Psychological Characteristics, Female Sex, and Opioid Use Predict Acute Postoperative Pain in Patients Surgically Treated for Thumb Base Osteoarthritis: A Cohort Study

2020 ◽  
Vol 146 (6) ◽  
pp. 1307-1316
Author(s):  
Robbert M. Wouters ◽  
Jarry T. Porsius ◽  
Mark J. W. van der Oest ◽  
Harm P. Slijper ◽  
J. Sebastiaan Souer ◽  
...  
Keyword(s):  
Cohort Study ◽  
Postoperative Pain ◽  
Psychological Characteristics ◽  
Opioid Use ◽  
Acute Postoperative Pain ◽  
Female Sex

scholarly journals Postoperative Pain Control Following Cardiac Implantable Electronic Device Implantation

2021 ◽  
Author(s):  
Peter Magnusson ◽  
Jo Ann LeQuang ◽  
Joseph V. Pergolizzi
Keyword(s):  
Postoperative Pain ◽  
Pain Control ◽  
Electronic Device ◽  
Perioperative Period ◽  
Cardiac Implantable Electronic Device ◽  
Opioid Use ◽  
Acute Postoperative Pain ◽  
Device Implantation ◽  
Analgesic Regimen ◽  
Short Course

Postoperative pain following cardiac implantable electronic device (CIED) surgery may not always be adequately treated. The postoperative pain trajectory occurs over several days following the procedure with tenderness and limited arm range of motion lasting for weeks after surgery. Pain control typically commences in the perioperative period while the patient is in the hospital and may continue after discharge; outpatients may be given a prescription and advice for their analgesic regimen. It is not unusual for CIED patients to be discharged a few hours after implantation. While opioids are known as an effective analgesic to manage acute postoperative pain, growing scrutiny on opioid use as well as their side effects and potential risks have limited their use. Opioids may be considered for appropriate patients for a short course of treatment of acute postoperative pain, but other analgesics may likewise be considered.

scholarly journals The Associations Between OPRM1 and COMT Genotypes and Postoperative Pain, Opioid Use, and Opioid-Induced Sedation

2012 ◽  
Vol 15 (3) ◽  
pp. 309-317 ◽  
Author(s):  
Richard A. Henker ◽  
Allison Lewis ◽  
Feng Dai ◽  
William R. Lariviere ◽  
Li Meng ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Postanesthesia Care Unit ◽  
Trauma Patients ◽  
Orthopedic Trauma ◽  
Nucleotide Polymorphisms ◽  
Opioid Use ◽  
Acute Postoperative Pain ◽  
Comt Genotype ◽  
Sedation Scores ◽  
Physiologic Responses

Previous studies have associated mu-opioid receptor ( OPRM1) genotype with pain and analgesia responses in postoperative and patient populations. This study investigates the role of catechol-O-methyltransferase ( COMT) and OPRM1 genotypes in acute postoperative pain scores, opioid use, and opioid-induced sedation after surgical procedures for orthopedic trauma in an otherwise healthy patient population. Verbal pain/sedation scores, opioid use, and physiologic responses in the immediate postoperative period were examined for association with genetic variants in Caucasians genotyped for OPRM1 single nucleotide polymorphisms (SNPs) A118G and C17T and COMT SNPs. The OPRM1 A118G genotype was associated with patients’ postoperative Numerical Pain scale (NPS) ratings at 15 min in the postanesthesia care unit (PACU) ( p = .01) and patients' sedation scores at 15 min in the PACU ( p = .02). COMT genotype (rs4818) was associated with opioid consumption in the first 45 min in the PACU ( p = .04). NPS ratings at 45 min were also higher in the group of patients with A/A genotype of rs4680 than in patients with the other two genotypes at this SNP ( p = .03). Our haplotype trend analysis identified a COMT haplotype “GCGG” significantly associated with NPS at 15 min ( p = .0013), amount of opioids consumed in the first 45 min ( p = .0024), and heart rate at 45 min in the PACU ( p = .017). The results indicate that genetic variations in COMT contribute to the acute postoperative pain and analgesia responses and physiologic responses in this group of otherwise healthy postoperative orthopedic trauma patients.

scholarly journals Patient and Procedural Determinants of Postoperative Pain Trajectories

2021 ◽  
Vol 134 (3) ◽  
pp. 421-434
Author(s):  
Terrie Vasilopoulos ◽  
Richa Wardhan ◽  
Parisa Rashidi ◽  
Roger B. Fillingim ◽  
Margaret R. Wallace ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Odds Ratio ◽  
Multivariable Analysis ◽  
Oral Morphine ◽  
Surgical Patient ◽  
Opioid Use ◽  
Acute Postoperative Pain ◽  
Patient Factors ◽  
Pain Group ◽  
Pain Trajectories

