An audit of post‐operative pain scores after endoscopic and microscopic ear surgery

2021 ◽  
Author(s):  
Rhona McCallum ◽  
Mohd Afiq Mohd Slim ◽  
Arunachalam Iyer
Keyword(s):  
Ear Surgery ◽  
Pain Scores ◽  
Post Operative Pain

Wide-Awake Local Anesthesia No Tourniquet (WALANT) versus Local or Intravenous Regional Anesthesia with Tourniquet in Atraumatic Hand Cases in Orthopedics: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 24 (04) ◽  
pp. 469-476 ◽  
Author(s):  
Ted Matthew P. Evangelista ◽  
John Hubert C. Pua ◽  
Mara Therese P. Evangelista-Huber
Keyword(s):  
Systematic Review ◽  
Patient Satisfaction ◽  
Confidence Interval ◽  
Local Anesthesia ◽  
Regional Anesthesia ◽  
Random Effects ◽  
Complication Rates ◽  
Pain Scores ◽  
Intravenous Regional Anesthesia ◽  
Post Operative Pain

Background: To compare outcomes of atraumatic hand surgeries using the WALANT technique versus intravenous regional anesthesia or local anesthesia with tourniquet. Methods: We conducted a comprehensive literature search using PubMed, MEDLINE, Embase, and Cochrane Library from inception to October 2018. All randomized or quasi-randomized trials and cohort studies comparing WALANT procedure versus local anesthesia or intravenous regional anesthesia with tourniquet among atraumatic hand surgeries were included. Methodological quality and risk of bias of eligible studies were assessed by three independent reviewers. The random effects model was used due to both statistical and clinical heterogeneity among studies. Results: The search yielded 496 records, of which 9 studies were included in the systematic review. We were able to pool findings for operative time, post-operative pain scores, patient satisfaction, and complication rates. On the average, the WALANT group had longer operative times by 2.06 minutes (pooled mean difference, random effects, 95% confidence interval 0.46 to 3.67 minutes, p = 0.01, I2 0%, p = 0.66). The post-operative pain scores were lower in the WALANT group by an average of two VAS points (random effects, pooled mean difference −2.40, 95% confidence interval −3.41 to −1.38, p < 0.00001; I2 0% p = 0.99). We had insufficient evidence to demonstrate a difference in terms of patient satisfaction (random effects, pooled risk ratio 0.98, 95% confidence interval 0.93 to 1.03, p = 0.36, I2 0%, p = 0.64) and complication rates (random effects, pooled risk ratio 0.40, 95% confidence interval 0.07 to 2.18, p = 0.29, I2 60% p = 0.08) between WALANT versus conventional methods. Conclusions: The WALANT group reported lower post-operative pain scores, but had slightly longer operative times. There are no significant differences between WALANT and conventional methods in terms of patient satisfaction and complication rates.

scholarly journals POST OPERATIVE PAIN ASSESSMENT AND OPIOID USE FOLLOWING ACL RECONSTRUCTION WITH QUADRICEPS VERSUS HAMSTRING TENDON AUTOGRAFT IN ADOLESCENTS AND YOUNG ADULTS

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0011
Author(s):  
Elizabeth S. Liotta ◽  
Edward G. Schleyer ◽  
Mininder S. Kocher ◽  
Lyle J. Micheli ◽  
Benton E. Heyworth
Keyword(s):  
Hamstring Tendon ◽  
Pain Level ◽  
Opioid Use ◽  
Nerve Blocks ◽  
Opioid Medication ◽  
Pain Scores ◽  
Hamstring Tendon Autograft ◽  
Post Operative Pain ◽  
Subjective Pain ◽  
Tendon Autograft

