Intravenous Lidocaine for Rib Fractures: Effect on Pain Control and Outcome

Background Multimodal analgesia in rib fractures (RFs) is designed to maximize pain control while minimizing narcotics. Prior research with intravenous lidocaine (IVL) efficacy produced conflicting results. We hypothesized IVL infusion reduces opioid utilization and pain scores. Methods A retrospective review of RF patients at an ACS-verified Level I trauma center from April 2018 to 2/2020 was conducted. Patients (pts) stratified as receiving IVL vs no IVL. Initial lidocaine dose: 1 mg/kg/hr with a maximum of 3 mg/kg/hr. Duration of infusion: 48 h. Pain quantified by the Stanford Pain Score system (PS). Bivariate and multivariate analyses of variables were performed on SPSS, version 21 (IBM Corp). Results 414 pts met inclusion criteria: 254 males and 160 females. The average age for the non-IVL = 67.4 ± 15.2 years vs IVL = 58.3 ± 17.1 years ( P < .001). There were no statistically significant differences between groups for ISS, PS for initial 48 h, and ICU length of stay (LOS). There was a difference in morphine equivalents per hour: non-IVL = 1.25 vs IVL = 1.72 ( P = .004) and LOS non-IVL = 10.2+/−7.6 vs IVL = 7.82+/−4.94. By analyzing IVL pts in a crossover comparison before and after IVL, there was reduction in opiates: 3.01 vs 1.72 ( P < .001) and PS: 7.0 vs 4.9 ( P < .001). Stanford Pain Score system reduction in the IVL = 48.3 ± 23.9%, but less effective in narcotic dependency (27 ± 22.9%, P = .035); IVL pts had hospital cost reduction: $82,927 vs $118,202 ( P < .01). Discussion In a crossover analysis, IVL is effective for reduction of PS and opiate use and reduces hospital LOS and costs. Patient age may confound interpretation of results. Our data support IVL use in multimodal pain regimens. Future prospective study is warranted.

Download Full-text

Multimodal Analgesia Protocol after Head and Neck Surgery: Effect on Opioid Use and Pain Control

Otolaryngology ◽

10.1177/0194599819841885 ◽

2019 ◽

Vol 161 (3) ◽

pp. 424-430 ◽

Cited By ~ 9

Author(s):

Eugenie Du ◽

Zainab Farzal ◽

Elizabeth Stephenson ◽

April Tanner ◽

Katherine Adams ◽

...

Keyword(s):

Head And Neck ◽

Pain Control ◽

Neck Surgery ◽

Multimodal Analgesia ◽

Quality Improvement Initiative ◽

Opioid Use ◽

Protocol Implementation ◽

Pain Scores ◽

Before And After ◽

Average Pain

Objective To assess the effect that implementation of a multimodal analgesic plan has on opioid requirements and pain control in head and neck (H&N) surgery patients. Study Design Prospective cohort. Setting Tertiary academic hospital. Subjects and Methods An institutional review board (IRB)–approved quality improvement initiative was undertaken to implement a multimodal analgesic protocol for all admitted H&N surgery patients starting November 2017. Postprotocol data from January to May 2018 were compared to preprotocol data from May to October 2017. Data were obtained from the electronic health records as well as through preoperative and postoperative surveys. Average pain scores and opioid use in morphine milligram equivalents (MMEs) before and after protocol implementation were compared. Results In total, 139 postprotocol patients were compared to 89 preprotocol patients. The adjusted MMEs in the first 24 hours after surgery decreased significantly from 93.7 mg to 58.6 mg ( P = .026) with protocol implementation. When averaged over the length of stay (MME/hospital day), the change was no longer statistically significant (57.9 vs 46.8 mg, P = .211). The average pain score immediately after surgery and on day of discharge did not change with protocol implementation. Conclusion Implementation of a multimodal analgesia plan reduced opioid use immediately after surgery but not over the course of hospitalization without any change in reported pain scores. This study shows that multimodal opioid-sparing analgesia after H&N surgery is feasible. Future studies are needed further refine the optimal analgesic strategy for H&N patients and assess the long-term efficacy, safety, and cost of such regimens.

Download Full-text

Efficacy of Methocarbamol for Acute Pain Management in Young Adults With Traumatic Rib Fractures

Annals of Pharmacotherapy ◽

10.1177/1060028020964796 ◽

2020 ◽

pp. 106002802096479

Author(s):

Lindsay P. Deloney ◽

Melanie Smith Condeni ◽

Cassandra Carter ◽

Alicia Privette ◽

Stuart Leon ◽

...

