A Model-Based Approach for Joint Analysis of Pain Intensity and Opioid Consumption in Postoperative Pain

Abstract Objective We aimed to evaluate the safety and efficacy of intra-articular (IA) magnesium (Mg) for postoperative pain relief after arthroscopic knee surgery. Methods We searched PubMed, Embase, Medline, Cochrane library, and Web of Science to identify randomized controlled trials that compared postoperative pain outcomes with or without IA Mg after knee arthroscopy. The primary outcomes were pain intensity at rest and with movement at different postoperative time points and cumulative opioid consumption within 24 h after surgery. Secondary outcomes included the time to first analgesic request and side effects. Results In total, 11 studies involving 677 participants met the eligibility criteria. Pain scores at rest and with movement 2, 4, 12, and 24 h after surgery were significantly lower, doses of supplementary opioid consumption were smaller, and the time to first analgesic requirement was longer in the IA Mg group compared with the control group. No significant difference was detected regarding adverse reactions between the groups. Conclusions Intra-articular magnesium is an effective and safe coadjuvant treatment for relieving postoperative pain intensity after arthroscopic knee surgery. Protocol registration at PROSPERO: CRD42020156403.

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589 Methadone in Procedural Care for Burn Injuries of 20–30% Total Burn Surface Area: A Retrospective Chart Review

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.239 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S146-S146

Author(s):

Loryn Taylor ◽

Kimberly Maynell ◽

Thanh Tran ◽

David J Smith

Keyword(s):

Physical Therapy ◽

Postoperative Pain ◽

Pain Intensity ◽

Surface Area ◽

Chart Review ◽

Retrospective Chart Review ◽

Opioid Consumption ◽

Burn Injuries ◽

Methadone Group ◽

Significant Difference

Abstract Introduction Prolonged opioid usage remains a concern in pain management in procedural care. Recent evidence also suggests that a considerable number of patients who were prescribed opioids struggle with transitioning to non-opioid pain medications. As a continuous effort to reduce opioid consumption following burn surgical procedures, our institution recently evaluated methadone administration for burn procedural care in patients with 20–30% total burn surface area (TBSA) requiring excision and grafting. Methods After IRB approval, we performed a retrospective chart review of patients who underwent excision and grafting procedure for 20–30% TBSA burn injuries between January 1, 2019 and June 30, 2020. The following data was evaluated: postoperative opioid consumption, postoperative pain intensity (rated as “No Pain” [NRS=0], “Minor Pain” [NRS 1 to 3], “Moderate Pain” [NRS 4 to 6], “Severe Pain” [NRS 7 to 10]), time to physical therapy and time to hospital discharge. Data was analyzed using chi square/Fisher exact test for categorical variables and t-test/Wilcoxon rank sum test for continuous variables. Results Our preliminary data included 12 patients who met inclusion criteria, of which two patients received methadone administration. Our patient sample consisted of average age of 43 years, 75% male, and 24% TBSA (92% were flame burns). Patients in both methadone and non-methadone groups had no significant differences in medical histories and TBSA (23% TBSA in methadone, 25% TBSA in non-methadone). There was no significant difference in reported preoperative pain intensity between the two groups, rating moderate to severe. Postoperative pain intensity remained the same, rating moderate to severe and controlled with fentanyl, oxycodone, morphine and non-opioid analgesics. While there was no difference in postoperative fentanyl, opioid and non-opioid analgesic consumptions between the two groups, morphine consumption was significantly lower in the methadone group compared to non-methadone group (2±2 mg vs 51±54 mg, respectively, p=0.02). There was no significant difference between average time from surgery to first physical therapy session and time to hospital discharge (about 21 days after surgery) between the two groups. Conclusions This evaluation shows a potential trend in reduction of inpatient postoperative opioid consumption with the conjunctive administration of methadone, although a bigger sample size is needed for further assessment.

