scholarly journals Upper-Extremity Nerve Decompression Under Local Anesthesia: A Systematic Review of Methods for Reduction of Postoperative Pain and Opioid Consumption

Hand ◽  
2019 ◽  
Vol 15 (4) ◽  
pp. 447-455
Author(s):  
Yehuda Chocron ◽  
Albaraa Aljerian ◽  
Stephanie Thibaudeau
Keyword(s):  
Systematic Review ◽  
Postoperative Pain ◽  
Upper Extremity ◽  
Local Anesthesia ◽  
Pain Reduction ◽  
Opioid Consumption ◽  
Health Concern ◽  
Specific Patient ◽  
Nerve Decompression ◽  
Prescription Practices

Background: Opioid abuse is a major health concern in North America. Data have shown an alarming increase in opioid-related deaths and complications, which has shed light on current prescription practices across many specialties, including hand surgery. To that end, we sought to conduct a focused literature review to determine the available modalities to decrease postoperative pain and opioid consumption following upper-extremity nerve decompression procedures, taking advantage of the homogeneity and inherent pain pathways of this specific patient cohort. Methods: A systematic review of the literature was conducted. Primary studies evaluating perioperative and intraoperative modalities for postoperative pain reduction and analgesic consumption following upper-extremity nerve decompression procedures under local anesthesia were included. Studies implementing modalities requiring non–hand surgeon expertise (ie, intravenous sedation), as well as studies that include non–nerve decompression procedures, were excluded. Results: A total of 1478 studies were identified, and 9 studies were included after full-text review. Six studies evaluated intraoperative and 3 studies evaluated preoperative and postoperative modalities. Successful interventions included buffered anesthetic, the use of hyaluronidase, and varying techniques and mixtures for anesthetic administration. No successful preoperative or postoperative modalities were identified. Conclusion: Despite data reporting on the dangers associated with current opioid prescription practices, evidence-based modalities to decrease postoperative pain and opioid consumption are limited in general. Several intraoperative modalities do exist, and nonopioid oral analgesics, standardized opioid protocols, and reduced postoperative prescriptions can be used. Large randomized controlled trials evaluating perioperative modalities for pain reduction are needed to further address this issue.

scholarly journals Outcome Following Lower Extremity Nerve Block during Foot and Ankle Surgery: A Systematic Review

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0022
Author(s):  
Arianna L. Gianakos ◽  
Filippo Romanelli ◽  
Malaka Badri ◽  
Naina Rao ◽  
Bart Lubberts ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pain Management ◽  
Postoperative Pain ◽  
Continuous Infusion ◽  
Nerve Block ◽  
Opioid Consumption ◽  
Foot And Ankle ◽  
Complication Risk ◽  
Prospective Comparison ◽  
Ankle Surgery

Category: Ankle; Other Introduction/Purpose: The purpose of this study was to perform a systematic review of the current literature assessing the management of pain with various block techniques in the perioperative period during elective foot and ankle surgery. Methods: A review of the literature was performed according to the PRISMA guidelines. Medline, Embase, and Cochrane databases were searched on October 1, 2019. Studies were identified by using synonyms for ‘foot’, ‘ankle’, ‘pain management’, ‘opioid’ and ‘nerve block’. Inclusion criteria were studies that 1) reported and compared the outcomes following various types of peripheral nerve blocks in in foot and ankle surgery, 2) were published in the English language, and 3) were published within the last 10 years. Results: Twenty-four articles evaluating 4,640 patients were included. Sixty-seven percent were randomized controlled trials, 17% were prospective comparison studies, and 17% were retrospective comparison studies. Nerve block techniques included: femoral, adductor canal, sciatic, popliteal, saphenous, and ankle. Ropivacaine and bupivacaine were most commonly utilized. Postoperative opioid consumption and postoperative pain levels were reduced with use of PNB when compared with systemic/local anesthesia, in patients receiving combined popliteal/femoral block, and in patients receiving continuous infusion popliteal block [Table 1, Table 2]. Studies demonstrated higher satisfaction with PNB, continuous infusion, and dual injections [Table 3]. One study reported 7% neurologic related complication risk and demonstrated a higher complication rate when with popliteal versus ankle block. All other studies were equivocal or failed to mention complications. Conclusion: Optimal pain management for elective foot and ankle surgery remains controversial and an ideal protocol from a risk-benefit perspective regarding use of PNB has yet to be established. Our study demonstrates improvements in postoperative pain levels, opioid consumption, and length of stay in patients receiving a PNB when compared with systemic anesthesia. Combined PNB and dual catheter administration may improve outcomes. Unfortunately, little data has been published on risks and tradeoffs in order to help guide patients and surgeons with a well informed shared decision making model. Future studies are needed to better clarify any respective tradeoffs to these options. [Table: see text]

scholarly journals Examining the Effects of Ketamine on Reducing the Incidence of Opiod-induced Hyperalgesia in the Perioperative Phase

