Impact of Intravenous Methadone Administered Intraoperatively on Postoperative Opioid Utilization

Background: Studies have shown that intravenous methadone intraoperatively can reduce opioid usage postoperatively. Objective: This study’s purpose was to evaluate the effect of intravenous methadone on postoperative opioid use. Methods: A prospective, single-center observational study was conducted to evaluate patients who received intravenous methadone intraoperatively. A control group was identified by matching procedure, gender, and age in a 1:3 ratio of methadone to control. Exclusion criteria included patients less than 18 years old or on methadone maintenance therapy. The primary outcome was morphine milligram equivalents (MME) administered 24h postoperatively. Secondary outcomes included MME administered 48h and 72h postoperatively, discharge prescription MME, daily mean postoperative pain scores, and length of hospital stay. A subgroup analysis was performed comparing opioid-naïve patients. Results: A total of 240 patients were included in the analysis. At 24h, postoperative MME was increased in the methadone group (142.6 vs 84.5; P = 0.0026). Postoperative MME was also increased in the methadone group at 48h and 72h. Daily pain scores were similar between both groups at all time intervals. Discharge prescription MME was reduced in the methadone group compared with controls, but not statistically significant. A subgroup analysis of opioid-naïve patients showed a significant reduction in MME at 48h ( P = 0.0240) and daily pain scores at 24h ( P = 0.0366) in the methadone group. Conclusion and Relevance: Intravenous methadone intraoperatively did not show a significant reduction in postoperative opioid use and discharge prescription MMEs when comparing all patients; however, benefit was seen when examining opioid-naïve patients.

Download Full-text

Stereotactic Electroencephalography Is Associated With Reduced Pain and Opioid Use When Compared with Subdural Grids: A Case Series

Operative Neurosurgery ◽

10.1093/ons/opab040 ◽

2021 ◽

Author(s):

Jonathan P Scoville ◽

Evan Joyce ◽

Joshua Hunsaker ◽

Jared Reese ◽

Herschel Wilde ◽

...

Keyword(s):

Hospital Stay ◽

Chart Review ◽

Statistical Tests ◽

Case Series ◽

Length Of Hospital Stay ◽

Retrospective Chart Review ◽

Opioid Use ◽

Pain Scores ◽

Surgical Methods ◽

Significant Difference

Abstract BACKGROUND Minimally invasive surgery (MIS) has been shown to decrease length of hospital stay and opioid use. OBJECTIVE To identify whether surgery for epilepsy mapping via MIS stereotactically placed electroencephalography (SEEG) electrodes decreased overall opioid use when compared with craniotomy for EEG grid placement (ECoG). METHODS Patients who underwent surgery for epilepsy mapping, either SEEG or ECoG, were identified through retrospective chart review from 2015 through 2018. The hospital stay was separated into specific time periods to distinguish opioid use immediately postoperatively, throughout the rest of the stay and at discharge. The total amount of opioids consumed during each period was calculated by transforming all types of opioids into their morphine equivalents (ME). Pain scores were also collected using a modification of the Clinically Aligned Pain Assessment (CAPA) scale. The 2 surgical groups were compared using appropriate statistical tests. RESULTS The study identified 43 patients who met the inclusion criteria: 36 underwent SEEG placement and 17 underwent craniotomy grid placement. There was a statistically significant difference in median opioid consumption per hospital stay between the ECoG and the SEEG placement groups, 307.8 vs 71.5 ME, respectively (P = .0011). There was also a significant difference in CAPA scales between the 2 groups (P = .0117). CONCLUSION Opioid use is significantly lower in patients who undergo MIS epilepsy mapping via SEEG compared with those who undergo the more invasive ECoG procedure. As part of efforts to decrease the overall opioid burden, these results should be considered by patients and surgeons when deciding on surgical methods.