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HTX-011, a Proprietary, Extended-Release Combination of Bupivacaine and Meloxicam, Reduces Acute Postoperative Pain Intensity and Opioid Consumption after Bunionectomy: Results From an Interim Analysis

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2017.07.617 ◽

2017 ◽

Vol 225 (4) ◽

pp. e37

Author(s):

Eugene R. Viscusi ◽

Oscare DeLeon-Casasola ◽

T.J. Gan ◽

Erol Onel ◽

Guy Boccia ◽

...

Keyword(s):

Postoperative Pain ◽

Pain Intensity ◽

Interim Analysis ◽

Extended Release ◽

Opioid Consumption ◽

Acute Postoperative Pain

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Effect of preoperative administration of systemic alpha-2 agonists on postoperative pain: a systematic review and meta-analysis

Anesthesia and Pain Medicine ◽

10.17085/apm.2020.15.2.157 ◽

2020 ◽

Vol 15 (2) ◽

pp. 157-166

Author(s):

Ji Youn Ju ◽

Kye-Min Kim ◽

Sangseok Lee

Keyword(s):

Postoperative Pain ◽

Pain Intensity ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Cochrane Collaboration ◽

Systemic Administration ◽

Opioid Consumption ◽

Cochrane Library ◽

Preoperative Administration

Background: Alpha-2 agonists have sedative, analgesic, and opioid-sparing effects. Moreover, intraoperative or postoperative systemic administration of alpha-2 adrenergic agonists is known to reduce postoperative pain and opioid consumption. This meta-analysis investigated whether preoperative administration of alpha-2 agonists can affect postoperative pain and opioid consumption.Methods: We searched the MEDLINE, EMBASE, Cochrane Library (CENTRAL), KoreaMed, and KMbase databases through March 2019 to identify relevant randomized controlled trials (RCTs) on the effect of preoperative systemic administration of alpha-2 agonists on postoperative pain and opioid consumption. We conducted a meta-analysis according to the Cochrane Collaboration guidelines. Standardized mean differences (SMDs) of postoperative pain intensity or dose of opioid consumption in the alpha-2 agonist group were extracted and combined using a random-effect model and were compared to those of the control group.Results: Eleven RCTs involving 748 participants were included in this meta-analysis. Preoperative administration of systemic alpha-2 agonists significantly reduced cumulative opioid consumption up to 6 h (SMD, –0.52; 95% confidence interval [–0.90 to –0.14]) and 24 h (SMD, –0.68 [–1.27 to –0.09]) after surgery. Moreover, preoperative administration of alpha-2 agonists significantly reduced postoperative pain intensity at 6 h (SMD, –0.50 [–0.78 to –0.21]) and 24 h (SMD, –0.44 [–0.86 to –0.03]).Conclusions: In this meta-analysis, high degree of heterogeneity limits the preoperative administration of alpha-2 agonists in reducing postoperative opioid consumption and pain intensity. Future powered large RCTs are required to increase the certainty of evidence on the effect in reducing postoperative opioid consumption and pain intensity.

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HTX-011 reduced pain intensity and opioid consumption versus bupivacaine HCl in herniorrhaphy: results from the phase 3 EPOCH 2 study

Hernia ◽

10.1007/s10029-019-02023-6 ◽

2019 ◽

Vol 23 (6) ◽

pp. 1071-1080 ◽

Cited By ~ 5

Author(s):

E. Viscusi ◽

H. Minkowitz ◽

P. Winkle ◽

S. Ramamoorthy ◽

J. Hu ◽

...

