scholarly journals Clinical Implementation of A Multimodal Analgesia Regimen for Cardiac Surgical Patients

2018 ◽  
Vol 5 (6) ◽  
pp. 333-345
Author(s):  
Roya Saffary ◽  
Cody Parsons ◽  
Einar Ottesta ◽  
Heather Pulley ◽  
Corinne Pogemiller ◽  
...  
Keyword(s):  
Multimodal Analgesia ◽  
Surgical Patients ◽  
Clinical Implementation

scholarly journals 421 Closed loop analgesia audit, a Single Centre Experience in Raigmore Hospital, Inverness, Scotland

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
J H Chan
Keyword(s):  
Closed Loop ◽  
Length Of Hospital Stay ◽  
Multimodal Analgesia ◽  
Surgical Patients ◽  
Post Intervention ◽  
Who Analgesic Ladder ◽  
Information Leaflets ◽  
Analgesic Ladder ◽  
Surgical Teams ◽  
Operative Recovery

Abstract Aim Assess are we following the analgesic step ladder accurately and if not are the reasons clear and documented? Method A closed-loop audit performed on the use of the WHO Analgesic ladder in surgical patients. We looked at the compliance of the analgesic ladder and are the reasons documented or explained when the ladder is not followed. The data was collated, analysed, and presented at an audit meeting. We then implemented changes in the form of educational sessions and information leaflets sharing, as well as email reminders among staff. Post-implementation showed an improvement in the documentation when the analgesic ladder was not followed. Results A total of 103 surgical patients were included. Prior to the implementation of interventions, 83.3% of patients had analgesia prescribed following the analgesic ladder. Of those remaining patients who had analgesia prescribed not according to the analgesic ladder, only 50% documented the indications and reasons. Post-implementation, the analgesic ladder compliance dropped to 50.9% with documentation improvement to 56%. Conclusions All surgical patients have prescribed analgesia when needed. Though WHO ladder compliance has shown reduction compared to the first data sample, the reasons are clinically justified, and improvements have been shown in documentation after intervention though there is still room for improvement for documentation. This is perhaps surgical teams are more aware of the choice of analgesia used post-intervention while taking the analgesic ladder into consideration. Stepwise multimodal analgesia prescribing will improve analgesic effect hence improves post-operative recovery hence reduce the length of hospital stay as part of the ERAS protocol.

Can enhanced recovery protocols impact non-opioid multimodal analgesia use in all surgical patients?

2020 ◽  
Vol 66 ◽  
pp. 109963
Author(s):  
Jared A. Herman ◽  
Ivan Urits ◽  
Alan D. Kaye ◽  
Richard D. Urman ◽  
Omar Viswanath
Keyword(s):  
Enhanced Recovery ◽  
Multimodal Analgesia ◽  
Surgical Patients ◽  
Recovery Protocols

scholarly journals Multicenter study of the effectiveness of postoperative pain relief in Ukraine using paracetаmol in surgical hospitals – “ROZUM”

Pain medicine ◽  
2021 ◽  
Vol 6 (3) ◽  
pp. 4-14
Author(s):  
Dmytro Dmitriev ◽  
Ya Feleshtynskyi ◽  
S Vasyliuk ◽  
V Shaprynskyi ◽  
Yu Derkach ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Multicenter Study ◽  
Postoperative Period ◽  
Pain Syndrome ◽  
Multimodal Analgesia ◽  
Surgical Patients ◽  
Postoperative Pain Relief

This article is devoted to the effectiveness of postoperative pain relief in surgical hospitals in Ukraine. Multicenter study of the effectiveness of postoperative pain relief in Ukraine using paracetаmol in surgical hospitals – ROZUM is descibed. The effectiveness of multimodal analgesia and other analgesia in the postoperative period has been determined. Predictors of inadequate pain relief in surgical patients were identified, and the risks of pain syndrome development in a surgical hospital were assessed. The use of paracetamol in the schemes of multim

Maximal Pharmacologic Reduction of Postoperative Nausea and Vomiting in Patients Undergoing Aesthetic Breast Surgery Under General Anesthesia

2016 ◽  
Vol 33 (4) ◽  
pp. 189-192 ◽  
Author(s):  
Mauree NaShea Beard ◽  
Arup De
Keyword(s):  
General Anesthesia ◽  
Postoperative Nausea ◽  
Breast Surgery ◽  
Postoperative Nausea And Vomiting ◽  
Multimodal Analgesia ◽  
Nausea And Vomiting ◽  
Surgical Patients ◽  
Control Group ◽  
Limited Data ◽  
Aesthetic Breast