Download Full-text

Perioperative Gabapentin Does Not Reduce Postoperative Delirium in Older Surgical Patients

Anesthesiology ◽

10.1097/aln.0000000000001804 ◽

2017 ◽

Vol 127 (4) ◽

pp. 633-644 ◽

Cited By ~ 18

Author(s):

Keyword(s):

Postoperative Pain ◽

Postoperative Delirium ◽

Intervention Group ◽

Group Versus ◽

Length Of Hospital Stay ◽

Treated Group ◽

Assessment Method ◽

Hospital Length Of Stay ◽

Control Group ◽

Opioid Use

Abstract Background Postoperative pain and opioid use are associated with postoperative delirium. We designed a single-center, randomized, placebo-controlled, parallel-arm, double-blinded trial to determine whether perioperative administration of gabapentin reduced postoperative delirium after noncardiac surgery. Methods Patients were randomly assigned to receive placebo (N = 347) or gabapentin 900 mg (N = 350) administered preoperatively and for the first 3 postoperative days. The primary outcome was postoperative delirium as measured by the Confusion Assessment Method. Secondary outcomes were postoperative pain, opioid use, and length of hospital stay. Results Data for 697 patients were included, with a mean ± SD age of 72 ± 6 yr. The overall incidence of postoperative delirium in any of the first 3 days was 22.4% (24.0% in the gabapentin and 20.8% in the placebo groups; the difference was 3.20%; 95% CI, 3.22% to 9.72%; P = 0.30). The incidence of delirium did not differ between the two groups when stratified by surgery type, anesthesia type, or preoperative risk status. Gabapentin was shown to be opioid sparing, with lower doses for the intervention group versus the control group. For example, the morphine equivalents for the gabapentin-treated group, median 6.7 mg (25th, 75th quartiles: 1.3, 20.0 mg), versus control group, median 6.7 mg (25th, 75th quartiles: 2.7, 24.8 mg), differed on the first postoperative day (P = 0.04). Conclusions Although postoperative opioid use was reduced, perioperative administration of gabapentin did not result in a reduction of postoperative delirium or hospital length of stay.

Download Full-text

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

Journal of Neurosurgery ◽

10.3171/2008.9.17689 ◽

2010 ◽

Vol 112 (2) ◽

pp. 268-272 ◽

Cited By ~ 27

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.

Download Full-text

Effect of intersphincteric fistula tract ligation versus anal fistulectomy on pain scores and serum levels of vascular endothelial growth factor and interleukin-2 in patients with simple anal fistulas

Journal of International Medical Research ◽

10.1177/0300060520949072 ◽

2020 ◽

Vol 48 (9) ◽

pp. 030006052094907

Author(s):

Xin Dong ◽

Zhanbo Jia ◽

Bianfang Yu ◽

Xuebin Zhang ◽

Fagang Xu ◽

...

Keyword(s):

Wound Healing ◽

Hospital Stay ◽

Length Of Hospital Stay ◽

Serum Levels ◽

Fistula Tract ◽

Control Group ◽

Anal Continence ◽

Anal Fistulas ◽

Operation Conditions ◽

Pain Scores

Objective This study was performed to explore the effects of ligation of the intersphincteric fistula tract (LIFT) on pain scores and serum levels of vascular endothelial growth factor (VEGF) and interleukin (IL)-2 in patients with simple anal fistulas. Methods Ninety patients with simple anal fistulas were evenly randomized into a study group (treated with LIFT) and a control group (treated with traditional anal fistulectomy) according to a random number table. The surgical outcomes, basic operation conditions (operation time, hospital stay, and anal continence), and postoperative wound healing rates were compared between the two groups. Results The study group had significantly better operation conditions (better anal continence and shorter length of hospital stay), a higher postoperative wound healing rate, lower pain scores, higher VEGF and IL-2 levels, and higher overall efficacy rate than the control group. However, the incidence of postoperative complications was not significantly different between the two groups. Conclusions Patients who underwent LIFT had better surgical outcomes, higher wound healing rates, better anal continence, a shorter length of hospital stay, and less severe postoperative pain than those who underwent simple anal fistulectomy. Increased levels of VEGF and IL-2 after surgery may promote wound healing.

Download Full-text

Comparing the Facial Emotion Recognition in Opioid Antecedent Subjects and Mixed Opioid-methamphetamine Antecedent Subjects under Methadone Maintenance Therapy with Control Group-A Retrospective Cohort Study

Iranian Journal of Psychiatry and Behavioral Sciences ◽

10.5812/ijpbs.95679 ◽

2021 ◽

Vol In Press (In Press) ◽

Author(s):

Kamaledin Alaedini ◽

Maryam Farahmandfar ◽

Maryam Sefidgarnia ◽

Parisa Islami Parkoohi ◽

Sepideh --- Jafari

Keyword(s):