Keyword(s):

Postoperative Pain ◽

Pain Intensity ◽

Local Anesthetic ◽

Immediate Release ◽

Opioid Consumption ◽

Opioid Use ◽

Phase 3 ◽

Double Blind ◽

Mesh Placement ◽

Number Of Patients

Abstract Purpose Currently available local anesthetics have not demonstrated sufficient analgesia beyond 12–24 h postoperatively. The purpose of the study was to assess the safety and efficacy of HTX-011 (bupivacaine and meloxicam in Biochronomer® polymer technology), a long-acting investigational anesthetic, in reducing both postoperative pain over 72 h and postoperative opioid use compared to bupivacaine hydrochloride (HCl). Methods A phase 3, randomized, double-blind, active-controlled multi-center study (EPOCH 2; NCT03237481) in subjects undergoing unilateral open inguinal herniorrhaphy with mesh placement was performed. Subjects randomly received a single intraoperative dose of HTX-011, immediate-release bupivacaine HCl, or saline placebo prior to closure. Results The study evaluated 418 subjects, and the primary and all key secondary efficacy endpoints were in favor of HTX-011. HTX-011 reduced mean pain intensity by 23% versus placebo (primary endpoint; p < 0.001) and by 21% versus bupivacaine HCl (p < 0.001) with significant reductions in the number of patients experiencing severe pain. Opioid consumption over 72 h was reduced by 38% versus placebo (p < 0.001) and 25% versus bupivacaine HCl (p = 0.024). Overall, 51% of HTX-011 subjects were opioid-free through 72 h (versus 22% for placebo [p < 0.001] and 40% for bupivacaine HCl [p = 0.049]). HTX-011 was generally well-tolerated with fewer opioid-related adverse events reported compared to the bupivacaine HCl and placebo and no evidence of local anesthetic systemic toxicity. Conclusions HTX-011 demonstrated significant improvement in postoperative pain control and a clinically meaningful reduction in opioid consumption when compared to the most widely used local anesthetic, bupivacaine HCl.

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HTX-011 effectively reduces postoperative pain intensity and opioid use in the elderly

Pain Management ◽

10.2217/pmt-2021-0043 ◽

2021 ◽

Author(s):

Tina Yip ◽

Jia Hu ◽

Pamela S Hawn ◽

Amy Yamamoto ◽

Gary Oderda

Keyword(s):

Clinical Trial ◽

Postoperative Pain ◽

Elderly Patients ◽

Pain Intensity ◽

Local Anesthetic ◽

Extended Release ◽

The Elderly ◽

Opioid Consumption ◽

Opioid Use ◽

Clinical Trial Registration

Aim: HTX-011 (ZYNRELEF™) is an extended-release, dual-acting local anesthetic containing bupivacaine and meloxicam. In bunionectomy and herniorrhaphy studies, HTX-011 resulted in less postoperative pain and less opioid consumption versus bupivacaine HCl. Here we evaluate HTX-011 in patients aged ≥65 years. Materials & methods: Patients received placebo, bupivacaine HCl or HTX-011 following surgery. End points included pain intensity, total opioid consumption, opioid-free patients and safety. Results: HTX-011-treated patients reported lower postoperative pain through 72 h versus bupivacaine HCl and placebo. Elderly patients administered HTX-011 used fewer opioids versus bupivacaine HCl, and a greater proportion remained opioid-free through 72 h. HTX-011 was well tolerated with a safety profile similar to bupivacaine HCl and placebo. Conclusion: HTX-011 maintained effectiveness and was well tolerated in elderly patients. Clinical Trial Registration: NCT03295721 and NCT03237481

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Thoracolumbar interfascial plane block for postoperative analgesia in spine surgery: A systematic review and meta-analysis

PLoS ONE ◽

10.1371/journal.pone.0251980 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0251980

Author(s):

Yu Ye ◽

Yaodan Bi ◽

Jun Ma ◽

Bin Liu

Keyword(s):

