Randomized Prospective Evaluation of Intraoperative Intravenous Acetaminophen in Pediatric Adenotonsillectomy

2017 ◽  
Vol 158 (2) ◽  
pp. 368-374 ◽  
Author(s):  
Christopher A. Roberts ◽  
Shivani Shah-Becker ◽  
Ashley O’Connell Ferster ◽  
Aaron Baker ◽  
Lauren E. Stahl ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Breakthrough Pain ◽  
Medical Center ◽  
Academic Medical Center ◽  
Postoperative Nausea And Vomiting ◽  
Postoperative Pain Management ◽  
Pain Medication ◽  
Pain Scores ◽  
Pain Medications ◽  
Group 2

Objective To establish the safety and efficacy of single-dose intraoperative intravenous (IV) acetaminophen in postoperative pain management following adenotonsillectomy in addition to a standardized regimen of oral pain medication. Study Design Randomized, controlled prospective clinical trial. Setting Single academic medical center. Subjects and Methods Patients between the ages of 3 and 17 years scheduled for tonsillectomy or adenotonsillectomy by a single surgeon between December 2014 and November 2016 were recruited. Patients were randomly assigned to 1 of 2 groups; group 1 received a single intraoperative dose of IV acetaminophen, and group 2 did not. Induction and maintenance of anesthesia, as well as operative technique, were standardized. Nursing pain scores, pain medications administered, and recovery times were reviewed during the 24-hour postoperative period. Postoperative pain regimen included standing alternating oral acetaminophen and ibuprofen. Results In total, 260 patients were included in the study, and 131 (50.4%) received a single intraoperative dose of IV acetaminophen. Patients receiving IV acetaminophen were more likely to experience postoperative nausea and vomiting than patients who did not receive IV acetaminophen (1.53% vs 0.00%, P = .016). There were no significant differences noted for postoperative pain scores, requirements for breakthrough pain medications, time to discharge from the recovery room or hospital, or postoperative complications. Conclusion The use of a single intraoperative dose of IV acetaminophen was associated with minimal additional adverse effects. However, a single intraoperative IV dose of acetaminophen added to standard narcotic and nonnarcotic pain medication does not provide a statistically significant improvement in pain control.

Postoperative pain management with tramadol after craniotomy: evaluation and cost analysis

2010 ◽  
Vol 112 (2) ◽  
pp. 268-272 ◽  
Author(s):  
Scott Y. Rahimi ◽  
Cargill H. Alleyne ◽  
Eric Vernier ◽  
Mark R. Witcher ◽  
John R. Vender
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Management Strategies ◽  
Length Of Hospital Stay ◽  
Postoperative Pain Management ◽  
Control Group ◽  
Pain Scores ◽  
Pain Medications ◽  
Hospitalization Costs ◽  
Hospital Stays

Object Patients undergoing craniotomies have traditionally received opiates with acetaminophen for the management of their postoperative pain. The use of narcotic pain medications can be costly, decrease rates of early postoperative ambulation, lengthen hospital stays, and alter a patient's neurological examination. The use of alternative pain medications such as tramadol may benefit patients by resolving many of these issues. Methods The authors conducted a randomized, blinded prospective study to evaluate the efficacy of alternative pain management strategies for patients following craniotomies. Fifty patients were randomly assigned either to a control group who received narcotics and acetaminophen alone or an experimental group who received tramadol in addition to narcotic pain medications (25 patients assigned to each group). Results The control group was noted to have statistically significant higher visual analog scale pain scores, an increased length of hospital stay, and increased narcotic use compared with the tramadol group. The narcotics and acetaminophen group also had increased hospitalization costs when compared with the tramadol group. Conclusions The use of scheduled atypical analgesics such as tramadol in addition to narcotics with acetaminophen for the management of postoperative pain after craniotomy may provide better pain control, decrease the side effects associated with narcotic pain medications, encourage earlier postoperative ambulation, and reduce total hospitalization costs.

scholarly journals Immediate Postoperative Pain Scores Predict Neck Pain Profile up to 1 Year Following Anterior Cervical Discectomy and Fusion

2017 ◽  
Vol 8 (3) ◽  
pp. 231-236 ◽  
Author(s):  
Owoicho Adogwa ◽  
Aladine A. Elsamadicy ◽  
Victoria D. Vuong ◽  
Ankit I. Mehta ◽  
Raul A. Vasquez ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Neck Pain ◽  
Medical Center ◽  
Academic Medical Center ◽  
Anterior Cervical Discectomy ◽  
Cervical Discectomy ◽  
Regression Methods ◽  
Pain Scores ◽  
Academic Medical ◽  
Patient Reported