Background: The culture of opioid abuse in the United States has brought attention to prescribing habits, especially as recent studies identify practices within the post-operative period as a risk factor for the development of opioid dependence in adolescents. The current study sought to explore the concept of post-operative pain control and opioid use following ACL reconstruction (ACLR), one of the most common orthopaedic procedures for adolescents. Because recent adult studies have suggested that use of quadriceps tendon autograft, a graft choice that appears to be growing in popularity, may be associated with lower post-operative pain scores than other graft sources, we additionally investigated an ACLR cohort who received quad tendon autograft (ACLR-Q) and compared their pain scores and opioid use to a cohort with the more commonly used hamstring tendon autograft (ACLR-HS). Methods: Between 2016 and 2018, patients aged 12-25 years who underwent primary ACLR-Q or ACLR-HS by one of three surgeons at tertiary care children’s hospital, were provided a journal to record daily subjective pain level and medication use. To avoid confounder or outliers, patients with a history of diagnosed clinical pain syndrome or underlying psychiatric condition were excluded. Logbooks contained a scale from ‘0-5’ to record pain level prior to each medication use and tables to record information detailing medication consumption. All patients were prescribed Oxycodone, 5 mg, for post-operative pain control. Patient demographics, surgical data, and prescription information were extracted from the electronic medical record. A two-sided t-test was used to evaluate statistical relationships of data between graft types. Results: Logbooks of 54 patients (27 ACLR-Q and 27 ACLR-HS) were collected for analysis. Both cohorts had a similar mean age at time of surgery (ACLR-Q: 16.7 years, range: 12-23; ACLR-HS: 16.8 years, range: 13-21), and preponderance of female subjects (ACLR-Q: 83.3%; ACLR-HS: 81.5%). The mean weight of patients who received the quadriceps tendon autograft (mean: 68.8lbs, range: 47-121) was slightly heavier than for patients who received the hamstring tendon autograft (mean: 62.0lbs, range 49-93), but not to a significant degree (p=0.084). More meniscal injuries were identified in ACLR-HS patients (77.8% vs. ACLR-Q: 48.1%, p=0.024), and treated with a repair procedure more commonly (81% vs. ACLR-Q: 46.2%, p=<0.001), than with meniscectomy (19%; ACLR-Q: 46.2%, p=0.282). Mean length of surgery and tourniquet time were longer in the ACLR-Q (129, 115 minutes) group than ACLR-HS group (80, 54 minutes) (p=<0.001; p=<0.001). While intra-operative nerve blocks were utilized by a similar proportion of both cohorts (ACLR-Q: 88.9%, ACLR-HS: 85.2%, p:0.692), the ACLR-Q group received more adductor canal blocks (89.9% vs. 14.8%, p: <0.001), while the ACLR-HS group received more femoral nerve blocks most frequently (ACLR-Q: 63% vs. 0%, p: <0.001). For the overall study population, the mean number of pills per Oxycodone prescription was 47.5 (range: 30-84). ACLR-Q patients consumed an average of 14.6 opioid pain pills (range: 3-46) over a mean of 13.7 doses (range: 3-36), with the last dose occurring on day 4.4 (range: 1-13). ACLR-HS patients consumed an average of 16.9 opioid pain pills (range: 0-39) over a mean of 14.0 doses (0-36), with the last dose occurring on day 3.7 (range: 0-13). There were no significant differences seen between number of pills consumed (p=0.387), number of doses (p=0.880), or number of days over which opioid medication was taken (p=0.364), between the two cohorts. Subjective pain experience was the same on day of surgery (DOS) for the two graft choices (score: 2.4). Average pain scores increased by the same amount on post-operative day 1 (score: 2.7) for both groups, likely as residual effects from regional anesthetic wore off. By post-operative day 3, average pain scores in the ACLR-Q group (score: 2.3) and ACLR-HS group (score: 2.0) had declined to less than that seen on DOS, without statistical difference (p=0.350) in the pain level between the cohorts. Conclusion/Significance: Despite longer tourniquet and operative times in the ACLR-Q group, which is likely reflective of graft harvest/preparation time and a surgical learning curve associated with a relatively newer technique, adolescents and young adults who received quadriceps and hamstring tendon grafts had a similar profile of subjective pain and use of post-operative opioid medication in the immediate post-operative period. Differing rates of concomitant meniscal injury and regional anesthetic techniques may represent confounding factors that warrant future studies controlling for such factors. Importantly, both reconstructive techniques resulted in a large surplus of unused opioid medication, furthering the notion that evidence-based prescription practices for post-operative care in different surgical techniques is warranted by orthopaedic surgeons and sports medicine physicians to help stem the rising tide of the opioid epidemic.