Postoperative Pain ◽

Pain Intensity ◽

Spine Surgery ◽

Analgesic Efficacy ◽

Opioid Consumption ◽

Controlled Trials ◽

Wound Infiltration ◽

Rescue Analgesia ◽

Randomized Controlled ◽

Analgesia Requirement

Introduction Thoracolumbar interfascial plane (TLIP) block has been discussed widely in spine surgery. The aim of our study is to evaluate analgesic efficacy and safety of TLIP block in spine surgery. Method We performed a quantitative systematic review. Randomized controlled trials that compared TLIP block to non-block care or wound infiltration for patients undergoing spine surgery and took the pain or morphine consumption as a primary or secondary outcome were included. The primary outcome was cumulative opioid consumption during 0-24-hour. Secondary outcomes included postoperative pain intensity, rescue analgesia requirement, and adverse events. Result 9 randomized controlled trials with 539 patients were included for analysis. Compared with non-block care, TLIP block was effective to decrease the opioid consumption (WMD -16.00; 95%CI -19.19, -12.81; p<0.001; I2 = 71.6%) for the first 24 hours after the surgery. TLIP block significantly reduced postoperative pain intensity at rest or movement at various time points compared with non-block care, and reduced rescue analgesia requirement ((RR 0.47; 95%CI 0.30, 0.74; p = 0.001; I2 = 0.0%) and postoperative nausea and vomiting (RR 0.58; 95%CI 0.39, 0.86; p = 0.006; I2 = 25.1%). Besides, TLIP block is superior to wound infiltration in terms of opioid consumption (WMD -17.23, 95%CI -21.62, -12.86; p<0.001; I2 = 63.8%), and the postoperative pain intensity at rest was comparable between TLIP block and wound infiltration. Conclusion TLIP block improved analgesic efficacy in spine surgery compared with non-block care. Furthermore, current literature supported the TLIP block was superior to wound infiltration in terms of opioid consumption.

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Role of VVZ-149, a Novel Analgesic Molecule, in the Affective Component of Pain: Results from an Exploratory Proof-of-Concept Study of Postoperative Pain following Laparoscopic and Robotic-Laparoscopic Gastrectomy

Pain Medicine ◽

10.1093/pm/pnab066 ◽

2021 ◽

Cited By ~ 1

Author(s):

Inkyung Song ◽

Sunyoung Cho ◽

Srdjan S Nedeljkovic ◽

Sang Rim Lee ◽

Chaewon Lee ◽

...

Keyword(s):

Postoperative Pain ◽

Pain Intensity ◽

Laparoscopic Gastrectomy ◽

Statistical Significance ◽

Opioid Consumption ◽

Phase 2 ◽

Patient Controlled Analgesia ◽

Rescue Analgesia ◽

Affective Component ◽

Phase 2 Study

Abstract Objective VVZ-149 is a small molecule that both inhibits the glycine transporter type 2 and the serotonin receptor 5 hydroxytryptamine 2 A. In a randomized, parallel-group, and double-blind trial (NCT02844725), we investigated the analgesic efficacy and safety of VVZ-149 Injections, which is under clinical development as a single-use injectable product for treating moderate to severe postoperative pain. Methods Sixty patients undergoing laparoscopic and robotic-laparoscopic gastrectomy were randomly assigned to receive a 10-hour intravenous infusion of VVZ-149 Injections or placebo, initiated approximately 1 hour before completion of surgical suturing. Major outcomes included pain intensity and opioid consumption via patient-controlled analgesia and rescue analgesia provided “as needed.” The treatment efficacy of VVZ-149 was further examined in a subpopulation requiring early rescue medication, previously associated with the presence of high levels of preoperative negative affect in a prior Phase 2 study (NCT02489526). Results Pain intensity was lower in the VVZ-149 (n = 30) than the placebo group (n = 29), reaching statistical significance at 4 hours post-emergence (P < .05), with a 29.5% reduction in opioid consumption for 24 hours and fewer demands for patient-controlled analgesia. In the rescued subgroup, VVZ-149 further reduced pain intensity (P < .05) with 32.6% less opioid consumption for 24 hours compared to placebo patients. Conclusions VVZ-149 demonstrated effective analgesia with reduced postoperative pain and opioid requirements. Consistent with the results from the previous Phase 2 study, patients with early rescue requirement had greater benefit from VVZ-149, supporting the hypothesis that VVZ-149 may alleviate the affective component of pain and mitigate excessive use of opioids postoperatively.