2019 ◽  
Author(s):  
Marie Rahme
Keyword(s):  
Systematic Review ◽  
Postoperative Pain ◽  
Patient Outcomes ◽  
Perioperative Period ◽  
Opioid Consumption ◽  
Emotional Impact ◽  
Perioperative Phase ◽  
Pain Scores ◽  
Gate Control Theory ◽  
Opioid Induced Hyperalgesia

Pain in the postoperative period is a serious issue that can have a negative physical and emotional impact on patient outcomes. Complications from postoperative pain can have detrimental outcomes for patient’s health and wellbeing as well as the increased economic burden of continued treatment. Better management of pain in the perioperative phase can result in improved patient outcomes, fewer postoperative complications, and increased patient satisfaction. Although opioids are the mainstay of treatment in the perioperative period for pain management, abnormal pain responses such as hyperalgesia may be induced by administration of opioids. The purpose of this systematic review is to examine the effect of ketamine on reducing the phenomenon of opioid-induced hyperalgesia. After a comprehensive literature search, the PRISMA Statement was used to frame this systematic review and elevate the validity of the results by providing transparency and clarity of the findings. The theoretical framework that guided this systematic review was Melzack and Wall’s (1965) Gate Control Theory of Pain which encompassed the physiologic and emotional responses of pain. Studies incorporated in this systematic review were critically appraised to evaluate reliability of randomized control trials. Variables such as intraoperative doses of opioids, intraoperative ketamine doses, postoperative pain scores, postoperative opioid consumption, and evidence of hyperalgesia were evaluated and put into tables for comparison. The results of this systematic review support the use of ketamine in decreasing postoperative opioid consumption, decreasing postoperative pain scores, and decreasing the incidence of opioid induced hyperalgesia.

Combination Lower Extremity Nerve Blocks and Their Effect on Postoperative Pain and Opioid Consumption: A Systematic Review

2021 ◽  
Vol 60 (1) ◽  
pp. 121-131
Author(s):  
Arianna L. Gianakos ◽  
Filippo Romanelli ◽  
Naina Rao ◽  
Malaka Badri ◽  
Bart Lubberts ◽  
...  
Keyword(s):  
Systematic Review ◽  
Postoperative Pain ◽  
Lower Extremity ◽  
Opioid Consumption ◽  
Nerve Blocks

scholarly journals Preemptive Analgesia in Thumb Basal Joint Arthroplasty: Immediate Postoperative Pain with Preincision versus Postincision Local Anesthesia

2017 ◽  
Vol 09 (02) ◽  
pp. 080-083 ◽  
Author(s):  
Asif Ilyas ◽  
Joseph Labrum
Keyword(s):  
Postoperative Pain ◽  
General Anesthesia ◽  
Local Anesthesia ◽  
Joint Arthroplasty ◽  
Opioid Consumption ◽  
Level Of Evidence ◽  
Pain Experience ◽  
Pain Scores ◽  
Significant Difference ◽  
Basal Joint

Purpose Currently no guidelines exist for the timing of the injection of anesthetics in surgeries performed under general anesthesia to minimize postoperative pain. To better understand the role of timing of the injection of local anesthesia in hand surgery performed under general anesthesia, we evaluated the effect of pre- versus postincisional local analgesic injection on immediate postoperative pain experience. We hypothesize that the preincisional (preemptive) injection will result in decreased immediate postoperative pain experience and analgesic use when compared with postincisional injection. Methods Consecutive cases of thumb basal joint arthroplasty performed over a 4-year period were retrospectively reviewed. During the first half of the study period, the surgical site was infiltrated with 0.5% bupivacaine at the completion of surgery following closure. During the second half of the study period, the surgical site was infiltrated with 0.5% bupivacaine prior to skin incision. Data collected included patient demographics, immediate postoperative recovery room (PACU) pain scores, and postoperative opioid consumption in morphine equivalents. Results Two-tailed t-test identified no significant difference between the pre- and postincision cohorts relative to PACU entrance pain scores and time spent in the PACU. PACU exit pain scores were significantly lower in the preincision cohort. The mean PACU pain score was also significantly lower in the preincision cohort. PACU opioid consumption, converted into morphine equivalents, was found to be 211 mg in the preincision versus 299 mg in the postincision cohort. Conclusion The preincisional (preemptive) injection of local anesthesia was found to result in lower pain scores during and upon exit of the PACU as compared with the postclosure group. In addition, the preincision cohort also trended toward lower opioid consumption while in the PACU. Consideration should be given to the routine use of preincision injection of local anesthesia to maximize pain relief in a multimodal pain strategy in hand surgical patients. Level of Evidence Therapeutic level III.

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