulatory Surgery ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Postoperative Pain Control ◽  
Recovery Unit ◽  
Postanesthesia Recovery

In 2016, more than 11 million people reported misuse of opioids in the previous year. In an effort to combat opioid use disorder (OUD), the use of agonist/antagonist is becoming increasingly common, with more than 2.2 million patients reporting use of a buprenorphine containing medication such as Suboxone®. Buprenorphine is a unique opioid which acts as a partial μ agonist and ĸ antagonist. These properties make it an effective tool in treating OUD and abuse. However, despite its advantages in treating OUD and abuse, buprenorphine can make it difficult to control acute perioperative pain. We present a case in which the Mayo Clinic Arizona protocol for patients undergoing minimally invasive ambulatory surgery while taking Suboxone® is successfully executed, resulting in adequate postoperative pain control and timely discharge from the postanesthesia recovery unit.

Postoperative Opioid Use in Sinonasal Surgery

2018 ◽  
Vol 160 (3) ◽  
pp. 402-408 ◽  
Author(s):  
Garrett D. Locketz ◽  
Jason D. Brant ◽  
Nithin D. Adappa ◽  
James N. Palmer ◽  
Andrew N. Goldberg ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Control ◽  
Smoking Status ◽  
Opioid Consumption ◽  
Smoking History ◽  
Opioid Use ◽  
Medical Centers ◽  
Academic Medical ◽  
Significant Difference ◽  
Average Pain

Objective To survey patients following sinonasal surgery regarding postoperative pain and opioid use. Study Design Patients were surveyed for 4 days following sinus and/or nasal surgery regarding their pain level and use of prescribed opioids. Setting Four academic medical centers and 1 private practice institution. Subjects Consecutive adult patients undergoing sinonasal surgery. Results A total of 219 subjects met criteria and were included for analysis; 134 patients (61%) took 5 or fewer combination oxycodone (5-mg) and acetaminophen (325-mg) tablets in the first 3 postoperative days, and 196 patients (89.5%) took fewer than 15. Fifty-one patients (23%) consumed no opioid pain medication. Opioid consumption was positively correlated with postoperative pain ( R2 = 0.2, P < .01) but was not correlated with the use of acetaminophen ( R2 = 0.002, P = .48). No significant difference in postoperative pain or opioid consumption was seen with respect to age, sex, specific procedures performed, postoperative steroids, or smoking history. Current smokers reported higher average pain than nonsmokers ( P < .001) and also required more postoperative opioids ( P = .02). Conclusions An evidence-based approach to postoperative pain control following sinonasal surgery that reduces the number of unused and potentially diverted opioids is needed. The current study suggests that 15 combination oxycodone (5-mg) and acetaminophen (325-mg) tablets provide sufficient pain control for 90% of patients in the immediate postoperative period following sinonasal surgery, irrespective of the specific procedures performed, use of acetaminophen, or use of systemic steroids. Smoking status may help surgeons predict which patients will require larger opioid prescriptions.

scholarly journals The effect of ketorolac on posterior thoracolumbar spinal fusions: a prospective double-blinded randomised placebo-controlled trial protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e025855 ◽  
Author(s):  
Chad F Claus ◽  
Evan Lytle ◽  
Doris Tong ◽  
Diana Sigler ◽  
Dominick Lago ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Length Of Stay ◽  
Pain Control ◽  
Average Length ◽  
Controlled Trial ◽  
Opioid Use ◽  
Postoperative Pain Control ◽  
Minimal Effective Dose ◽  
Spinal Fusions ◽  
Double Blinded

IntroductionKetorolac has been shown to provide quality postoperative pain control and decrease opioid requirement with minimal side effects following spinal surgery. However, the literature addressing its use in spinal fusions is highly variable in both its effectiveness and complications, such as pseudarthrosis. Recent literature postulates that ketorolac may not affect fusion rates and large randomised controlled trials are needed to demonstrate ketorolac as a safe and effective adjuvant treatment to opioids for postoperative pain control.Methods and analysisThis is a multihospital, prospective, double-blinded, randomised placebo-controlled trial. Data concerning fusion rates, postoperative opioid use, pain scores, length of stay will be recorded with the aim of demonstrating that the use of ketorolac does not decrease thoracolumbar spinal fusion rates while identifying possible adverse events related to short-term minimal effective dose compared with placebo. Additionally, this investigation aims to demonstrate a decrease in postoperative opioid use demonstrated by a decrease in morphine equivalence while showing equivalent postoperative pain control and decrease the average length of stay.Ethics and disseminationEthical approval was obtained at all participating hospitals by the institutional review board. The results of this study will be submitted for publication in peer-reviewed journals.Trial registration numberNCT03278691.

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