Background The primary goal of this study was to evaluate patterns in acute postoperative pain in a mixed surgical patient cohort with the hypothesis that there would be heterogeneity in these patterns. Methods This study included 360 patients from a mixed surgical cohort whose pain was measured across postoperative days 1 through 7. Pain was characterized using the Brief Pain Inventory. Primary analysis used group-based trajectory modeling to estimate trajectories/patterns of postoperative pain. Secondary analysis examined associations between sociodemographic, clinical, and behavioral patient factors and pain trajectories. Results Five distinct postoperative pain trajectories were identified. Many patients (167 of 360, 46%) were in the moderate-to-high pain group, followed by the moderate-to-low (88 of 360, 24%), high (58 of 360, 17%), low (25 of 360, 7%), and decreasing (21 of 360, 6%) pain groups. Lower age (odds ratio, 0.94; 95% CI, 0.91 to 0.99), female sex (odds ratio, 6.5; 95% CI, 1.49 to 15.6), higher anxiety (odds ratio, 1.08; 95% CI, 1.01 to 1.14), and more pain behaviors (odds ratio, 1.10; 95% CI, 1.02 to 1.18) were related to increased likelihood of being in the high pain trajectory in multivariable analysis. Preoperative and intraoperative opioids were not associated with postoperative pain trajectories. Pain trajectory group was, however, associated with postoperative opioid use (P < 0.001), with the high pain group (249.5 oral morphine milligram equivalents) requiring four times more opioids than the low pain group (60.0 oral morphine milligram equivalents). Conclusions There are multiple distinct acute postoperative pain intensity trajectories, with 63% of patients reporting stable and sustained high or moderate-to-high pain over the first 7 days after surgery. These postoperative pain trajectories were predominantly defined by patient factors and not surgical factors. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

scholarly journals The Impact of Demographic, Clinical, Symptom and Psychological Characteristics on the Trajectories of Acute Postoperative Pain After Total Knee Arthroplasty

Pain Medicine ◽  
2016 ◽  
Vol 18 (1) ◽  
pp. 124-139 ◽  
Author(s):  
Maren Falch Lindberg ◽  
Christine Miaskowski ◽  
Tone Rustøen ◽  
Leiv Arne Rosseland ◽  
Steven M. Paul ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Pain ◽  
Clinical Symptom ◽  
Knee Arthroplasty ◽  
Psychological Characteristics ◽  
Acute Postoperative Pain ◽  
Total Knee ◽  
The Impact

scholarly journals Prevention of Acute Postoperative Pain in Breast Cancer: A Comparison between Opioids versus Ketamine in the Intraoperatory Analgesia

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Mirian López ◽  
María Luz Padilla ◽  
Blas García ◽  
Javier Orozco ◽  
Ana María Rodilla
Keyword(s):  
Breast Cancer ◽  
Postoperative Pain ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Opioid Use ◽  
Acute Postoperative Pain ◽  
Systemic Side Effects ◽  
Waking Up

Background. Acute postoperative pain (APP) has a high incidence in breast surgery, and opioids are the most commonly used drugs for its management; however, they are not free from systemic side effects, which may increase comorbidity. In the past few years, opioid-free anaesthesia has been favoured with promising results. Methods. We conducted a descriptive study including 71 patients who underwent breast cancer surgery. The opioid group (n = 41) received fentanyl for induction, remifentanil for maintenance, and rescue morphine before waking up, whereas the ketamine group (n = 30) received a ketamine bolus for induction followed by continuous ketamine infusion during surgery. Later, the presence and intensity of pain were registered, using the Numeric Rating Scale (NRS 1–10) for pain, at different times in the recovery room, at 24 hours and at 3 months. Results. Administration of ketamine is more effective than opioid use for APP prevention in breast cancer surgery because the ketamine group presented with less pain than the opioid group ( p  < 0.05) at all measured times. When there was pain, patients in the ketamine group gave a lower score to its intensity ( p  < 0.05). Conclusions. Ketamine could reduce the incidence of APP in breast cancer surgery, compared to opioids.

scholarly journals Severe acute postoperative pain self-reported by children after ambulatory surgeries: a cohort study

2021 ◽  
Vol 74 (suppl 4) ◽  
Author(s):  
Louise Amália de Moura ◽  
Lilian Varanda Pereira ◽  
Ruth Minamisava ◽  
Natália de Carvalho Borges ◽  
Thaila Corrêa Castral ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Postoperative Pain ◽  
Hospital Discharge ◽  
Surgical Procedures ◽  
Cox Regression ◽  
Preoperative Anxiety ◽  
Acute Postoperative Pain ◽  
Preoperative Pain ◽  
Severe Postoperative Pain

ABSTRACT Objectives: to estimate the incidence and the risk factors for severe acute postoperative pain self-reported on the first day after hospital discharge. Methods: cohort study with 279 children from both sexes (5-12 years old), indicated for ambulatory surgery in two Brazilian hospitals. Children were assessed at the pre-surgery, immediate postoperative and first postoperative day. Faces Pain Scale-Revised and Yale Preoperative Anxiety Scale Modified were used. Severe postoperative pain was defined as score ≥6. Cox regression analyses were used. Results: the incidence of severe postoperative pain was 15.8% (95%CI:10.7%-20.4%) on the first postoperative day. Preoperative anxiety (HR=2.23; p=0.049), severe preoperative pain (HR=2.78; p=0.031) and having undergone two surgical procedures (HR=2.91; p=0.002) were associated with severe postoperative pain. Conclusions the incidence of severe postoperative pain self-reported after hospital discharge was high. Anxiety and severe preoperative pain, in addition to performing two surgical procedures at the same time were confirmed as risk factors.

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