Retrospective Cohort ◽

Methadone Maintenance ◽

Opioid Use Disorder ◽

Methadone Maintenance Therapy ◽

Facial Emotion ◽

Control Group ◽

Opioid Use ◽

Methamphetamine Use ◽

History Of ◽

Methamphetamine Use Disorder

Background: Facial emotion recognition (FER) is an important social skill. Some studies have determined the capability of FER in substance abusers, but their results are contradictory. Objectives: This study aimed to investigate FER ability in opioid antecedent subjects and mixed opioid-methamphetamine antecedent subjects under methadone maintenance therapy compared to a control group. Methods: Following a retrospective cohort design, 71 methadone-maintained subjects (MMS) (40 individuals with a history of only opioid use disorder and 31 patients with a history of both opioid and methamphetamine use disorder) and 40 healthy participants filled the Persian version of Ackman and Friesen facial emotion experiment, which were matched based on age, education, and gender. Demographic and substance use characteristics were evaluated. Both groups were similar concerning the duration of the opioid use disorder, methadone maintenance treatment, and currently prescribed methadone dose. Data were analyzed using the chi-square, independent t-test, one-way ANOVA, and Welch test. Statistical significance was considered when P-value < 0.05. Results: Total FER scores were significantly lower in MMS compared to the control group. Concerning the subgroups, recognition of sadness was impaired in patients with a history of opioid use disorder (with and without a history of methamphetamine use disorder), while in recognition of anger and wonder, patients with both opioid and methamphetamine use disorder history had a significantly lower performance. There was no other significant difference between the groups. Conclusions: The findings suggest that social cognition deficit should be considered in strategies related to the addiction (both treatment and rehabilitation).

Download Full-text

Opioid-Sparing Effect of Intravenous Outpatient Ketamine Infusions Appears Short-Lived in Chronic-Pain Patients with High Opioid Requirements

January 2018 - Pain Physician ◽

10.36076/ppj.2010/13/389 ◽

2010 ◽

Vol 4;13 (4;7) ◽

pp. 389-394

Author(s):

Leo Kapural

Keyword(s):

Chronic Pain ◽

Pain Relief ◽

Pain Clinic ◽

Control Group ◽

Supraventricular Arrhythmia ◽

Opioid Use ◽

Pain Scores ◽

Opioid Sparing ◽

Significant Difference ◽

Intravenous Ketamine

Background and Objectives: Ketamine is opioid-sparing. It attenuates the onset of opioid tolerance, and suppresses opioid-induced hyperalgesia. This study evaluated whether or not repeated outpatient infusions of intravenous ketamine reduced the amount of pain and the amount of opioid requirements for patients suffering with chronic, noncancerous pain. Study Design: Retrospective study Setting: Outpatient pain clinic Methods: We reviewed the records of 18 patients taking high doses of opioids chronically and nonetheless reporting poorly controlled pain. A comparison control group of 18 similar patients with high opioid requirements who were not given ketamine were selected from our clinic population. Intervention: Intravenous ketamine infusions Measurement: VAS pain scores and opioid use Results: Morphometric and demographic characteristics, baseline opioid use, and pain scores were similar in the ketamine and comparison groups. Five patients given ketamine experienced no benefit and discontinued treatment after 1-2 infusions. One patient developed a supraventricular arrhythmia which immediately resolved upon cessation of the infusion. And another, despite pain relief, felt overly-anxious and opted out. Eleven patients thus completed 3-6 weekly ketamine infusions. At 6 months, 5 patients maintained less than 50% of their baseline opioid use, while the remaining patients returned to the baseline opioid use or increased their requirements. There was no significant difference in pain scores at 6 months in patients who received ketamine infusions and control group patients. Limitations: Retrospective nature of the study Conclusions: Outpatient intravenous ketamine infusions did not improve long-term pain scores in patients with high opioid requirements and only a few were able to substantially reduce opioid use. Considering infusion risks and cost of such outpatient treatment, ketamine infusions do not appear to be a feasible option for improving pain relief and decreasing opioid use in high-opioid requirement patients. Key words: Ketamine; anesthesia; chronic pain; opioids; continuous infusion; opioid requirements

Download Full-text

Predicting the Risk of Opioid Use Disorder Based on Early Maladaptive Schemas

American Journal of Men s Health ◽

10.1177/1557988317742230 ◽

2017 ◽

Vol 12 (2) ◽

pp. 202-209

Author(s):

Somayeh Zamirinejad ◽

Seyed Kaveh Hojjat ◽

Alireza Moslem ◽

Vahideh MoghaddamHosseini ◽

Arash Akaberi

Keyword(s):