Keyword(s):

Young Adults ◽

Pain Control ◽

Oral Morphine ◽

Hospital Length ◽

Rib Fractures ◽

Hospital Length Of Stay ◽

Control Regimen ◽

Before And After ◽

The Impact ◽

Level 1 Trauma Center

Background: Rib fractures account for more than one-third of blunt thoracic injuries and are associated with serious complications. Use of nonopioid adjunctive agents such as methocarbamol for pain control has increased considerably. Objective: This study aimed to assess the impact of methocarbamol addition to the pain control regimen on daily opioid requirements for young adults with rib fractures. Methods: This observational, retrospective study included patients aged 18 to 39 years with 3 or more rib fractures who were admitted to a level 1 trauma center between July 2014 and July 2018. Patients were dichotomized based on admission before and after methocarbamol addition to the institutional rib fracture protocol. The primary outcome was to determine the impact of methocarbamol on daily opioid requirements. Secondary outcomes included hospital length of stay (LOS) and diagnosis of pneumonia. Results: A total of 50 patients were included, with 22 and 28 patients in the preprotocol and postprotocol groups, respectively. All patients in the latter group received methocarbamol, whereas no patient in the preprotocol group received methocarbamol. Cumulative opioid exposure was significantly less for patients admitted after methocarbamol addition to the protocol (219 vs 337 mg oral morphine equivalents; P = 0.01), and hospital LOS was also decreased (4 vs 3 days; P = 0.03). No significant differences in the incidence of pneumonia or adverse effects were observed. Conclusion and Relevance: This is the first study to evaluate the impact of methocarbamol on reducing opioid requirements. Given the risks associated with opioids, use of methocarbamol as an analgesia-optimizing, opioid-sparing multimodal agent may be reasonable.

Download Full-text

Multimodal Analgesia (MMA) Versus Patient-Controlled Analgesia (PCA) for One or Two-Level Posterior Lumbar Fusion Surgery

Journal of Clinical Medicine ◽

10.3390/jcm9041087 ◽

2020 ◽

Vol 9 (4) ◽

pp. 1087

Author(s):

Sung-Woo Choi ◽

Hyeung-Kyu Cho ◽

Suyeon Park ◽

Jae Hwa Yoo ◽

Jae Chul Lee ◽

...

Keyword(s):

Side Effects ◽

Hospital Stay ◽

Pain Score ◽

Pain Control ◽

Lumbar Fusion ◽

Length Of Hospital Stay ◽

Multimodal Analgesia ◽

Opioid Consumption ◽

Patient Controlled Analgesia ◽

Posterior Lumbar Fusion

A multimodal analgesic method was known to avoid the high-dose requirements and dose-dependent adverse events of opioids, and to achieve synergistic effects. The purpose of this study was to compare the efficacy of our multimodal analgesia (MMA) regimen with that of the patient-controlled analgesia (PCA) method for acute postoperative pain management. Patients who underwent one or two-level posterior lumbar fusion (PLF) followed by either MMA or PCA administration at our hospital were compared for pain score, additional opioid and non-opioid consumption, side effects, length of hospital stay, cost of pain control, and patient satisfaction. From 2016 through 2017, a total 146 of patients were screened. After propensity score matching, 66 remained in the PCA and 34 in the MMA group. Compared with the PCA group, the MMA group had a shorter length of hospital stay (median (interquartile range): 7 days (5–8) vs. 8 (7–11); P = 0.001) and lower cost of pain control (70.6 ± 0.9 USD vs. 173.4 ± 3.3, P < 0.001). Baseline data, clinical characteristics, pain score, additional non-opioid consumption, side effects, and patient subjective satisfaction score were similar between the two groups. The MMA seems to be a good alternative to the PCA after one or two-level PLF.

Download Full-text

Study of Pain Level Control Targets After Arthroscopic Surgery

10.21203/rs.3.rs-253532/v2 ◽

2021 ◽

Author(s):

Wang Xin ◽

Liu Congying ◽

Zhang Xiaole ◽

Wang Hong ◽

Xu Yan ◽

...

Keyword(s):

Postoperative Pain ◽

Pain Score ◽

Pain Control ◽

Rating Scale ◽

Numerical Rating Scale ◽

Arthroscopic Surgery ◽

Daily Activities ◽

Pain Level ◽

Convenience Sampling ◽

The Impact

Abstract Objective: To explore the goal of pain control in patients after arthroscopic surgery.Design: Investigation. Postoperative pain, pain control satisfaction and the effect of pain on daily activities were investigated and evaluated.Setting: Department of Sports Medicine,Peking University 3rd Hospital,Beijing, P.R.ChinaSubjects: 514 patients selected by convenience sampling from patients hospitalized in a level A hospital in Beijing from 2020.06-2020.11. The patient inclusion criteria were an age of at least 18 years, no history of diagnosis of mental illness, the ability to clearly express his or her pain and an agreement to voluntarily cooperate with the investigators. The exclusion criteria were patients who were unable to complete follow-up.Methods: Postoperative pain, pain control satisfaction and the effect of pain on daily activities were investigated and evaluated by administering a homemade questionnaire to 514 patients selected by convenience sampling from patients hospitalized in a level A hospital in Beijing from 2020.06-2020.11. Pain was assessed using a digital pain numerical rating scale (NRS) (0-10), and a digital score ranging from 0 to 10 was used for satisfaction with pain control and the impact of pain on aspects of daily living.Results: The pain level was most severe in patients 6-24 hours after arthroscopic surgery, during which pain control satisfaction was at its worst. The pain score was significantly related to the effects of pain on aspects of daily life, and the degree of these effects changed significantly for pain scores greater than 2 points.Conclusion: Pain control 6 to 24 hours after surgery is not satisfactory. It is recommended that a pain score of 2 points is used as the goal for pain control after arthroscopic surgery to guide both doctors and patients to effectively control postoperative pain.

