scholarly journals Influence of Preoperative Anxiety Level on Postoperative Pain After Cardiac Surgery

2021 ◽  
Author(s):  
Muhammad Kashif ◽  
Mohammad Hamid ◽  
Amir Raza
Keyword(s):  
Cardiac Surgery ◽  
Postoperative Pain ◽  
Assessment Tool ◽  
Preoperative Anxiety ◽  
University Hospital ◽  
Morphine Consumption ◽  
Anxiety Group ◽  
Pain Scores ◽  
Postoperative Morphine ◽  
Severe Anxiety

Abstract IntroductionPreoperative anxiety is generally neglected in evaluation of cardiac surgery patients due to various reasons including insufficient literature and lack of simple assessment tool. In addition, association between anxiety and postoperative complications including pain has been scarcely studied.Present study was designed, to assess preoperative anxiety levels in all patients coming for cardiac surgery and then evaluate the effect of different levels of anxiety on postoperative pain scores. MethodsThis prospective cohort study was conducted in a single university hospital, from March 2018 to December 2019. 100 consecutive cardiac surgery patients between the ages of 18-65 year were enrolled in this study. Level of preoperative anxiety ( assessed by State Anxiety Inventory) and its effect on postoperative pain and morphine consumption was assessed.ResultsThe average age of the patients was 58.24±10.03 year in which 68% were male and 32% female. Preoperative mild anxiety was observed in 64% patients and moderate to severe anxiety in 36% patients. Post-operative mean pain score was significantly high in moderate to severe anxiety group as compared to mild anxiety group [Mean pain difference =1.64 (95%CI: 1.38-1.89) p=0.0005], [Mean pain difference =0.51 (95%CI: 0.29-0.73) p=0.0005] at 12 hour and 24 hour respectively. Intraoperative and postoperative morphine consumption was significantly high in patients with moderate to severe anxiety group.ConclusionsPatients with moderate to severe anxiety before cardiac surgery experienced higher pain scores at post-operative period which is significantly different from mild anxiety group. Intraoperative and postoperative analgesic requirements were also significantly increased.

scholarly journals Comparison between femoral block and PENG block in femoral neck fractures: A cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252716
Author(s):  
Céline Allard ◽  
Emmanuel Pardo ◽  
Christophe de la Jonquière ◽  
Anne Wyniecki ◽  
Anne Soulier ◽  
...  
Keyword(s):  
Side Effects ◽  
Postoperative Pain ◽  
Femoral Neck ◽  
Enhanced Recovery ◽  
Length Of Hospital Stay ◽  
Femoral Neck Fractures ◽  
University Hospital ◽  
Morphine Consumption ◽  
Regional Analgesia ◽  
Postoperative Morphine

Background Regional analgesia is worth performing in the multimodal postoperative management of hip fracture (HF) because it reduces hospital morbidity and mortality. The aim of this study is to compare the efficacy and side effects of the recently described “Pericapsular Nerve Group (PENG) Block” with those of the femoral block, which is considered the standard of care for postoperative pain control after femoral neck fracture. Materials and methods We conducted a comparative observational study at a university hospital (Saint Antoine Hospital, Sorbonne University, Paris, France), where the PENG block was introduced in August 2019. We include all patients from June to October 2019, who were coming for femoral neck fractures and who had an analgesic femoral block or PENG block before their surgery. The primary outcome was the comparison of cumulative postoperative morphine consumption 48 hours after surgery. Results Demographics, medical charts, and perioperative data of 42 patients were reviewed: 21 patients before (Femoral group) and 21 patients after the introduction of PENG block (PENG group) in clinical practice. Thirteen total hip arthroplasties (THA) and eight hemi arthroplasties (HA) were included in each group. Demographics were also comparable. The median, postoperative, morphine equivalent consumption at 48 hours was 10 [0–20] mg and 20 [0–50] mg in Femoral and PENG groups respectively (p = 0.458). No statistically significant differences were found in postoperative pain intensity, time to ambulation, incidence of morphine-related side effects, or length of hospital stay. The postoperative muscle strength of the quadriceps was greater in the PENG group than in the Femoral group (5/5 vs. 2/5, p = 0.001). Conclusion In the management of hip fractures, PENG block is not associated in our study with a significant change in postoperative morphine consumption, compared to femoral block. However, it does significantly improve the immediate mobility of the operated limb, making it appropriate for inclusion in enhanced recovery programs after surgery.

scholarly journals Perioperative pregabalin for reducing pain, analgesic consumption, and anxiety and enhancing sleep quality in elective neurosurgical patients: a prospective, randomized, double-blind, and controlled clinical study