Psychological Distress ◽

Methadone Maintenance ◽

Short Form ◽

Opioid Use Disorder ◽

Early Maladaptive Schemas ◽

Control Group ◽

Maladaptive Schemas ◽

Opioid Use ◽

Cross Sectional ◽

Opioid Users

Substance use is a globally devastating social problem. Early maladaptive schemas (EMSs) are inefficient mechanisms leading directly or indirectly to psychological distress. The current study aimed to assess the role of EMSs in predicting opioid use disorder. The cross-sectional study was conducted in 2013 in Bojnurd at northeast of Iran on 60 male opioid users who received Methadone Maintenance Treatment (MMT) and 60 control males. The opioid users were selected randomly from MMT clinics and control subjects were selected and matched with opioid users using demographic variables. The subjects completed the Young Schema Questionnaire-Short Form (YSQ-SF). Except for SS (self-sacrifice), EG (entitlement/grandiosity), US (unrelenting standards), and FA (Failure to Achieve), the mean of other maladaptive schemas in the opioid user group were significantly higher than that of the control group, adjusted for multiple comparisons. Multivariate analysis of variance (MANOVA) indicated significant differences in maladaptive schemas between the two groups. Logistic regression identified that Emotional Deprivation, Mistrust/Abuse, and Unrelenting Standards can predict opioid use. As a result, the risk of opioid-related disorders in people with higher YSQ-SF scores in these schemas is higher. The findings conclude that the existence of underlying EMS may constitute a vulnerability factor for developing opioid use disorders later on in life. Provided the vast amount of scientific literature in evidence-based treatments focusing on EMSs, maladaptive schemas and related core beliefs can be detected and treated in adolescence to prevent the enactment of the schema and psychological distress likely to induce opioid use.

Download Full-text

Do perioperative protocols of enhanced recovery after cardiac surgery improve postoperative outcome?

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivaa001 ◽

2020 ◽

Vol 30 (5) ◽

pp. 706-710 ◽

Cited By ~ 1

Author(s):

Yasser Ali Kamal ◽

Ahmed Hassanein

Keyword(s):

Cardiac Surgery ◽

Patient Outcomes ◽

Fast Track ◽

Enhanced Recovery ◽

Length Of Hospital Stay ◽

Postoperative Outcome ◽

Opioid Use ◽

Pain Scores ◽

Enhanced Recovery Protocol ◽

Study Type

Abstract A best evidence topic was constructed according to a structured protocol. The question addressed was whether the application of an enhanced recovery protocol or pathway improves patient outcomes after cardiac surgery. A total of 3091 papers were found using the reported search. Finally, 12 papers represented the best available evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Six studies referred to enhanced recovery protocol as fast track (FT) and another 6 studies referred to it as enhanced recovery after surgery (ERAS). Significant differences from conventional care were reported for time to extubation or intubation time in 4 studies (3 FT, 1 ERAS), duration of intensive care unit stay in 6 studies (4 FT, 2 ERAS), length of hospital stay (LOS) in 8 studies (5 FT, 3 ERAS), cost in 5 studies (4 FT, 1 ERAS), pain scores in 2 studies (2 ERAS) and opioid use in 3 studies (3 ERAS). We conclude that FT or ERAS improve postoperative outcomes including length of stay and pain control, without increasing morbidity, mortality or readmission. However, there is a need for prospective studies and standardized protocols.

Download Full-text

Effects of intraoperative liposomal bupivacaine on pain control and opioid use after pediatric Chiari I malformation surgery: an initial experience

Journal of Neurosurgery Pediatrics ◽

10.3171/2020.6.peds20370 ◽

2021 ◽

Vol 27 (1) ◽

pp. 9-15

Author(s):

Victor M. Lu ◽

David J. Daniels ◽

Dawit T. Haile ◽

Edward S. Ahn

Keyword(s):