scholarly journals 4326 Effects of Single-dose Preoperative Pregabalin on Postoperative Pain and Opioid Consumption in Cleft Orthognathic Surgery

2020 ◽  
Vol 4 (s1) ◽  
pp. 29-29
Author(s):  
Abdullah Said ◽  
Ema Zubovic ◽  
Austin Y Ha ◽  
Gary B Skolnic ◽  
Jacob AuBuchon ◽  
...  
Keyword(s):  
Single Dose ◽  
Postoperative Pain ◽  
Orthognathic Surgery ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Opioid Consumption ◽  
Control Group ◽  
Assessment Scores ◽  
Pain Scores ◽  
Post Operative Pain

OBJECTIVES/GOALS: The current opioid epidemic has placed post-operative pain management under scrutiny. Limiting post-operative pain can decrease overall opioid usage in the recovery period, especially after orthognathic surgery. Several studies have illustrated the efficacy of pregabalin in decreasing postoperative pain and opioid usage in adults undergoing orthognathic surgery. We aim to study the effects of a single dose of preoperative pregabalin on postoperative pain and total opioid consumption after orthognathic surgery in individuals with cleft lip and palate. METHODS/STUDY POPULATION: This was a retrospective cohort study of consecutive patients who received Le Fort I midface advancement between June 2012 and July 2019 by one of two surgeons at a single institution. We took advantage of our institution’s implementation, beginning in 2016, of a one-time dose of preoperative pregabalin for LeFort I midface advancement. All patients had diagnosed cleft lip and palate. The treatment group received a one-time preoperative dose of pregabalin. The control group did not receive pregabalin. Total morphine milligram equivalents (MME) consumption was calculated by adding intraoperative opioid administration and postoperative opioid consumption during admission. Postoperative pain control during admission consisted of oral oxycodone and intravenous (IV) hydromorphone or morphine. Duration of hospitalization and pain intensity assessed with the numeric pain rating scale (0-10) were also recorded. The mean postoperative pain assessment scores during admission was calculated for each patient. The median of these individual mean pain assessment scores for each group was subsequently computed. RESULTS/ANTICIPATED RESULTS: Twenty-three patients (14 males, 9 females) were included in this study; 12 patients received pregabalin (median dose: 150mg, range: 100-200mg). Mean age (years) at operation of the pregabalin (18.3 ± 1.9) and control groups (17.8 ± 1.9) were also equivalent (p = 0.571). Median hospital stay for both groups was 1.0 day. The pregabalin group had significantly lower consumption of total opioids during admission (total MME 70.95 MME; IQR: 24.65-150.17) compared to the control group (138.00 MME; IQR: 105.00-232.48) (MU = 31.00, p = 0.031). Although pain scores in the treatment group (3.21 ± 2.03) were lower than in the control group (3.71 ± 2.95), the difference was not statistically significant (p = 0.651, 95% Cl [−1.75, 2.75]). DISCUSSION/SIGNIFICANCE OF IMPACT: Based on the results, a one-time preoperative oral dose of pregabalin before orthognathic surgery in patients with cleft lip and palate reduced total opioid consumption during admission. However, there was no difference in length of stay or pain scores within the two groups. A single preemptive oral dose of pregabalin should be considered an effective adjunct to pain management protocols in patients undergoing orthognathic surgery.