Download Full-text

Efficacy of continuous epidural block with epidural electrical stimulation compared to conventional continuous epidural block for acute herpes zoster management: A retrospective study

10.21203/rs.2.14636/v1 ◽

2019 ◽

Author(s):

Chung Hun Lee ◽

Sang Sik Choi ◽

Mi Kyoung Lee ◽

Yeon Joo Lee ◽

Jong Sun Park

Keyword(s):

Electrical Stimulation ◽

Herpes Zoster ◽

Complete Remission ◽

Pain Score ◽

Pain Control ◽

Odds Ratio ◽

Electric Stimulation ◽

Adjusted Odds Ratio ◽

Epidural Block ◽

Acute Herpes Zoster

Abstract Background Continuous epidural block is commonly used in clinical settings and reduces the likelihood of transition to postherpetic neuralgia via pain control. The purpose of the present study was to compare the efficacies of conventional continuous epidural block and continuous epidural block involving electric stimulation-guided localization of the catheter to areas with neurological damage, in the treatment of herpes zoster pain and prevention of postherpetic neuralgia.Methods We analyzed the medical records of 114 patients in the present study. The patients were divided into two groups: esopocan (conventional continuous epidural block) and epistim (continuous epidural block with epidural electric stimulation). In the esopocan group, the position of the epidural catheter was confirmed using contrast medium alone, whereas in the epistim group, the site of herpes zoster infection was identified through electric stimulation using the guidewire in the catheter. Clinical efficacy was assessed using a numerical rating scale (pain score) up to 6 months after the procedures. We compared the percentage of patients who showed complete remission (pain score less than 2 and no further medication) in each group. We also investigated whether the patients required additional interventional treatment due to insufficient pain control during the 6 month follow-up period after each procedure.Results After adjusting for confounding variables, the pain score was significantly lower in the epistim group than in the esopocan group for 6 months after the procedure. The adjusted odds ratio of patients included in the complete remission category was 1.9 times higher in the epistim group than the esopocan group (95% confidence interval: 0.81-4.44, P = 0.14). The adjusted odds ratio for other interventions within 6 months after the procedure was 3.62 times higher in the esopocan group than the epistim group (95% confidence interval: 1.17-11.19, P = 0.03). Conclusion Epidural drug administration to specific spinal segments using electrical stimulation catheters may be more helpful than conventional continuous epidural block in improving pain and preventing postherpetic neuralgia in acute herpes zoster.

Download Full-text

The Effect of Aroma Therapy Olive Oil Massage to Pain Dysmenorrhea on Midwifery Level I and II Students at Tri Mandiri Sakti Institute of Health Sciences

Jurnal Sains Kesehatan ◽

10.37638/jsk.25.3.22-32 ◽

2018 ◽

Vol 25 (3) ◽

pp. 22-32

Author(s):

Tria Nopi Herdiani ◽

Mika Oktarina ◽

Yeni Nuraeni

Keyword(s):

Standard Deviation ◽

Olive Oil ◽

Sampling Technique ◽

Health Sciences ◽

Pain Scale ◽

Adolescent Women ◽

Before And After ◽

Post Test ◽

Average Pain ◽

Level I

Reproductive health problems are dysmenorrhea is a problem related with menstruation. research show the highest prevalence of menstrual pain in adolescent women, adolescent who experience dysmenorrhea report pain that interferes with daily activities. Handling to reduce pain during menstruation, one of which is using the olive oil aroma therapy aroma method. This research to determine the effect of aroma therapy olive oil massage pain dysmenorrhea on midwifery student level I and II Stikes Tri Mandiri Sakti Bengkulu.This study used a pre experiment in one group (one group pre-post test design) the dependent variable of pain before and after treatment. Sampling was done by accidental sampling technique using the criteria totaling 41 student who experience dysmenorrhea. The study was conducted from May to June 2017. Retrievel of data using the observatioan sheet and analyzed using compared mean paired T-test. The Result of the research: (1) At 41 people in the first and second grade obstetric students who had dysmenorrhea before the massive olive oil odor therapy aroma got the average pain scale 5,73 with the standard deviation 1,450. (2) In 41 subjects who had dysmenorrhea after the massage of olive oil odor therapy, the average pain scale was 5,00 with a standard deviation of 1,414. (3) There is massive effect of olive oil odor therapy to dysmenorrhea pain in female students of Level I and II Prodi DIII Midwifery Tri Mandiri Sakti Institute of Health Sciences Bengkulu. Keywords : aroma therapy, dysmenorrhea, massage

Download Full-text