Pain Control ◽

Potential Role ◽

Chiari I Malformation ◽

Control Group ◽

Initial Experience ◽

Opioid Use ◽

Liposomal Bupivacaine ◽

Pain Scores ◽

Significant Difference ◽

Chiari I

OBJECTIVEPediatric Chiari I malformation decompression is a common neurosurgical procedure. Liposomal bupivacaine (LB) is a novel formulation that can have an impact on postoperative recovery for particular procedures, but its potential role in pediatric neurosurgery is largely unexplored. The authors sought to describe and assess their initial experience with LB in pediatric Chiari I malformation decompression to better define its potential role as an analgesic agent in a procedure for which the postoperative course is often remarkably painful.METHODSA retrospective review of all pediatric Chiari procedures performed at the authors’ institution between 2018 and 2020 was conducted. Patients were divided into those who were treated with a single intraoperative dose of LB (LB group) and those who were not (control group). Comparisons of total opioid use and pain control were made using chi-square and Wilcoxon rank-sum tests.RESULTSA total of 18 patients were identified, 9 (50%) in the LB group and 9 (50%) in the control group. Overall, there were 13 (72%) female and 5 (28%) male patients with a mean age of 15.9 years. No surgical complications were observed over a mean length of stay of 2.7 days. Within the first 24 hours after surgery, the LB group had significantly lower total opioid use than the control group (17.5 vs 47.9 morphine milligram equivalents, respectively; p = 0.03) as well as lower mean pain scores reported by patients using a 10-point visual analog scale (3.6 vs 5.5 for the LB vs control groups, p = 0.04). However, from the first 24 postoperative hours to discharge, total opioid use (p = 0.51) and mean pain scores (p = 0.09) were statistically comparable between the two groups. There were 2/9 (22%) LB patients versus 0/9 (0%) control patients who did not require opioid analgesia at any point during hospitalization.CONCLUSIONSThe use of a single intraoperative dose of LB in pediatric Chiari I malformation surgery appears to be safe and has the potential to reduce pain scores and opioid use when administered during the first 24 postoperative hours. From that time period to discharge, however, there may be no significant difference in total opioid use or pain scores.

Download Full-text

Effect of Maternal Methadone Use on Neonatal Outcomes: Results of a Cohort Study

Iranian Journal of Pediatrics ◽

10.5812/ijp.119240 ◽

2021 ◽

Vol In Press (In Press) ◽

Author(s):

Lida Jarahi ◽

Javad Irvani ◽

Majid Khadem Rezaiyan

Keyword(s):

Cohort Study ◽

Methadone Maintenance ◽

Demographic Characteristics ◽

The Other ◽

Neonatal Outcomes ◽

Control Group ◽

Chronic Hypertension ◽

Drug Abusers ◽

Methadone Group ◽

Healthy Control

Background: Substance abuse treatment is challenging in pregnancy, and methadone maintenance therapy (MMT) is a therapeutic choice. Methadone can cross the placenta and is poorly secreted in breast milk. Given these inconsistent findings of methadone effect on neonatal outcomes, this study was done to investigate the results in neonates of mothers treated with methadone in Mashhad. Methods: In this retrospective cohort study, mothers referring to two academic hospitals of Mashhad University of Medical Sciences were studied. Three groups were considered: MMT, other drug abusers, and healthy control. Maternal information, including demographic characteristics, fertility characteristics, and methadone treatment-related characteristics, and neonatal information, including demographic characteristics and neonatal outcomes, were assessed. Results: Overall, 122 pregnant women with a mean age of 29.14 ± 4.44 years were studied in three groups: control (n = 59), MMT (n = 32), and other drug abusers (n = 31). Baseline characteristics (mothers’ age, residence, chronic hypertension, preeclampsia, diabetes, heart disease, thyroid disease, and other diseases) were not different between the three groups. The highest history of miscarriage was seen in other drug abusers (35.5%) (P = 0.023). The mean weight, height, and head circumference of neonates in the control group were significantly higher than the methadone group (P < 0.001), and in the methadone group was higher than in the other drugs abusers (P < 0.001). The highest prevalence of malformations (16.1%) and hospitalization in the NICU (51.6%) was observed in infants of other drug abusers. After adjusting for confounding variables, the odds ratio (OR) of low-birth-weight infants was 13.7 in the methadone group and 1946 in the other drugs group compared to the healthy control group. The OR of neonates less than 50cm in height was 11.4 in the methadone group and 22.5 in the other drugs. Besides, the OR of neonates less than 35cm was 4.7 in the methadone group and 7.3 in other drugs. Conclusions: Although the neonates of mothers who used methadone had a higher rate of inappropriate intrauterine growth indices than healthy women, methadone consumption compared to other drugs had significantly reduced unacceptable outcomes in neonates. Increased gestational age and reduced preterm delivery risk were observed in methadone-treated mothers.

Download Full-text