Multimodal analgesia for postoperative pain in Asia: a review of evidence with clinical focus on dexketoprofen and tramadol/dexketoprofen fixed-dose combination

2021 ◽  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Postoperative Period ◽  
Opioid Analgesic ◽  
Postoperative Pain Management ◽  
Multimodal Analgesia ◽  
Fixed Dose ◽  
Opioid Use ◽  
Asian Patients ◽  
Anti Inflammatory

The majority of patients who have undergone surgery experience moderate-to-severe postoperative pain. Asian patients tend to under-report pain and are consequently under-treated. Poor postoperative pain management increases the risk of morbidity, prolonged opioid use, lower quality of life outcomes and the risk of chronic post-surgical pain. Multimodal analgesia is the cornerstone of postoperative pain management. Non-steroidal anti-inflammatory drugs are considered a core component of multimodal analgesia due to their anti-inflammatory and analgesic properties. Use of a consistent non-steroidal anti-inflammatory throughout the postoperative period can help to achieve and maintain adequate pain relief. This review investigates the use of multimodal analgesia in postoperative pain management in Asia, with a focus on clinicians’ experience with dexketoprofen as a non-steroidal anti-inflammatory therapy throughout the postoperative period and its combination as fixed dose with Tramadol, a centrally acting synthetic opioid analgesic, in Asian patients, when necessary.

Transversus abdominis block utilizing liposomal bupivacaine as a non-opioid analgesic for postoperative pain management

2018 ◽  
Vol 33 (8) ◽  
pp. 2657-2662 ◽  
Author(s):  
Thomas C. Robertson ◽  
Kathryn Hall ◽  
Susan Bear ◽  
Kyle J. Thompson ◽  
Timothy Kuwada ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Opioid Analgesic ◽  
Postoperative Pain Management ◽  
Transversus Abdominis ◽  
Liposomal Bupivacaine

scholarly journals Postoperative Pain and Opioid Use Following Surgical Treatment of Ankle Fractures

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0033
Author(s):  
Matthew Pate ◽  
Jacob Hall ◽  
John Anderson ◽  
Donald Bohay ◽  
John Maskill ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Ankle Fracture ◽  
Management Practices ◽  
Opioid Analgesic ◽  
The United States ◽  
Ankle Fractures ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Opioid Medication

Category: Ankle, Bunion, Trauma Introduction/Purpose: Chronic opioid abuse is one of the greatest public health challenges in the United States. The most common first exposure to opioids comes from acute care prescriptions, such as those after surgery. Moreover, opioids are often prescribed excessively, with current estimates suggesting ˜75% of the pills prescribed are unused. Ankle fractures are the most common operatively treated fracture in orthopaedic surgery, and management of acute pain following surgery is challenging. The optimal perioperative pain regimen is still a point of controversy, as there is limited data available regarding appropriate amount of opioid to prescribe. This study evaluates opioid prescribing techniques of multiple foot and ankle surgeons, and associated patient outcomes. We aim to help surgeons improve their pain management practices and to limit opioid overprescription. Methods: Chart review and phone survey were performed on forty two adult patients within three to six months of ankle fracture fixation at our institution. These patients were offered to voluntarily participate in a standardized questionnaire regarding pain scores, opioid use, non-opioid analgesic use, pain management satisfaction, and patient prescription education. Results: 57% of patients reported that they were given “more” or ”much more” opioid medication than needed, 38% stated that they were given the “right amount”, and 5% reported that they were given ”less” or “much less” than needed. 40.0% were on opioids prior to operation. 53.5% did not require refill of discharge opioid prescriptions, 30.2% of patients did not fill any posteroperative opioid prescription. 16.3% of patients filled their discharge prescription and at least one additionall refill (mean refill = 2.22). Mean number of reported opioid pills taken after surgery was 17.4. Mean satisfaction with overall pain management at phone follow up was 8.6/10. Conclusion: While postoperative pain and management vary substantially, a majority of patients feel that they are given more opioid medication than necessary following ankle fracture repair, and a majority of opioid prescriptions are not completely used. Going forward, it is likely that a majority of patients could experience the same beneficial results with less prescription opioid pain medication, which would reduce overpresciption and potential misuse.

scholarly journals The efficacy of pre-emptive analgesia on pain management in total knee arthroplasty: a mini-review

Arthroplasty ◽  
2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Jianda Xu ◽  
Huan Li ◽  
Chong Zheng ◽  
Bin Wang ◽  
Pengfei Shen ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Pain Management ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Physiological Mechanism ◽  
Cost Effective ◽  
Postoperative Pain Management ◽  
Multimodal Analgesia ◽  
Total Knee ◽  
End Stage

Abstract Total knee arthroplasty (TKA) is considered a cost-effective and efficacious treatment for patients with end-stage knee arthritis. Meanwhile, TKA has been regarded as one of the most painful orthopaedic surgeries. Pain control after TKA remains a challenging task. Many analgesic innovations are used to reduce the level of pain, but none has been proven to be the optimum choice till now. Multimodal analgesia incorporates the use of analgesic adjuncts with different mechanisms of action to enhance postoperative pain management. This approach is a preferable choice in relieving postoperative pain with minimum side effects. This paper aims to review pre-emptive analgesia for pain management in TKA. We reviewed the application of pre-emptive analgesia, its physiological mechanism, and the techniques.

