scholarly journals Postoperative Pain Management of Non–“Opioid-Naive” Patients Undergoing Hand and Upper-Extremity Surgery

Hand ◽  
2019 ◽  
Vol 15 (5) ◽  
pp. 651-658
Author(s):  
Kelvin A. Wong ◽  
Kanu S. Goyal
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Upper Extremity ◽  
Pain Control ◽  
Control Program ◽  
Postoperative Pain Management ◽  
Categorical Variables ◽  
Fisher Exact Test ◽  
Opioid Use ◽  
Opioid Users

Background: Patients with prior opioid use are often difficult to manage postoperatively. We examined potential strategies for managing these patients: (1) prescribing a different opioid; and (2) encouraging the use of nonopioid analgesics over opioids. Methods: A pain control program was implemented at an outpatient hand and upper-extremity center. Patients were recruited before (n = 305) and after (n = 225) implementation. Seventy of them were taking opioids prior to surgery. Information about pain control satisfaction and opioid use was collected. The Fisher exact test was used to compare categorical variables with small expected frequencies. Wilcoxon rank sum test was used to compare nonnormally distributed continuous variables. Results: Opioid users used 28.8 ± 25.6 opioid pills; nonopioid users used 14.5 ± 21.5 pills. Furthermore, 41.4% of opioid users sought more pills after surgery compared with 14.0% among nonopioid users. The pain control program was more effective in reducing opioid consumption and waste and increasing nonopioid consumption for nonopioid users than for opioid users. Prior opioid users who were prescribed a different opioid after surgery used 24.6 ± 22.0 opioid pills. Patients prescribed the same opioid used 37.9 ± 30.8 pills. Conclusions: Patients taking opioids prior to hand and upper-extremity surgery use more opioid pills, seek more pills after surgery, and are less satisfied with their pain control than their nonopioid user counterparts. Furthermore, the comprehensive pain plan was less effective in this patient population. Prescribing a different opioid reduced medication requirements for these patients, but additional strategies are needed to address postoperative pain management.

Written Prescription for Over-the-Counter Nonopioid Pain Medications Does Not Increase the Likelihood of Use after Ambulatory Hand and Upper Extremity Surgery

2020 ◽  
Author(s):  
Daniel J. Lynch ◽  
James S. Lin ◽  
Kanu S. Goyal
Keyword(s):  
Postoperative Pain ◽  
Soft Tissue ◽  
Upper Extremity ◽  
Pain Control ◽  
Control Program ◽  
Postoperative Pain Control ◽  
Over The Counter ◽  
Unequal Variance ◽  
Pain Medications ◽  
Medication Consumption

Abstract Introduction This study looked to determine how providing written prescriptions of nonopioids affected postoperative pain medication usage and pain control. Materials and Methods Patients undergoing hand and upper-extremity surgery (n = 244) were recruited after the implementation of a postoperative pain control program encouraging nonopioids before opioids. Patients were grouped based on procedure type: bone (n = 66) or soft tissue (n = 178). Patients reported postoperative medication consumption and pain control scores. Two-tailed t-tests assuming unequal variance were performed to look for differences in postoperative pain control and medication consumption between those who were and were not given written prescriptions for nonopioids. Results For both soft tissue and bone procedure patients, a written prescription did not significantly affect patients’ postoperative pain control or medication consumption. Regardless of receiving a written prescription, patients who underwent soft tissue procedures consumed significantly more daily nonopioids than opioids. Conclusion Receiving written prescriptions for nonopioids may not have a significant effect on postoperative pain control or medication consumption. Patients undergoing soft tissue hand and upper extremity procedures may be more likely to consume more daily nonopioids than opioids postoperatively compared to bone procedure patients regardless of whether they receive a written prescription for nonopioids.

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

2005 ◽  
Vol 102 (2) ◽  
pp. 421-428 ◽  
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.