2016 ◽  
Vol 125 (6) ◽  
pp. 1513-1522 ◽  
Author(s):  
Nir Shimony ◽  
Uri Amit ◽  
Bella Minz ◽  
Rachel Grossman ◽  
Marc A. Dany ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Sleep Quality ◽  
Rating Scale ◽  
Preoperative Anxiety ◽  
Controlled Study ◽  
Double Blind ◽  
Analgesic Consumption ◽  
Pain Scores ◽  
Neurosurgical Patients ◽  
Duration Of Surgery

OBJECTIVE The aim of this study was to assess in-hospital (immediate) postoperative pain scores and analgesic consumption (primary goals) and preoperative anxiety and sleep quality (secondary goals) in patients who underwent craniotomy and were treated with pregabalin (PGL). Whenever possible, out-of-hospital pain scores and analgesics usage data were obtained as well. METHODS This prospective, randomized, double-blind and controlled study was conducted in consenting patients who underwent elective craniotomy for brain tumor resection at Tel Aviv Medical Center between 2012 and 2014. Patients received either 150 mg PGL (n = 50) or 500 mg starch (placebo; n = 50) on the evening before surgery, 1.5 hours before surgery, and twice daily for 72 hours following surgery. All patients spent the night before surgery in the hospital, and no other premedication was administered. Opioids and nonsteroidal antiinflammatory drugs were used for pain, which was self-rated by means of a numerical rating scale (score range 0–10). RESULTS Eighty-eight patients completed the study. Data on the American Society of Anesthesiologists class, age, body weight, duration of surgery, and intraoperative drugs were similar for both groups. The pain scores during postoperative Days 0 to 2 were significantly lower in the PGL group than in the placebo group (p < 0.01). Analgesic consumption was also lower in the PGL group, both immediately and 1 month after surgery. There were fewer requests for antiemetics in the PGL group, and the rate of postoperative nausea and vomiting was lower. The preoperative anxiety level and the quality of sleep were significantly better in the PGL group (p < 0.01). There were no PGL-associated major adverse events. CONCLUSIONS Perioperative use of twice-daily 150 mg pregabalin attenuates preoperative anxiety, improves sleep quality, and reduces postoperative pain scores and analgesic usage without increasing the rate of adverse effects. Clinical trial registration no.: NCT01612832 (clinicaltrials.gov)

Early postoperative patient-controlled analgesia ratio predicts 24-hour morphine consumption and pain in children undergoing scoliosis surgery

2014 ◽  
Vol 10 (1) ◽  
pp. 39 ◽  
Author(s):  
Clyde T. Matava, MBCHB ◽  
Mark W. Crawford, MBBS ◽  
Carolyne Pehora, RN ◽  
Basem Naser, MD ◽  
Conor McDonnell, MBCHB
Keyword(s):  
Side Effects ◽  
Postoperative Pain ◽  
Hospital Stay ◽  
Univariate Analysis ◽  
Morphine Consumption ◽  
Scoliosis Surgery ◽  
Patient Controlled Analgesia ◽  
Duration Of Hospital Stay ◽  
Pain Scores ◽  
Severe Postoperative Pain

Background: The identification of patients at risk for developing severe postoperative pain and/or opioid-related side effects is difficult due to a lack of sensitive indicators. The patient-controlled analgesia (PCA) ratio of demands to deliveries is a potential tool for early identification of patients who experience severe postoperative pain. The authors hypothesized that the PCA ratio is able to predict morphine requirement in the first 24 hours after scoliosis surgery.Methods: The authors performed a retrospective study of adolescents who had surgery for idiopathic scoliosis. They collected data describing PCA demands and deliveries, morphine consumption, numerical rating scale (NRS) pain scores, opioidrelated side effects, and duration of hospital stay. Spearman rank analysis assessed association among 4-hour PCA ratios, NRS pain score, and 24-hour morphine consumption. Patients were divided into groups on the basis of PCA ratios <1.5 and ≥1.5. Univariate analysis and multiple regression were used to identify independent factors predictive for increased 24-hour morphine. Mann-Whitney rank-sum and Fisher exact tests were used to compare data. p < 0.05 was considered statistically significant.Results: One hundred forty-seven patients were included in the analysis, mean (SD) age and weight were 15 (1.8) years and 55 (27) kg, respectively. There was a significant positive correlation between the 4-hour PCA ratio and initial 24-hour cumulative morphine consumption (r = 0.33, p = 0.0002). Patients with a 4-hour PCA ratio ≥1.5 demonstrated a significantly greater initial 24-hour morphine consumption (p = 0.0002), greater pain scores at 24 hours after surgery (p = 0.02), a greater incidence of at least one opioid-related side effect within the initial 24 hours after surgery, and a longer duration of hospital stay (p = 0.04) compared with those patients with a 4-hour PCA ratio <1.5. PCA ratio ≥1.5, age, and patient sex were predictive for 24-hour morphine consumption.Conclusions: The authors have demonstrated that a PCA ratio of demands/deliveries ≥1.5 is predictive of increased opioid requirements and is associated with greater pain scores in the initial 24 hours after surgery, an increased incidence of opioid-related side effects, and duration of hospital stay.