Study Design: Retrospective cohort review. Objective: To assess whether immediate postoperative neck pain scores accurately predict 12-month visual analog scale–neck pain (VAS-NP) outcomes following Anterior Cervical Discectomy and Fusion surgery (ACDF). Methods: This was a retrospective study of 82 patients undergoing elective ACDF surgery at a major academic medical center. Patient reported outcomes measures VAS-NP scores were recorded on the first postoperative day, then at 6-weeks, 3, 6, and 12-months after surgery. Multivariate correlation and logistic regression methods were utilized to determine whether immediate postoperative VAS-NP score accurately predicted 1-year patient reported VAS-NP Scores. Results: Overall, 46.3% male, 25.6% were smokers, and the mean age and body mass index (BMI) were 53.7 years and 28.28 kg/m2, respectively. There were significant correlations between immediate postoperative pain scores and neck pain scores at 6 weeks VAS-NP ( P = .0015), 6 months VAS-NP ( P = .0333), and 12 months VAS-NP ( P = .0247) after surgery. Furthermore, immediate postoperative pain score is an independent predictor of 6 weeks, 6 months, and 1 year VAS-NP scores. Conclusion: Our study suggests that immediate postoperative patient reported neck pain scores accurately predicts and correlates with 12-month VAS-NP scores after an ACDF procedure. Patients with high neck pain scores after surgery are more likely to report persistent neck pain 12 months after index surgery.

scholarly journals Opioid Utilization in Adults Hospitalized with Sickle Cell Pain Crises: An Understudied Population

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5884-5884
Author(s):  
Angie Mae Rodday ◽  
Kimberly S Esham ◽  
Nicole S Savidge ◽  
Daqin Mao ◽  
Ruth Ann Weidner ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Sickle Cell ◽  
Medical Center ◽  
Academic Medical Center ◽  
Pain Medication ◽  
Acute Chest Syndrome ◽  
Opioid Prescription ◽  
Medication Prescription ◽  
Pain Scores ◽  
Long Acting

Abstract Background: Vaso-occlusive crises (VOC), also known as painful crises, are the hallmark of sickle cell disease (SCD) and adults hospitalized with VOC are among the most severe cases. In the midst of the opioid epidemic, appropriate pain management must be available for these patients when they develop VOC. We describe patient, disease, and treatment characteristics at the time of hospitalization for patients with SCD experiencing VOC. Methods: This retrospective cohort study includes 449 consecutive hospitalizations for VOC among 63 adult patients (≥18 years) with SCD from 2013-2016 at Tufts Medical Center, an academic medical center in Boston, MA. For the current analysis, one hospitalization was randomly selected for each patient (median hospitalizations per patient=4, range=1-45). Demographics, SCD characteristics and complications, pain scores (0-10), and pain medication regimens (pre-admission, inpatient, discharge) were abstracted from electronic medical records (EMR) by trained study staff. History of SCD complications (e.g., acute chest syndrome, avascular necrosis), modeled after the 9-item ASCQ-Me SCD Medical History Checklist (Keller et al. Health and Quality of Life Outcomes, 2017), were obtained from the EMR and subsequently reviewed by two hematologists. Data were described using summary statistics, including means, standard deviations (SD) medians, quartiles (q1, q3), frequencies, and percentages. Results: Mean age was 27.6 years (SD=8.1), 44.4% were male, 77.8% were black, and 19.1% were Hispanic. The majority of patients (92.1%) were publicly insured (27.0% Medicare; 65.1% Medicaid); only 7.9% were privately insured. Patients had a median of 3 medical complications of SCD. Affective disorders were documented for 33.3%; substance use disorders for 6.4%. Median pain scores were 9 (8, 10) at admission and 4 (2, 6) at discharge; the median length of stay was 8 days (5, 11). Prior to admission, 87.3% of patients had a home opioid prescription and 20.6% had a neuropathic pain medication prescription (Table). During the hospitalization, 100% received opioids with 36.5% delivered via patient-controlled analgesia (PCA). Neuropathic pain medication was given to 28.6% of hospitalized patients. At discharge, nearly all (98.4%) were prescribed home opioids and 24.6% were discharged with neuropathic pain medication. With regards to treatment combinations across phases of care, approximately half of patients received both short- and long-acting opioids and less than 20% received long-acting opioids and neuropathic pain medication. Conclusions: All patients with SCD hospitalized with VOC were admitted with significant pain and treated with opioids. Pain decreased during the hospitalization, but did not fully resolve by discharge. Treatment combinations of short- and long-acting opioids and neuropathic pain medication suggest complex acute-on-chronic SCD pain with mixed pain types among this cohort of patients with high-severity SCD. Opioids are an integral component of treatment regimens for patients suffering from debilitating acute-on-chronic pain, such as those with SCD. Disclosures Parsons: Seattle Genetics: Research Funding.