Pre-emptive Effects of Ibuprofen Syrup and Lidocaine Infiltration on Postoperative Analgesia in Children Undergoing Adenotonsillectomy

2005 ◽  
Vol 33 (2) ◽  
pp. 188-195 ◽  
Author(s):  
A Kedek ◽  
A Derbent ◽  
M Uyar ◽  
C Bilgen ◽  
M Uyar ◽  
...  
Keyword(s):  
Side Effects ◽  
Food Intake ◽  
Oral Feeding ◽  
Bleeding Control ◽  
Local Infiltration ◽  
Adverse Side Effects ◽  
Pain Scores ◽  
Post Operative Pain ◽  
Lidocaine Solution ◽  
Duration Of Operation

We aimed to compare the effects of lidocaine and adrenaline with ibuprofen syrup (administered before adenotonsillectomy) on post-operative analgesia and initiation of oral feeding. One group of 20 children received 100 g/5 ml ibuprofen suspension (10 mg/kg) 1 h before anaesthesia; bleeding control was provided by pre-incisional administration of 1:200000 adrenaline solution (10 ml). The same amount of 0.5% lidocaine solution plus 1:200000 adrenaline was applied pre-incisionally in a similar manner in a second group of 20 children. No significant differences were observed between the two groups in terms of the duration of operation and anaesthesia, post-operative pain scores, paracetamol requirements, times to initiation of liquid and solid food intake, or adverse side-effects. We conclude that ibuprofen syrup applied pre-incisionally and local infiltration with lidocaine are equally effective for post-operative analgesia.

scholarly journals The randomised prospective comparative study to see the duration of analgesia following intravenous or rectal acetaminophen after adenotonsillectomy in children

2019 ◽  
Vol 6 (3) ◽  
pp. 1119
Author(s):  
Neerupam Gupta ◽  
Naine Bhadrala ◽  
Jasmeen . ◽  
Saloni .
Keyword(s):  
Analgesic Efficacy ◽  
Cost Effective ◽  
Surgical Trauma ◽  
Age Group ◽  
Pain Medicine ◽  
Pediatric Pain ◽  
Pain Scores ◽  
Group I ◽  
Post Operative Pain ◽  
Prospective Comparative Study

Background: The greatest advance in pediatric pain medicine is the recognition that untreated pain is a significant cause of morbidity and even mortality after surgical trauma. Author compared the analgesic efficacy and duration of analgesia of rectal acetaminophen and I.V. acetaminophen.Methods: A total of 80 children in the age group of 2-5 years were randomly selected and divided into 2 groups. Group I received 15 mg/kg I.V. paracetamol and group II received 40 mg/kg rectal acetaminophen. Post-operative pain scores were measured using Face, Legs, Activity, Cry and Consolability scale and duration of analgesia were recorded and compared.Results: The pain scores in group I was lower immediately after extubation and at 30 minutes post extubations but at one, two and four hours the pains score were comparable in both the groups. At 6 hours, the pain score was significantly more in I.V. group and also the duration of analgesia was 9-10 hours in rectal acetaminophen group where as in I.V. group, it was 5-6 hours.Conclusions: Rectal acetaminophen 40 mg/kg produces prolonged analgesia as compared to I.V. paracetamol 15 mg/kg and also is more convenient and cost effective and is devoid of side effects of I.V. cannulation.

scholarly journals The Use of Preemptive Ketamine for the Prevention of Postoperative Pain in Surgical Patients

2018 ◽  
Author(s):  
Nicole Brecher
Keyword(s):  
Acute Pain ◽  
Healing Process ◽  
Pain Medication ◽  
Surgical Patients ◽  
Warning Sign ◽  
Pain Syndromes ◽  
Pain Scores ◽  
Post Operative Period ◽  
Post Operative Pain ◽  
Surgical Setting

Post-operative pain is accompanied with strong emotional and physical responses which may often discourage the healing process. Acute pain serves as a physical warning sign to the patient but when left unchecked, the acute pain process can increase nociceptor sensitivity and ultimately lead to chronic pain syndromes. Currently, it is thought that providing pain medication to block pain receptors prior to nociception might decrease the development of, or severity of, pain. Some practitioners have used ketamine as an adjunct pain medication perioperatively to decrease pain. The purpose of this review is to investigate the efficacy of Ketamine administered in a pre-hospital or pre-surgical setting on the overall pain management of surgical patients A literature search was performed on PubMed and Medline and using the PRISMA flowchart, and appropriate studies were identified. Each study was critically appraised and organized into tables to organize related variables and results. Variables included ketamine dosing, route of administration, the use of opioid or local anesthetic for comparison, type of surgery, and the length of duration into the post-operative period that pain scores were recorded. This systematic review supports that preemptive ketamine reduces acute pain in the immediate post-operative period.