Intraoperative Methadone for the Prevention of Postoperative Pain

2015 ◽  
Vol 122 (5) ◽  
pp. 1112-1122 ◽  
Author(s):  
Glenn S. Murphy ◽  
Joseph W. Szokol ◽  
Michael J. Avram ◽  
Steven B. Greenberg ◽  
Jesse H. Marymont ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Pain Management ◽  
Tracheal Extubation ◽  
Perceived Quality ◽  
Pain Scores ◽  
Methadone Group ◽  
Group 2 ◽  
Postoperative Morphine ◽  
Fentanyl Group

Abstract Background: The intensity of pain after cardiac surgery is often underestimated, and inadequate pain control may be associated with poorer quality of recovery. The aim of this investigation was to examine the effect of intraoperative methadone on postoperative analgesic requirements, pain scores, patient satisfaction, and clinical recovery. Methods: Patients undergoing cardiac surgery with cardiopulmonary bypass (n = 156) were randomized to receive methadone (0.3 mg/kg) or fentanyl (12 μg/kg) intraoperatively. Postoperative analgesic requirements were recorded. Patients were assessed for pain at rest and with coughing 15 min and 2, 4, 8, 12, 24, 48, and 72 h after tracheal extubation. Patients were also evaluated for level of sedation, nausea, vomiting, itching, hypoventilation, and hypoxia at these times. Results: Postoperative morphine requirements during the first 24 h were reduced from a median of 10 mg in the fentanyl group to 6 mg in the methadone group (median difference [99% CI], −4 [−8 to −2] mg; P &lt; 0.001). Reductions in pain scores with coughing were observed during the first 24 h after extubation; the level of pain with coughing at 12 h was reduced from a median of 6 in the fentanyl group to 4 in the methadone group (−2 [−3 to −1]; P &lt; 0.001). Improvements in patient-perceived quality of pain management were described in the methadone group. The incidence of opioid-related adverse events was not increased in patients administered methadone. Conclusions: Intraoperative methadone administration resulted in reduced postoperative morphine requirements, improved pain scores, and enhanced patient-perceived quality of pain management.

scholarly journals A prospective randomized double-blind trial of the efficacy of a bilateral lumbar erector spinae block on the 24h morphine consumption after posterior lumbar interbody fusion surgery

2019 ◽  
Author(s):  
margaretha breebaart ◽  
David Van Aken ◽  
Olivier De Fré ◽  
Luc Sermeus ◽  
Niels Kamerling ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Spine Surgery ◽  
Movement Time ◽  
Posterior Lumbar Interbody Fusion ◽  
Erector Spinae ◽  
Morphine Consumption ◽  
Double Blind ◽  
Fusion Surgery ◽  
Regional Technique ◽  
Postoperative Morphine

Abstract Background: Spine surgery is associated with considerable postoperative pain and can be challenging to treat. A loco-regional technique suitable for spine surgery should cover the dorsal root of the spinal nerves at the levels where surgery is performed. The erector spinae block is a loco-regional technique with promising results that was recently described at the thoracic level. There are no randomized trials of this technique on a lumbar level. This study tests the hypothesis that the 24hour postoperative morphine consumption is significantly lower in patients undergoing posterior lumbar inter-body fusion surgery with a lumbar erector spinae (LUMBES) block when compared to a sham block. Methods: This prospective randomized double-blind multicentre study will randomly allocate 80 adult patients undergoing elective posterior lumbar inter-body fusion surgery during general anaesthesia to one of two groups as follows: 1. bilateral erector spinae block (20 mL 0,25% levobupivacaine) or 2. bilateral sham block (20 ml NaCl 0,9% ). Our primary endpoint is the 24 hour postoperative morphine consumption. Secondary endpoints include: 72-hour morphine consumption, intraoperative sufentanil dosage, postoperative pain scores at regular time intervals both at rest and during movement, time to first post-operative mobilization and the Quality of Recovery 40 score. Discussion: The LUMBES trial is a pragmatic clinical study that will provide evidence of whether a bilateral lumbar erector spinae block is effective in reducing 24 hour postoperative morphine consumption in patients undergoing lumbar inter-body fusion surgery. If this hypothesis is confirmed, this finding could contribute to more widespread implementation of this technique. Trial registration: local ethic committee B300201837508, clinicaltrials.gov: NCT03825198