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

2019 ◽  
Vol 102 (2) ◽  
pp. 383-387 ◽  
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

scholarly journals An Interactive Pain Application (MServ) Improves Postoperative Pain Management

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.

scholarly journals Self-Reported Pain Tolerance and Opioid Pain Medication Use after Foot and Ankle Surgery

2019 ◽  
Vol 4 (2) ◽  
pp. 2473011419S0000
Author(s):  
Laura E. Sokil ◽  
Elizabeth McDonald ◽  
Ryan G. Rogero ◽  
Daniel J. Fuchs ◽  
Steven M. Raikin ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Pain Control ◽  
Pain Threshold ◽  
Postoperative Pain Management ◽  
Pain Medication ◽  
Pain Tolerance ◽  
Foot And Ankle ◽  
Ankle Surgery ◽  
Perceived Pain

Category: Pain Management Introduction/Purpose: The opioid epidemic in the United States continues to take lives. As one of the top prescribing groups, orthopaedic surgeons must tailor post-surgical pain control to minimize the potential for harm from prescription opioid use. Patients often reference their own pain threshold as a benchmark for how they will tolerate the pain of surgery, but current literature suggests that there is not a significant correlation between an individual’s perceived pain threshold and their actual threshold for heat stimulus. The purpose of this study was to determine whether there is a correlation between a patient’s self- reported pain tolerance and their actual prescription narcotic medication usage after foot and ankle surgery. Methods: This was a prospective cohort study of adult patients that underwent outpatient foot and ankle surgeries performed by 5 fellowship-trained foot and ankle surgeons at a large, multispecialty orthopaedic practice over a one year period. Demographic data, procedural details and anesthesia type were collected. Narcotic usage data including number of pills dispensed and pill counts performed at the first postoperative visit were obtained. Patients were contacted via email or telephone between 7-19 months postoperatively, and asked to respond to the validated statement “Pain doesn’t bother me as much as it does most people” by choosing “strongly disagree”, “disagree”, “neither”, “agree” or “strongly agree”. Patients scored their pain threshold on a scale of 1- 100 with 0 being “pain intolerant” and 100 a ”high pain threshold" and ranked their expectations of the pain after surgery and satisfaction with pain management on respective five-point Likert scales. Data was analyzed using a Spearman’s correlation. Results: Of the 486 patients who completed surveys, average age was 51.24 years, 32.1% were male and 7.82% current smokers. After controlling for age and anesthesia type, both agreement with the validated statement and higher pain tolerance score had a weak negative correlation with pills taken (r=-0.13, p=0.004 and r=-0.14, p=0.002, respectively); patients with higher perceived pain thresholds took fewer opioid pills after surgery (Table 1). Correlation between high expectations of postoperative pain and pills taken was weakly negative (r=-0.28, p=<0.001) (Table 1). Patients who found surgery more painful than they expected took less pain medication. There was a small, positive correlation between pain tolerance and satisfaction with pain management (r=0.12, p=0.008), indicating that patients with a relatively high pain tolerance had more satisfaction (Table 1). Conclusion: Assessment of both subjective description and quantitative score of a patient’s pain threshold prior to surgery may assist the surgeon in tailoring postoperative pain control regimens. Unexpectedly, patients who found surgery less painful than expected actually took a greater number of opioid pills. This may highlight an educational opportunity regarding postoperative pain management in order to reduce narcotic requirement. Setting expectations on safe utilization of prescribed pain medications may also increase satisfaction. This study provides useful information for surgeons to customize pain management regimens and to perform effective preoperative education and counseling regarding postoperative pain management. [Table: see text]

Implications of uninterrupted preoperative transdermal buprenorphine use on postoperative pain management

2019 ◽  
Vol 44 (3) ◽  
pp. 342-347 ◽  
Author(s):  
Yvette N Martin ◽  
Amy C S Pearson ◽  
John R Tranchida ◽  
Toby N Weingarten ◽  
Phillip J Schulte ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Pain Score ◽  
Recovery Room ◽  
Severe Pain ◽  
Receptor Agonist ◽  
Postoperative Pain Management ◽  
Opioid Use ◽  
Intravenous Morphine ◽  
Matched Study

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.