Preemptive analgesia in hip arthroscopy: intra-articular bupivacaine does not improve pain control after preoperative peri-acetabular blockade

2020 ◽  
pp. 112070002095024
Author(s):  
Efi Kazum ◽  
Ehud Rath ◽  
Amir Shlaifer ◽  
Zachary T Sharfman ◽  
Hal D Martin ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Hip Arthroscopy ◽  
Pain Control ◽  
Recovery Room ◽  
Postoperative Pain Management ◽  
Control Group ◽  
Analgesic Consumption ◽  
Pain Scores ◽  
Group 2 ◽  
Group 1

Introduction: Literature addressing postoperative pain management after hip arthroscopy is relatively scarce. This study aimed to assess if there was added analgesic benefit associated with postoperative intra-articular bupivacaine blockade for patients who received preoperative peri-acetabular blockade for hip arthroscopy procedures. Methods: 52 patients were included in this comparative cohort study. Group 1 consisted of 20 patients who received preoperative peri-acetabular blockade and postoperative intra-articular blockade. The control group (Group 2), consisted of 32 patients who received only preoperative peri-acetabular blockade. Postoperative pain was recorded via visual analogue scale (VAS) pain scores, analgesic consumption, and pain diaries for 2 weeks postoperatively. Results: Postoperative VAS pain scores were significantly lower in the experimental group at the 30-minute recovery room assessment (VAS scores Group 1: 1.1; Group 2: 3.00, p = 0.034). Other than the 30-minute recovery room assessment, VAS pain scores, narcotic medication consumption, and non-narcotic analgesic consumption did not differ between the 2 groups at any time point in the study period. Conclusions: This study did not demonstrate significant clinical benefit for patients who receive postoperative intra-articular blockade in addition to preoperative peri-acetabular blockade with bupivacaine 0.5%. We recommend the use of preoperative peri-acetabular bupivacaine blockade without intra-articular blockade postoperatively for pain control in the setting of hip arthroscopy surgery.

Transdermal Buprenorphine- A novel Medication for Postoperative Pain Management Following Abdominal Hysterectomy for Benign Gynecological Conditions

2021 ◽  
Vol 17 ◽  
Author(s):  
Aarti Yevale ◽  
Jyothi Shetty ◽  
Vidyashree G Poojari ◽  
Vasudeva Guddattu
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Postoperative Nausea And Vomiting ◽  
Postoperative Pain Management ◽  
Abdominal Hysterectomy ◽  
Postoperative Pain Relief ◽  
Safe Alternative ◽  
Intravenous Paracetamol ◽  
Semisynthetic Derivative ◽  
Time Frames

Background: Buprenorphine is a semisynthetic derivative of thebaine which is 75–100 times more potent than morphine and causes less respiratory depression. Efficacy and safety of transdermal buprenorphine have been well established in chronic pain, but data regarding acute postoperative pain relief are still limited. Aim: In this study we compared the efficacy of transdermal buprenorphine patch with injectable tramadol for the relief of postoperative pain (POP) following abdominal hysterectomy for benign gynecological conditions. Settings and design: three-year prospective observational study. Methods and material: One hundred patients undergoing abdominal hysterectomy were allocated to one of two groups. Buprenorphine group: we applied 10 mcg/hr transdermal buprenorphine patch on the lateral upper arm after surgery. The onset of relief from a patch is 8 to 16 hours. So, all patients were given diclofenac suppository 100mg before induction of anesthesia as preemptive analgesic to reduce postoperative pain. Injectable tramadol group : received intramuscular tramadol injections 50mg every 8 hours in the postoperative period. Patients were followed for two days to look for postoperative pain relief and adverse effects. If patients showed a visual analog pain (VAS) score >3, intravenous paracetamol was administered as rescue analgesic. Results: POP was assessed at different time frames: 12, 24, 36 and 48 hours after hysterectomy. Mean pain score at rest, in buprenorphine group was significantly lower than that of the tramadol group. Patients experienced less pain on mobility in the buprenorphine group compared with the tramadol group, which was statistically significant. Conclusion: We concluded that transdermal buprenorphine is an effective and safe alternative to injectable tramadol for providing postoperative analgesia. It provides a higher degree of pain relief, faster postoperative mobilization, lower incidence of postoperative nausea and vomiting and higher satisfaction scores starting 12 hours after surgery. However, for the first 12 post-operative hours, there is need for additional analgesia.

