Implications of uninterrupted preoperative transdermal buprenorphine use on postoperative pain management

Background and objectivesBuprenorphine is a partial µ-receptor agonist resistant to displacement from receptors by conventional opioids, which can block the effect of conventional opioids and may interfere with postoperative pain management. We aimed to quantify perioperative opioid use in patients receiving transdermal buprenorphine (TdBUP).MethodsWe identified patients receiving TdBUP who underwent surgery between 2004 and 2016. To compare opioid requirements (intravenous morphine equivalents (IV-MEq)), we constructed a matched study, matching each TdBUP patient with two opioid-naive patients by sex, age, and type of anesthesia and procedure.ResultsNineteen unique patients underwent 22 procedures while receiving TdBUP. Total (IQR) amounts of IV-MEq (intraoperative, recovery room, and 24 hours after recovery-room discharge) were 98 (63, 145) and 46 (30, 65) mg IV-MEq for TdBUP and opioid-naive patients, respectively (p<0.001). Postoperative IV-MEq requirements were 54 (38, 90) and 15 (3, 35) mg for TdBUP and opioid-naive patients, respectively (p<0.001). Among TdBUP patients, higher preoperative doses of TdBUP were associated with greater postoperative opioid requirements (p=0.02). Specifically, patients with a 20 µg/hour TdBUP patch required 133.8 mg IV-MEq more postoperatively than patients with a 5 µg/hour patch (p=0.002). Following discharge from the recovery room, 17 (77%) TdBUP patients and 15 (34%) opioid-naive patients reported severe pain (OR 6.6 (95% CI 2.0 to 21.3); p<0.001; adjusting for baseline pain score, 5.0 (95% CI, 1.4 to 17.8); p=0.01).ConclusionsAnalgesic management for patients receiving TdBUP therapy must account for increased opioid needs, and greater preoperative doses of TdBUP were associated with greater postoperative opioid requirements.

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Subcutaneous sumatriptan: association with decreases in postoperative pain and opioid use after elective cranial surgery

Journal of Neurosurgery ◽

10.3171/2019.10.jns192503 ◽

2020 ◽

pp. 1-9

Author(s):

Kunal S. Patel ◽

Azim N. Laiwalla ◽

Jasmine A. T. DiCesare ◽

Matthew C. Garrett ◽

Anthony C. Wang

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Pain Score ◽

Pediatric Patients ◽

Maximum Dose ◽

Postoperative Pain Management ◽

Opioid Use ◽

Primary Headache Disorders ◽

Randomized Controlled Studies ◽

Subcutaneous Sumatriptan

OBJECTIVESumatriptan, a serotonin receptor agonist, has been used in the management of primary headache disorders and has been shown to affect trigeminal dural afferents. There is limited literature on the safety and efficacy of sumatriptan for postcraniotomy pain management. This study aimed to identify whether subcutaneous sumatriptan is a safe and efficacious pain management strategy after elective craniotomy.METHODSThe authors retrospectively reviewed patients who underwent supratentorial or suboccipital craniotomy between 2016 and 2019 that was performed by a single provider at a single institution to identify patients given subcutaneous sumatriptan in the postoperative period. Pain scores and intravenous and oral opioid use were compared in patients with (n = 15) and without (n = 45) sumatriptan administration.RESULTSPatients with and without sumatriptan administration had no significant differences in baseline characteristics or surgery type. There were no sumatriptan-related complications. The average pain score decreased from 3.9 to 1.3 within 1 hour after sumatriptan administration (p = 0.014). In both adult and pediatric patients there was decreased postoperative pain (adults: pain score of 1.1 vs 7.1, p < 0.001; pediatric: 1.1 vs 3.9, p = 0.007) within the first 48 hours. There were decreases in intravenous opioid use, length of intravenous opioid use, maximum dose of intravenous opioid used, oral opioid use, length of oral opioid use, and maximum dose of oral opioid used in both adult and pediatric patients.CONCLUSIONSThe authors identified subcutaneous sumatriptan as a safe and efficacious tool for postoperative pain management after craniotomy. Large multicenter randomized controlled studies are needed to further evaluate the specific role of sumatriptan in postoperative pain management after craniotomy.