scholarly journals Comparison of Single Antibiotic Paste Nitrofurantoin and Calcium Hydroxide Paste as Intracanal Medicaments in Alleviating Post-Operative Pain in Patients with Symptomatic Irreversible Pulpitis -A Randomized Controlled Trial

2021 ◽  
pp. 484-494
Author(s):  
Hira Abbasi ◽  
Abhishek Lal ◽  
Ammara Shamim Jaffrani
Keyword(s):  
Randomized Controlled Trial ◽  
Calcium Hydroxide ◽  
Controlled Trial ◽  
Control Group ◽  
Randomized Controlled ◽  
Pain Scores ◽  
Post Operative Pain ◽  
Group 2 ◽  
Irreversible Pulpitis ◽  
Group 1

Aims: This study aims to compare the efficacy in alleviating pain between intracanal medicaments, namely Nitrofurantoin and Calcium Hydroxide Paste. Study Design:  Randomized Controlled Trial. Place and Duration of Study: Sample: Department of Operative Dentistry, Sir Syed College of Medical Sciences, Pakistan, between January 2021 and May 2021. Methodology: 60 patients were randomly divided into 3 groups, each group having 20 patients as following: Group 1: Nitrofurantoin, Group 2: Calcium Hydroxide and Group 3: Control. Preoperative pain was recorded using a numerical pain scale. After access preparation, chemomechanical preparation was performed with subsequent placement of intracanal medicaments. Pre-operative pain score was initially recorded, followed by post-operative pain at 12, 24, 48, and 72 hours, respectively. Root canal treatment was performed in single rooted teeth with patients suffering from symptomatic irreversible pulpitis Results: Majority of the patients in all 3 groups were initially presented with moderate to severe pre-operative pain. After 72 hours post-operatively, 50% patients in Group 1 reported no pain, while 5% patients in both Group 2 and 3 had no pain. Pain significantly subsided in Group 1 as compared to Group 2 and 3. Regarding age and gender, both had no significant relationship with the pain scores in all of the 3 groups Conclusion: Nitrofurantoin has been proven to be an effective intracanal medicament in alleviating immediate post-operative pain in patients with symptomatic irreversible pulpitis as compared to calcium hydroxide. While the control group with no intracanal medicament showed little reduction in pain scores. So, nitrofurantoin can be used as a substitute to currently available standard intracanal medicaments.

scholarly journals Post-operative pain after laparoscopic right hemicolectomy for Crohn’s disease: a case control study

2021 ◽  
Vol 84 (2) ◽  
pp. 271-274
Author(s):  
K McKevitt ◽  
S.M. Sahebally ◽  
S Patchett ◽  
A O’Toole ◽  
S Galvin ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Inflammatory Response ◽  
Right Hemicolectomy ◽  
Abdominal Abscess ◽  
Patient Gender ◽  
Pain Scores ◽  
Post Operative Pain ◽  
Equivalent Length ◽  
Laparoscopic Right Hemicolectomy