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Intra-articular Magnesium to Alleviate Postoperative Pain After Arthroscopic Knee Surgery: A Meta-analysis of Randomized Controlled Trials

10.21203/rs.3.rs-112208/v1 ◽

2020 ◽

Author(s):

Lijun Shi ◽

Haiyun Zhu ◽

Jinhui Ma ◽

Li-Li Shi ◽

Fuqiang Gao ◽

...

Keyword(s):

Postoperative Pain ◽

Randomized Controlled Trials ◽

Pain Intensity ◽

Adverse Reactions ◽

Opioid Consumption ◽

Knee Surgery ◽

Controlled Trials ◽

Arthroscopic Knee Surgery ◽

Randomized Controlled ◽

Arthroscopic Knee

Abstract Objective: We evaluated the safety and efficacy of intra-articular (IA) magnesium (Mg) for postoperative pain relief after arthroscopic knee surgery. Methods. We searched PubMed, Embase, Medline, Cochrane library, and Web of Science to identify randomized controlled trials that compared postoperative pain outcomes with or without IA Mg after knee arthroscopy. The primary outcomes were pain intensity at rest and with movement at different postoperative time points and cumulative opioid consumption within 24 hours after surgery. Secondary outcomes included the time to first analgesic request and side effects. Results. In total, 11 randomized controlled trials involving 677 subjects met the eligibility criteria. Pain scores at rest and with movement 2, 4, 12, and 24 h after surgery were significantly lower, doses of supplementary opioid consumption were smaller, and the time to first analgesic requirement was longer in the IA Mg group compared with the control group. No significant difference was detected regarding adverse reactions between the groups. Conclusions. Administering IA Mg following arthroscopic knee surgery is effective for relieving postoperative pain intensity, reducing opioid consumption, and prolonging the time before analgesics are needed without increasing adverse reactions. Protocol registration at Prospero: CRD42020156403.

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Intra-articular Magnesium to Alleviate Postoperative Pain After Arthroscopic Knee Surgery: A Meta-analysis of Randomized Controlled Trials

10.21203/rs.3.rs-112208/v2 ◽

2021 ◽

Author(s):

Lijun Shi ◽

Haiyun Zhu ◽

Jinhui Ma ◽

Li-Li Shi ◽

Fuqiang Gao ◽

...

Keyword(s):

Postoperative Pain ◽

Randomized Controlled Trials ◽

Pain Intensity ◽

Opioid Consumption ◽

Knee Surgery ◽

Cochrane Library ◽

Controlled Trials ◽

Arthroscopic Knee Surgery ◽

Randomized Controlled ◽

Arthroscopic Knee

Abstract Objective: We aimed to evaluate the safety and efficacy of intra-articular (IA) magnesium (Mg) for postoperative pain relief after arthroscopic knee surgery. Methods. We searched PubMed, Embase, Medline, Cochrane library, and Web of Science to identify randomized controlled trials that compared postoperative pain outcomes with or without IA Mg after knee arthroscopy. The primary outcomes were pain intensity at rest and with movement at different postoperative time points and cumulative opioid consumption within 24 hours after surgery. Secondary outcomes included the time to first analgesic request and side effects. Results. In total, 11 studies involving 677 participants met the eligibility criteria. Pain scores at rest and with movement 2, 4, 12, and 24 h after surgery were significantly lower, doses of supplementary opioid consumption were smaller, and the time to first analgesic requirement was longer in the IA Mg group compared with the control group. No significant difference was detected regarding adverse reactions between the groups. Conclusions. Intra-articular magnesium is an effective and safe coadjuvant treatment for relieving postoperative pain intensity after arthroscopic knee surgery.Protocol registration at Prospero: CRD42020156403.

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