Efficacy of Perioperative Administration of Intravenous Parecoxib on Postoperative Morphine Consumption after Video-Assisted Thoracoscopic Surgery

2021 ◽  
Vol 104 (11) ◽  
pp. 1836-1842
Keyword(s):  
Postoperative Pain ◽  
Pain Score ◽  
Rating Scale ◽  
Thoracoscopic Surgery ◽  
Morphine Consumption ◽  
High Dose ◽  
Video Assisted ◽  
Significant Difference ◽  
Postoperative Morphine ◽  
Video Assisted Thoracoscopic Surgery

Background: Morphine is commonly used to relief pain after video-assisted thoracoscopic surgery (VATS), however high dose morphine is usually related with many complications. Parecoxib is a potent cyclo-oxygenase inhibitor for parenteral administration that has a role in acute pain management addition to opioid protocol. Objective: To investigate the potential benefits of intravenous parecoxib for relieving postoperative pain after VATS. Materials and Methods: The present study was a randomized controlled trial that assigned 22 patients undergoing VATS into two groups to received either parecoxib 40 mg as P group with 11 patients, or placebo using 2 mL of Normal Saline Solution as C group with 11 patients with an intravenous administration at 30 minutes prior to surgery and then 12 hours later. In the postoperative period, all patients received intravenous patient-controlled analgesia (PCA) with morphine. The primary outcome was the total morphine consumption for 24 hours postoperatively. The secondary outcomes were pain score at 2, 6, 12, and 24 hours postoperatively, using a numeric rating scale (NRS, 0 to 10) and the incidence of side effects. Results: The total morphine consumption was significantly lower in P group (26.64±4.41 mg) than C group (39.82±3.87 mg) at 24 hours postoperatively (p<0.001). The NRS pain score at rest and on coughing at 24 hours postoperatively between P group compared with C group were 1.09±1.04 versus 4.45±0.69 (p<0.001) and 2.91±0.83 versus 5.36±0.81 (p<0.001), respectively. The incidences of nausea and vomiting were found in both groups at 2, 6, and 12 hours, postoperatively, but there was no statistically significant difference between both groups (p>0.05). Other adverse events such as sedation, pruritus, dyspepsia, headache, hypotension, and respiratory depression were not found. Conclusion: Perioperative administration of parecoxib was safe and effectively decrease postoperative morphine consumption and pain score at rest and on coughing within 24 hours postoperatively after VATS. Keywords: Intravenous parecoxib; Video-assisted thoracoscopic surgery; Acute postoperative pain

scholarly journals Comparison of Patient-Controlled Analgesia and Nurse-Controlled Infusion Analgesia after Cardiac Surgery

1994 ◽  
Vol 22 (6) ◽  
pp. 672-678 ◽  
Author(s):  
Paul S. Myles ◽  
Mark R. Buckland ◽  
Graham B. Cannon ◽  
Michael A. Bujor ◽  
Mark Langley ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Serum Cortisol ◽  
Tracheal Extubation ◽  
Morphine Consumption ◽  
Controlled Clinical Trial ◽  
Randomized Controlled Clinical Trial ◽  
Patient Controlled Analgesia ◽  
Elective Cardiac Surgery ◽  
Randomized Controlled ◽  
Pain Scores

A randomized, controlled clinical trial was conducted on 72 patients undergoing elective cardiac surgery to compare patient-controlled analgesia (PCA) to nurse-titrated infusion of morphine. Pain and nausea scores were assessed at 5, 20, 32 and 44 hours after cardiopulmonary bypass. Serum cortisol estimations were performed at 24 and 48 hours, and morphine consumption was measured at 0-24 and 24-48 hours. There was no difference between pain scores (P=0.72), nausea scores (P=0.52), serum cortisol at 24 and 48 hours (P=0.32 and P=0.34), and morphine consumption at 0-24 and 24-48 hours (P=0.16 and P=0.12). There was also no difference in the time to tracheal extubation (P=0.79) and discharge from ICU (P=0.64). There was a significant association between pain and serum cortisol at 48 hours (P=0.023). This study also found a tenfold difference in the amount of morphine used (range = 11 to 108 mg), with no significant association with patient age or sex. We could find no significant benefit from the routine use of PCA in cardiac surgical patients.