scholarly journals Ultrasound-Guided Funicular Block: Ropivacaine Injection into the Tissue around the Spermatic Cord to Improve Analgesia during Orchiectomy in Dogs

Animals ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 1275
Author(s):  
Vincenzo Cicirelli ◽  
Pasquale Debidda ◽  
Nicola Maggio ◽  
Michele Caira ◽  
Giovanni M. Lacalandra ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
General Anaesthesia ◽  
Spermatic Cord ◽  
Postoperative Pain Management ◽  
Control Group ◽  
Ultrasound Guided ◽  
Hemodynamic Stability ◽  
Pain Scores ◽  
Lower Pain ◽  
Ropivacaine Hydrochloride

Orchiectomy is a common surgical procedure performed on small animals, and it requires postoperative pain management despite its relative simplicity. This study aimed to evaluate the hemodynamic stability, intraoperative administration of additional hypnotic and/or analgesic drugs, and postoperative pain scores following the combination of ultrasound-guided injection of ropivacaine hydrochloride into the spermatic cord and infiltration by the same anaesthetic of the incisional prescrotal line (ROP) or general anaesthesia. Dogs in the ROP group showed greater intraoperative hemodynamic stability and lower pain scores than the control group. The locoregional approach used in this study proved effective in minimising the responses to the surgical stimulus and ensured adequate analgesia intra- and postoperatively. This method, called ultrasound-guided funicular block, allows orchiectomy to be performed under deep sedation without general anaesthesia.

Sex, Race, Insurance, and Pain: Do Patient Sociodemographics Influence Postoperative Opioid Prescriptions Among Hand Surgeons?

Hand ◽  
2021 ◽  
pp. 155894472199802
Author(s):  
Connor J. Peck ◽  
Martin Carney ◽  
Alexander Chiu ◽  
Kitae E. Park ◽  
Alexandre Prassinos ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Medical Center ◽  
Carpal Tunnel Release ◽  
Private Insurance ◽  
Academic Medical Center ◽  
Age Groups ◽  
Postoperative Pain Management ◽  
Patient Treatment ◽  
Opioid Prescription ◽  
History Of

Background: Social and demographic factors may influence patient treatment by physicians. This study analyzes the influence of patient sociodemographics on prescription practices among hand surgeons. Methods: We performed a retrospective analysis of all hand surgeries (N = 5278) at a single academic medical center from January 2016 to September 2018. The average morphine milligram equivalent (MME) prescribed following each surgery was calculated and then classified by age, race, sex, type of insurance, and history of substance use or chronic pain. Multivariate linear regression was used to compare MME among groups. Results: Overall, patients with a history of substance abuse were prescribed 31.2 MME more than those without ( P < .0001), and patients with a history of chronic pain were prescribed 36.7 MME more than those without ( P < .0001). After adjusting for these variables and the type of procedure performed, women were prescribed 11.2 MME less than men ( P = .0048), and Hispanics were prescribed 16.6 MME more than whites ( P = .0091) overall. Both Hispanic and black patients were also prescribed more than whites following carpal tunnel release (+19.0 and + 20.0 MME, respectively; P < .001). Patients with private insurance were prescribed 24.5 MME more than those with Medicare ( P < .0001), but 25.0 MME less than those with Medicaid ( P < .0001). There were no differences across age groups. Conclusions: Numerous sociodemographic factors influenced postoperative opioid prescription among hand surgeons at our institution. These findings highlight the importance of establishing more uniform, evidence-based guidelines for postoperative pain management, which may help minimize subjectivity and prevent the overtreatment or undertreatment of pain in certain patient populations.

scholarly journals Analgesic Effects of Preincision Ketamine on Postspinal Caesarean Delivery in Uganda’s Tertiary Hospital: A Randomized Clinical Trial

2017 ◽  
Vol 2017 ◽  
pp. 1-6
Author(s):  
Richard Mwase ◽  
Tonny Stone Luggya ◽  
John Mark Kasumba ◽  
Humphrey Wanzira ◽  
Andrew Kintu ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Rating Scale ◽  
Breakthrough Pain ◽  
Numerical Rating Scale ◽  
Postoperative Pain Management ◽  
Mulago Hospital ◽  
Clinical Trial Registry ◽  
Analgesic Effects ◽  
Pain Scores ◽  
Intravenous Ketamine