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Pain management after lung surgery

Nursing Reports ◽

10.4081/nursrep.2014.3225 ◽

2014 ◽

Vol 4 (1) ◽

Cited By ~ 2

Author(s):

Maria Frödin ◽

Margareta Warrén Stomberg

Keyword(s):

Quality Of Care ◽

Pain Management ◽

Postoperative Pain ◽

Severe Pain ◽

Postoperative Pain Management ◽

Lung Surgery ◽

Moderate Pain ◽

Number Of Patients ◽

Severe Postoperative Pain

Pain management is an integral challenge in nursing and includes the responsibility of managing patients’ pain, evaluating pain therapy and ensuring the quality of care. The aims of this study were to explore patients’ experiences of pain after lung surgery and evaluate their satisfaction with the postoperative pain management. A descriptive design was used which studied 51 participants undergoing lung surgery. The incidence of moderate postoperative pain varied from 36- 58% among the participants and severe pain from 11-26%, during their hospital stay. Thirty-nine percent had more pain than expected. After three months, 20% experienced moderate pain and 4% experienced severe pain, while after six months, 16% experienced moderate pain. The desired quality of care goal was not fully achieved. We conclude that a large number of patients experienced moderate and severe postoperative pain and more than one third had more pain than expected. However, 88% were satisfied with the pain management. The findings confirm the severity of pain experienced after lung surgery and facilitate the apparent need for the continued improvement of postoperative pain management following this procedure.

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Ketamine Improves the Management of Exaggerated Postoperative Pain Observed in Perioperative Fentanyl-treated Rats

Anesthesiology ◽

10.1097/00000542-200502000-00028 ◽

2005 ◽

Vol 102 (2) ◽

pp. 421-428 ◽

Cited By ~ 95

Author(s):

Philippe Richebé ◽

Cyril Rivat ◽

Jean-Paul Laulin ◽

Pierre Maurette ◽

Guy Simonnet

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Weight Bearing ◽

Experimental Studies ◽

Postoperative Pain Management ◽

Opioid Use ◽

Short Term ◽

Postoperative Rehabilitation ◽

Pain Hypersensitivity ◽

Plantar Incision

Background Although opioids are unsurpassed analgesics, experimental and clinical studies suggest that opioids activate N-methyl-d-aspartate pronociceptive systems leading to pain hypersensitivity and short-term tolerance. Because it is difficult in humans to differentiate pain from hyperalgesia during the postoperative period, the authors performed experimental studies with fentanyl using the rat incisional pain model for evaluating relations between hyperalgesia and short-term tolerance. Because N-methyl-d-aspartate receptor antagonists oppose both pain hypersensitivity and tolerance induced by opioids, the authors examined the capability of ketamine for improving exaggerated postoperative pain management. Methods During halothane anesthesia, a hind paw plantar incision was performed in rats receiving four fentanyl subcutaneous injections (100 microg/kg per injection, every 15 min). In some groups, three subcutaneous ketamine injections (10 mg/kg per injection, every 5 h) were performed in saline- or fentanyl-treated rats. One day after surgery, the analgesic effect of morphine (2 mg/kg subcutaneous) was tested. Analgesia, mechanical hyperalgesia, tactile allodynia, and pain score were assessed for several days using the paw pressure vocalization test, the von Frey application test, and the postural disequilibrium test. Results Fentanyl induced analgesia but also produced exaggerated postoperative pain as indicated by the enhancement of hyperalgesia, allodynia, and weight-bearing decrease after hind paw plantar incision. Ketamine pretreatment prevented such a fentanyl-induced enhancement of postoperative pain and improved its management by morphine. Conclusions By opposing postoperative pain hypersensitivity and subsequent short-term tolerance induced by perioperative opioid use, ketamine not only improves exaggerated postoperative pain management but also provides better postoperative rehabilitation.

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Patient education and engagement in postoperative pain management decreases opioid use following knee replacement surgery

Patient Education and Counseling ◽

10.1016/j.pec.2018.09.001 ◽

2019 ◽

Vol 102 (2) ◽

pp. 383-387 ◽

Cited By ~ 19

Author(s):

Meghana Yajnik ◽

Jonay N. Hill ◽

Oluwatobi O. Hunter ◽

Steven K. Howard ◽

T. Edward Kim ◽

...

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Patient Education ◽

Knee Replacement ◽

Postoperative Pain Management ◽

Opioid Use ◽

Knee Replacement Surgery ◽

Replacement Surgery

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Comparative analysis of length of stay, hospitalization costs, opioid use, and discharge status among spine surgery patients with postoperative pain management including intravenous versus oral acetaminophen

Current Medical Research and Opinion ◽

10.1080/03007995.2017.1297702 ◽

2017 ◽

Vol 33 (5) ◽

pp. 943-948 ◽

Cited By ~ 26

Author(s):

Ryan N. Hansen ◽

An T. Pham ◽

Elaine A. Böing ◽

Belinda Lovelace ◽

George J. Wan ◽

...