A prospective study of opioid use for postoperative pain management after breast operation

2020 ◽  
Vol 219 (1) ◽  
pp. 8-14
Author(s):  
Kristen E. Limbach ◽  
SuEllen J. Pommier ◽  
Kristen P. Massimino ◽  
Rodney F. Pommier ◽  
Arpana M. Naik
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Prospective Study ◽  
Postoperative Pain Management ◽  
Opioid Use ◽  
A Prospective Study

Continuous Peripheral Catheters/Regional Anesthesia in Postoperative Pain Management

2017 ◽  
Author(s):  
David E. Hirsch ◽  
Daneshvari R. Solanki
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Regional Anesthesia ◽  
Pain Control ◽  
Lipid Emulsion ◽  
Postoperative Pain Management ◽  
Anesthetic Techniques ◽  
Postoperative Pain Control ◽  
Recent Developments ◽  
Drug Technology

As the number of surgical procedures has increased worldwide, so has the need for safe and effective postoperative pain control. Regional anesthesia, in which a provider uses local anesthesia and potentially other medications to provide anesthesia by focusing on blocking sensation at the surgical site, has become an important part of the postoperative pain regimen, thereby improving outcomes and comfort. Regional anesthesia plays a critical and significant role with regard to preemptive analgesia and multimodal anesthetic techniques. With the widespread use of ultrasonography and the introduction of peripheral nerve catheters, regional anesthesia has grown in its ability to provide longer-lasting, safe, and targeted pain control. Extended-relief lipid emulsion bupivacaine is another example of recent developments in drug technology that will further aid regional anesthesia delivery in the future. This review contains 5 figures, 4 tables, and 23 references. 

scholarly journals Stemming the Tide of Opioid Addiction—Dramatic Reductions in Postoperative Opioid Requirements Through Preoperative Education and a Standardized Analgesic Regimen

2019 ◽  
Vol 185 (3-4) ◽  
pp. 436-443 ◽  
Author(s):  
Rowan R Sheldon ◽  
Jessica B Weiss ◽  
Woo S Do ◽  
Dominic M Forte ◽  
Preston L Carter ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Pain Management ◽  
Postoperative Pain ◽  
Pain Control ◽  
Inclusion Criteria ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Management Protocol ◽  
Patient Reported ◽  
Nonopioid Analgesics

Abstract Introduction Surgery is a known gateway to opioid use that may result in long-term morbidity. Given the paucity of evidence regarding the appropriate amount of postoperative opioid analgesia and variable prescribing education, we investigated prescribing habits before and after institution of a multimodal postoperative pain management protocol. Materials and Methods Laparoscopic appendectomies, laparoscopic cholecystectomies, inguinal hernia repairs, and umbilical hernia repairs performed at a tertiary military medical center from 01 October 2016 until 30 September 2017 were examined. Prescriptions provided at discharge, oral morphine equivalents (OME), repeat prescriptions, and demographic data were obtained. A pain management regimen emphasizing nonopioid analgesics was then formulated and implemented with patient education about expected postoperative outcomes. After implementation, procedures performed from 01 November 2017 until 28 February 2018 were then examined and analyzed. Additionally, a patient satisfaction survey was provided focusing on efficacy of postoperative pain control. Results Preprotocol, 559 patients met inclusion criteria. About 97.5% were provided an opioid prescription, but prescriptions varied widely (256 OME, standard deviation [SD] 109). Acetaminophen was prescribed often (89.5%), but nonsteroidal anti-inflammatory drug (NSAID) prescriptions were rare (14.7%). About 6.1% of patients required repeat opioid prescriptions. After implementation, 181 patients met inclusion criteria. Initial opioid prescriptions decreased 69.8% (77 OME, SD 35; P &lt; 0.001), while repeat opioid prescriptions remained statistically unchanged (2.79%; P = 0.122). Acetaminophen prescribing rose to 96.7% (P = 0.002), and NSAID utilization increased to 71.0% (P &lt; 0.001). Postoperative survey data were obtained in 75 patients (41.9%). About 68% stated that they did not use all of the opioids prescribed and 81% endorsed excellent or good pain control throughout their postoperative course. Conclusions Appropriate preoperative counseling and utilization of nonopioid analgesics can dramatically reduce opioid use while maintaining high patient satisfaction. Patient-reported data suggest that even greater reductions may be possible.

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