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 Post-operative pain management modalities employed in clinical trials for adult patients in LMIC; a systematic review

2020 ◽  
Author(s):  
Gauhar Afshan ◽  
Robyna Irshad Khan ◽  
Aliya Ahmed ◽  
Ali Sarfraz Siddiqui ◽  
Azhar Rehman ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Pain Management ◽  
Postoperative Pain ◽  
Postoperative Pain Management ◽  
Multimodal Analgesia ◽  
Adult Patients ◽  
Cochrane Library ◽  
Regional Analgesia ◽  
Post Operative Pain

Abstract Background: Unrelieved postoperative pain afflicts millions each year in low and middle income countries (LMIC). Despite substantial advances in the study of pain, this area remains neglected. Current systematic review was designed to ascertain the types of clinical trials conducted in LMIC on postoperative pain management modalities over the last decade. Methods: A comprehensive search was performed in June 2019 on PubMed, Cochrane Library, CINAHL Plus, and Web of Science databases to identify relevant trials on the management of postoperative pain in LMIC. Out of 1450 RCTs, 108 studies were reviewed for quality evidence using structured form of critical appraisal skill program. Total of 51 clinical trials were included after applying inclusion/exclusion criteria. Results:Results are charted according to the type of surgery. Eleven trials on laparoscopic cholecystectomy used multimodal analgesia including some form of regional analgesia. Different analgesic modalities were studied in 4 trials on thoracotomy, but none used multimodal approach. In 11 trials on laparotomy, multimodal analgesia was employed along with the studied modalities. In 2 trials on hysterectomy, preemptive pregabalin or gabapentin were used for reduction in rescue analgesia. In 13 trials on breast surgical procedures and 10 on orthopaedic surgery, multimodal analgesia was used with some form of regional analgesia. Conclusion: We found that over the past 10 years, clinical trials for postoperative pain modalities have evolved in LMIC according to the current postoperative pain management guidelines i.e. multi-modal approach with some form of regional analgesia. The current review shows that clinical trials were conducted using multimodal analgesia including but not limited to some form of regional analgesia for postoperative pain in LMIC however this research snapshot (of only three countries) may not exactly reflect the clinical practices in all 47 countries. Post Operative Pain Management Modalities Employed in Clinical Trials for Adult Patients in LMIC; A Systematic Review

scholarly journals Post-operative pain management modalities employed in clinical trials for adult patients in LMIC: a systematic review

2020 ◽  
Author(s):  
Gauhar Afshan ◽  
Robyna Irshad Khan ◽  
Aliya Ahmed ◽  
Ali Sarfraz Siddiqui ◽  
Azhar Rehman ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Pain Management ◽  
Postoperative Pain ◽  
Postoperative Pain Management ◽  
Multimodal Analgesia ◽  
Cochrane Library ◽  
Clinical Practices ◽  
Regional Analgesia ◽  
Rescue Analgesia

Abstract Background: Unrelieved postoperative pain afflicts millions each year in low and middle income countries (LMIC). Despite substantial advances in the study of pain, this area remains neglected. Current systematic review was designed to ascertain the types of clinical trials conducted in LMIC on postoperative pain management modalities over the last decade. Methods: A comprehensive search was performed in June 2019 on PubMed, Cochrane Library, CINAHL Plus, and Web of Science databases to identify relevant trials on the management of postoperative pain in LMIC. Out of 1450 RCTs, 108 studies were reviewed for quality evidence using structured form of critical appraisal skill program. Total of 51 clinical trials were included after applying inclusion/exclusion criteria. Results: Results are charted according to the type of surgery. Eleven trials on laparoscopic cholecystectomy used multimodal analgesia including some form of regional analgesia. Different analgesic modalities were studied in 4 trials on thoracotomy, but none used multimodal approach. In 11 trials on laparotomy, multimodal analgesia was employed along with the studied modalities. In 2 trials on hysterectomy, preemptive pregabalin or gabapentin were used for reduction in rescue analgesia. In 13 trials on breast surgical procedures and 10 on orthopaedic surgery, multimodal analgesia was used with some form of regional analgesia. Conclusion: We found that over the past 10 years, clinical trials for postoperative pain modalities have evolved in LMIC according to the current postoperative pain management guidelines i.e. multi-modal approach with some form of regional analgesia. The current review shows that clinical trials were conducted using multimodal analgesia including but not limited to some form of regional analgesia for postoperative pain in LMIC however this research snapshot (of only three countries) may not exactly reflect the clinical practices in all 47 countries.

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