Background. Good postoperative analgesic management improves maternal satisfaction and care of the neonate. Postoperative pain management is a challenge in Mulago Hospital, yet ketamine is accessible and has proven benefit. We determined ketamine’s postoperative analgesic effects.Materials and Methods. We did an RCT among consenting parturients that were randomized to receive either intravenous ketamine (0.25 mg/kg) or placebo after spinal anesthetic. Pain was assessed every 30 mins up to 24 hours postoperatively using the numerical rating scale. The first complaint of pain requiring treatment was noted as “time to first breakthrough pain.”Results. We screened 100 patients and recruited 88 that were randomized into two arms of 44 patients that received either ketamine or placebo. Ketamine group had 30-minute longer time to first breakthrough pain and lower 24-hour pain scores. Postoperative diclofenac consumption was lesser in the ketamine group compared to placebo and Kaplan-Meier graphs showed a higher probability of experiencing breakthrough pain earlier in the placebo group.Conclusion. Preincision intravenous ketamine (0.25 mg/kg) offered 30-minute prolongation to postoperative analgesia requirement with reduced 24-hour pain scores. We recommend larger studies to explore this benefit. This trial is registered with Pan African Clinical Trial Registry numberPACTR201404000807178.

scholarly journals Our first Experience of Continuous Fascia Iliaca Compartment Block for Post Operative Analgesia in a Case of Fracture Femur in TU Teaching Hospital

2018 ◽  
Vol 16 (2) ◽  
pp. 248-250
Author(s):  
Bigen Man Shakya ◽  
Ninadini Shrestha
Keyword(s):  
Case Report ◽  
Pain Management ◽  
Postoperative Pain ◽  
Teaching Hospital ◽  
Postoperative Pain Management ◽  
The Elderly ◽  
Pain Medication ◽  
Fracture Femur ◽  
Fascia Iliaca Compartment Block

The postoperative pain management in the elderly is challenging due to comorbidities and change in physiology due to age itself. This limit the use of medication which include pain medication also. The fascia iliaca compartment block has been described in the literature for fracture of femur. It has even been safely used by non anaesthesiologist also. To our knowledge, we did not find any case report of continuous fascia iliaca compartment block published in Nepal. This is our first experience of successful continous fasicia iliaca compartment block in case of 89 year old lady with multiple co morbidities in whom traditional pain medication might be difficult to use. We encourage to practice this block which is both safe and easy to perform with good results.

scholarly journals Reduced Postoperative Pain and Complications after a Modified Multidisciplinary Approach for Bariatric Surgery

2013 ◽  
Vol 5 (1) ◽  
pp. 60-64 ◽  
Author(s):  
Rachel A. Karlnoski ◽  
Collin Sprenker B.S ◽  
Suvikram Puri ◽  
Ren Chen ◽  
Devanand Mangar ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Pain Management ◽  
Postoperative Pain ◽  
Hospital Stay ◽  
Medical Center ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Pain Scores ◽  
Operative Care ◽  
Analgesic Regimen

Background: There are considerable implications for pain management in morbidly obese patients undergoing weight loss operations. The purpose of this study was to determine if a modified postoperative analgesic regimen and a dedicated postoperative bariatric team reduced pain scores, length of stay and postoperative complications. Materials and Methods: We performed a retrospective analysis of morbidly obese patients admitted to our medical center for laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic adjustable gastric banding (LAGB). Our previous postoperative pain regimen was ketorolac (30 mg IV plus 15 mg q6h) and patient controlled analgesia (PCA) morphine and was converted to ketorolac (30 mg IV and 30 mg i.m, plus 15 mg q6h), and IV PCA hydromorphone. Visual analog scale (VAS) pain scores from the post-operative care unit were collected retrospectively. The bariatric team was led by a nurse practitioner consisted of a psychologist, exercise physiologist, and nutritionist. Results: Eighty-five patients underwent bariatric operations in the year prior to implementation of the revised postoperative pain management regimen and 372 patients underwent bariatric surgery in the 2 years following implementation. Patient age, gender and BMI were evenly distributed for both groups. Mean VAS scores on postoperative days 1 through 5 were significantly lower after implanting our modified pain regimen (p<0.0001). Pain scores were significantly higher for patients that underwent LRYGB compared to LAGB (p<0.0001). Overall, length of hospital stay was unaffected by the new pain regimen, however a significant reduction was found in patients that underwent LAGB (0.8 days less; p=0.0001). Conclusion: Use of our modified pain regimen resulted in a more effective analgesic protocol and a reduction of hospital stay, without added complications or side effects.

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