Keyword(s):

Comparative Analysis ◽

Pain Management ◽

Postoperative Pain ◽

Length Of Stay ◽

Spine Surgery ◽

Postoperative Pain Management ◽

Opioid Use ◽

Hospitalization Costs ◽

Discharge Status

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Assessment of quality of care in acute postoperative pain management

Vojnosanitetski pregled ◽

10.2298/vsp0902156m ◽

2009 ◽

Vol 66 (2) ◽

pp. 156-162 ◽

Cited By ~ 8

Author(s):

Dragana Milutinovic ◽

Verica Milovanovic ◽

Miroslava Pjevic ◽

Mirjana Martinov-Cvejin ◽

Tomislav Cigic

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Nursing Care ◽

Severe Pain ◽

Postoperative Pain Management ◽

Care Quality ◽

Acute Postoperative Pain ◽

Nursing Care Quality ◽

The Difference

Background/Aim. Managing of acute postoperative pain should be of great interest for all hospital institutions, as one of the key components of patients satisfaction, which indicates quality, as well as the outcome of treatment. The aim of this study was to assess the quality of nursing care in managing acute postoperative pain and to establish factors which influence patients assessment of the same. Method. The investigation was conducted on the sample of 135 patients hospitalized in surgical clinics of the Clinical Centre of Vojvodina in Novi Sad in the form of cross-sectional study, by interviewing patients during the second postoperative day and collecting sociodemographic variables, type of surgical procedure and applied analgesic therapy which were taken from their medical documentation. The modified questionnaire of the Strategic and Clinical Quality Indicators in Postoperative Pain Management (SCQIPP) was used as the instrument of the investigation. The data were processed with suitable mathematical statistics methods such as multivariate analyses of variance (MANOVA), discriminative and other parametric procedures and methods. Roy's test, Pearson's coefficient contingency (?), multiple correlation coefficient (R) were conducted amongst other invariant procedures. Results. The mean score for the individual items of SCQIPP questionnaire was between 2.0 and 4.7 (scale range 1-5) and the percentage of patients answers 'strongly agree' ranged from 4.4 to 77%. The smallest number of positive answers were given by the patients for the item 'In order to assess pain intensity, some of the staff asked me at least once in the morning, in the afternoon and in the evening to show the number from 0-10'. Most of the patients (57%) evaluated severe pain during the previous 24 hours, as moderate pain, which represents significantly greater number of patients which complain of severe pain and mild pain (p < 0.001). The analysis of patients evaluation (MANOVA p < 0.05 and discriminative p < 0.05) indicates the existence of significant difference between the assessment of nursing care quality in managing acute postoperative pain as regards to clinics as the place for pain management, patient's sex and his expectations. Evaluation from 'communication' subscale gives the greatest contribution (24.9%) to the difference between the observed clinics, and the greatest contribution (25.7%) to the difference in evaluation of nursing care quality as regards to patients' sex has the evaluations from 'procedure' subscale. Conclusion. The results of this study show a useful evidence and identify aspects of nursing care in postoperative management of acute pain which are still to be improved. According to the patients' answers the priority should be given to a regular assessment of the intensity of postoperative pain and evaluation of the effects of analgesic therapy.

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An Interactive Pain Application (MServ) Improves Postoperative Pain Management

Pain Research and Management ◽

10.1155/2021/8898170 ◽

2021 ◽

Vol 2021 ◽

pp. 1-12

Author(s):

Richard Gordon-Williams ◽

Andreia Trigo ◽

Paul Bassett ◽

Amanda Williams ◽

Stephen Cone ◽

...

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Nursing Staff ◽

Pain Control ◽

Standard Care ◽

Severe Pain ◽

Postoperative Pain Management ◽

Pain Scale ◽

Opioid Prescription ◽

Patient Reported

Background. Most patients have moderate or severe pain after surgery. Opioids are the cornerstone of treating severe pain after surgery but cause problems when continued long after discharge. We investigated the efficacy of multifunction pain management software (MServ) in improving postoperative pain control and reducing opioid prescription at discharge. Methods. We recruited 234 patients to a prospective cohort study into sequential groups in a nonrandomised manner, one day after major thoracic or urological surgery. Group 1 received standard care (SC, n = 102), group 2 were given a multifunctional device that fed back to the nursing staff alone (DN, n = 66), and group 3 were given the same device that fed back to both the nursing staff and the acute pain team (DNPT, n = 66). Patient-reported pain scores at 24 and 48 hours and patient-reported time in severe pain, medications, and satisfaction were recorded on trial discharge. Findings. Odds of having poor pain control (>1 on 0–4 pain scale) were calculated between standard care (SC) and device groups (DN and DNPT). Patients with a device were significantly less likely to have poor pain control at 24 hours (OR 0.45, 95% CI 0.25, 0.81) and to report time in severe pain at 48 hours (OR 0.62, 95% CI 0.47–0.80). Patients with a device were three times less likely to be prescribed strong opioids on discharge (OR 0.35, 95% CI 0.13 to 0.95). Interpretation. Using an mHealth device designed for pain management, rather than standard care, reduced the incidence of poor pain control in the postoperative period and reduced opioid prescription on discharge from hospital.

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