Aim: Surgery for Crohn’s disease (CD) is characterized by an enhanced inflammatory response. While inflammation can induce hyperalgesia, post-operative pain following surgery for CD has not been characterized. This retrospective study compared a consecutive series of patients undergoing laparoscopic right hemicolectomy for CD and neoplasia performed by a single surgeon. Method: Elective resections performed between Jan-2016 and Aug-2017 managed in an enhanced recovery pathway were eligible for inclusion. Patients were excluded if open surgery was performed, an ileostomy was fashioned, no patient-controlled analgesia (PCA) was used or data were incomplete. Results : 38 cases were included, 20 for neoplasia and 18 for ileocolonic CD. There was no difference in patient gender (P=0.520). CD patients were younger (39.8±2.8 Vs 77.2±2.1 years, P<0.001) but had an equivalent length of resection (312.9±43.5 Vs 283.3±71.7 mm, P=0.915). CD patients had higher pain scores on post-operative day 1 (6.8±0.8 Vs 2.6±1.0, P<0.001), day 2 (5.0±0.5 Vs 1.6±0.9, P<0.001) and day 3 (4.1±0.6 Vs 1.3±0.7, P=0.008). CD patients used their PCA for longer (85.7±16.3 Vs 47.7±4.2 hours, P=0.017) and used a greater total amount of morphine (148.6±33.8 Vs 37.0±7.8 mg, P<0.001). Post-operative CRP was higher in patients with CD on day 1 (P=0.011), day 2 (P=0.001), day 3 (P=0.001) and day 4 (P=0.007), but no leak or intra-abdominal abscess occurred in either group. Results: 38 cases were included, 20 for neoplasia and 18 for ileocolonic CD. There was no difference in patient gender (P=0.520). CD patients were younger (39.8±2.8 Vs 77.2±2.1 years, P<0.001) but had an equivalent length of resection (312.9±43.5 Vs 283.3±71.7 mm, P=0.915). CD patients had higher pain scores on post-operative day 1 (6.8±0.8 Vs 2.6±1.0, P<0.001), day 2 (5.0±0.5 Vs 1.6±0.9, P<0.001) and day 3 (4.1±0.6 Vs 1.3±0.7, P=0.008). CD patients used their PCA for longer (85.7±16.3 Vs 47.7±4.2 hours, P=0.017) and used a greater total amount of morphine (148.6±33.8 Vs 37.0±7.8 mg, P<0.001). Post-operative CRP was higher in patients with CD on day 1 (P=0.011), day 2 (P=0.001), day 3 (P=0.001) and day 4 (P=0.007), but no leak or intra-abdominal abscess occurred in either group. Conclusions: CD patients experience increased post-operative pain, require more post-operative analgesia and have an enhanced post-operative inflammatory response. Further studies to elucidate the mechanism of this hyperalgesia and strategies to obviate it are required.

scholarly journals A comparative study of efficacy of epidural versus interpleural bupivacaine for post operative analgesia after open cholecystectomy

2014 ◽  
Vol 9 (4) ◽  
pp. 15-23
Author(s):  
RK Yadav ◽  
PC Majhi
Keyword(s):  
Pain Relief ◽  
Open Cholecystectomy ◽  
Fixed Time ◽  
Medical Sciences ◽  
Time Intervals ◽  
Thoracic Epidural ◽  
Pain Scores ◽  
Post Operative Pain ◽  
Clinically Significant ◽  
Made In

Background The conventional methods of administering the prescribed doses of intramuscular or intravenous analgesics at fixed time intervals results in widely fluctuating and inadequate plasma level leads to poor post operative pain relief. Despite all advances made in the field of medicine, this symptom called “Pain” has not been combated well. Objective The present study was carried out to compare the efficacy of epidural verses interpleural administration of bupivacaine(0.5%) with adrenaline for post operative pain relieve in patients undergoing open cholecystectomy. Methods We prospectively randomized and compared the post operative pain relieve with the reference of visual analog score (VAS) in patients undergoing elective open cholecystectomy in college of medical sciences-teaching hospital, Bharatpur, Chitwan. Forty adult patients undergoing elective cholecystectomy were divided into two groups. Twenty patients in each group were subjected to a different technique of post-operative analgesia, namely thoracic epidural and interpleural instillation of 0.5% bupivacaine. These two groups were then compared in relation to changes produced in the pain scores, vital parameters and complication and side effects associated with the two techniques. The study was conducted for 24 hour postoperatively. Observation: Both thoracic epidural and interpleural instillation of 0.5% bupivacaine compared favorably with regard to analgesia in the present study. In general, the pain relief following thoracic epidural was more complete compared to interpleural but this was not clinically significant. Conclusion The present study shows that both the techniques are equally effective in providing analgesia following cholecystectomy. However, neither technique rendered the patients completely pain free at all times during first 24 hours. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-4, 15-23 DOI: http://dx.doi.org/10.3126/jcmsn.v9i4.10232

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