Influence of opioid selection and dosage on postoperative pain and morphine consumption after cardiac surgery

2010 ◽  
Vol 27 ◽  
pp. 211
Author(s):  
J. Fechner ◽  
H. Ihmsen ◽  
S. Kreiel ◽  
A. Wilkerling ◽  
C. Jeleazcov
Keyword(s):  
Cardiac Surgery ◽  
Postoperative Pain ◽  
Morphine Consumption

scholarly journals A prospective randomized double-blind trial of the efficacy of a bilateral lumbar erector spinae block on the 24h morphine consumption after posterior lumbar interbody fusion surgery

2019 ◽  
Author(s):  
margaretha breebaart ◽  
David Van Aken ◽  
Olivier De Fré ◽  
Luc Sermeus ◽  
Niels Kamerling ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Spine Surgery ◽  
Movement Time ◽  
Posterior Lumbar Interbody Fusion ◽  
Erector Spinae ◽  
Morphine Consumption ◽  
Double Blind ◽  
Fusion Surgery ◽  
Regional Technique ◽  
Postoperative Morphine

Abstract Background: Spine surgery is associated with considerable postoperative pain and can be challenging to treat. A loco-regional technique suitable for spine surgery should cover the dorsal root of the spinal nerves at the levels where surgery is performed. The erector spinae block is a loco-regional technique with promising results that was recently described at the thoracic level. There are no randomized trials of this technique on a lumbar level. This study tests the hypothesis that the 24hour postoperative morphine consumption is significantly lower in patients undergoing posterior lumbar inter-body fusion surgery with a lumbar erector spinae (LUMBES) block when compared to a sham block. Methods: This prospective randomized double-blind multicentre study will randomly allocate 80 adult patients undergoing elective posterior lumbar inter-body fusion surgery during general anaesthesia to one of two groups as follows: 1. bilateral erector spinae block (20 mL 0.25% levobupivacaine) or 2. bilateral sham block (20 ml NaCl 0.9%). Our primary endpoint is the 24-hour postoperative morphine consumption. Secondary endpoints include: 72-hour morphine consumption, intraoperative sufentanil dosage, postoperative pain scores at regular time intervals both at rest and during movement, time to first post-operative mobilization and the Quality of Recovery 40 score. Discussion: The LUMBES trial is a pragmatic clinical study that will provide evidence of whether a bilateral lumbar erector spinae block is effective in reducing 24-hour postoperative morphine consumption in patients undergoing lumbar inter-body fusion surgery. If this hypothesis is confirmed, this finding could contribute to more widespread implementation of this technique.

scholarly journals A prospective randomized double-blind trial of the efficacy of a bilateral lumbar erector spinae block on the 24h morphine consumption after posterior lumbar interbody fusion surgery

2019 ◽  
Author(s):  
margaretha breebaart ◽  
David Van Aken ◽  
Olivier De Fré ◽  
Luc Sermeus ◽  
Niels Kamerling ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Spine Surgery ◽  
Movement Time ◽  
Posterior Lumbar Interbody Fusion ◽  
Erector Spinae ◽  
Morphine Consumption ◽  
Double Blind ◽  
Fusion Surgery ◽  
Regional Technique ◽  
Postoperative Morphine

Abstract Abstract Background: Spine surgery is associated with considerable postoperative pain and can be challenging to treat. A loco-regional technique suitable for spine surgery should cover the dorsal root of the spinal nerves at the levels where surgery is performed. The erector spinae block is a loco-regional technique with promising results that was recently described at the thoracic level. There are no randomized trials of this technique on a lumbar level. This study tests the hypothesis that the 24hour postoperative morphine consumption is significantly lower in patients undergoing posterior lumbar inter-body fusion surgery with a lumbar erector spinae (LUMBES) block when compared to a sham block. Methods: This prospective randomized double-blind multicentre study will randomly allocate 80 adult patients undergoing elective posterior lumbar inter-body fusion surgery during general anaesthesia to one of two groups as follows: 1. bilateral erector spinae block (20 mL 0,25% levobupivacaine) or 2. bilateral sham block (20 ml NaCl 0,9%). Our primary endpoint is the 24-hour postoperative morphine consumption. Secondary endpoints include: 72-hour morphine consumption, intraoperative sufentanil dosage, postoperative pain scores at regular time intervals both at rest and during movement, time to first post-operative mobilization and the Quality of Recovery 40 score. Discussion: The LUMBES trial is a pragmatic clinical study that will provide evidence of whether a bilateral lumbar erector spinae block is effective in reducing 24-hour postoperative morphine consumption in patients undergoing lumbar inter-body fusion surgery. If this hypothesis is confirmed, this finding could contribute to more widespread implementation of this technique.

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