Postoperative nausea and vomiting (PONV) is a major patient dissatisfier in aesthetic ambulatory surgical patients. Limited data exist demonstrating single surgeon reduction in PONV after utilizing modern pharmacologic techniques for analgesia and PONV chemoprophylaxis for patients who receive general anesthesia. In our study, multimodal analgesia included pregabalin, oxycontin, ketamine, and opioids; PONV chemoprophylaxis included transdermal scopolamine, diphenhydramine, dexamethasone, and ondansetron. A treatment arm of 36 patients undergoing aesthetic breast surgery was evaluated prospectively and compared with a retrospective control group of 47 patients who underwent similar procedures in the prior year. The aggressive screening for PONV risk factors preoperatively and preemptive treatment resulted in an overall reduction in PONV rate from 31.9% to 5.6%.

scholarly journals The association of multimodal analgesia and high-risk opioid discharge prescriptions in opioid-naive surgical patients

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Erica Langnas ◽  
Rosa Rodriguez-Monguio ◽  
Yanting Luo ◽  
Rhiannon Croci ◽  
R. Adams Dudley ◽  
...  
Keyword(s):  
High Risk ◽  
Hospital Discharge ◽  
Medical Center ◽  
Academic Medical Center ◽  
Multimodal Analgesia ◽  
Surgical Patients ◽  
Surgical Patient ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Analgesic Agents

Abstract Background Opioids and multimodal analgesia are widely administered to manage postoperative pain. However, little is known on how improvements in inpatient pain control are correlated with high-risk (> 90 daily OME) discharge opioid prescriptions for opioid naïve surgical patients. Methods We conducted a retrospective observational study of adult opioid-naïve patients undergoing surgery from June 2012 through December 2018 at a large academic medical center. We used multivariate logistic regression to assess whether multimodal analgesic drugs consumed in the 24 h prior to discharge was associated with a reduction in high-risk opioid discharge prescriptions. We identified other risk factors for receiving a high-risk discharge opioid prescription. Results Among the 32,511 patients, 83% of patients were discharged with an opioid prescription. In 2013, 34.1% of patients with a discharge opioid prescription received a high-risk prescription and this declined to 17.7% by 2018. Use of multimodal analgesic agents during the final 24 h of hospitalization increased each year, with over 80% receiving at least one multimodal analgesic agent by 2018. The median OME consumed in the 24 h prior to discharge peaked in 2013 at 31 and steadily decreased to 19.8 by 2018. There was a significant association between the use of acetaminophen in the 24 h prior to discharge and a high-risk prescription at discharge (p < 0.01). OMEs consumed in the 24 h prior to discharge was a significant predictor of receiving a high-risk discharge prescription, even at low doses. Other factors associated with receipt of a high-risk discharge opioid prescription included male gender, race, history of anxiety disorder, and discharge service. Discussion Use of multimodal analgesia regimens in hospitalized surgical patients in the 24 h prior to hospital discharge increased between 2012 and 2018. Simultaneously, opioid use prior to hospital discharge decreased. Despite these gains, approximately one in five discharge prescriptions was high-risk (> 90 daily OME). In addition, we found that prescribing of discharge opioids above inpatient opioid requirements remains common in opioid naive surgical patients. Conclusion Providers should account for pre-discharge opioid consumption and use of multimodal analgesia when considering the total and daily OME’s that may be appropriate for an individual surgical patient on the discharge opioid prescription.

scholarly journals Optimizing opioid prescriptions after laparoscopic appendectomy and cholecystectomy

2021 ◽  
Vol 64 (1) ◽  
pp. E69-E75
Author(s):  
Adina E. Feinberg ◽  
Sergio A. Acuna ◽  
David Smith ◽  
Brian Kashin ◽  
Aaron Mocon ◽  
...  
Keyword(s):  
Laparoscopic Appendectomy ◽  
Primary Outcome ◽  
Multimodal Analgesia ◽  
Median Number ◽  
Opioid Consumption ◽  
Prescribing Patterns ◽  
Surgical Patients ◽  
Quality Improvement Intervention ◽  
Second Phase ◽  
Improvement Intervention

Background: There has been an increase in opioid usage and opioid-related deaths. Opioids prescribed to surgical patients have similarly increased. The aim of this study was to assess opioid consumption in patients undergoing laparoscopic appendectomy (LA) and laparoscopic cholecystectomy (LC) and to determine whether a standardized prescription could affect opioid consumption without affecting patient satisfaction. Methods: Patients undergoing LA or LC were recruited prospectively during 2 time periods (April to June 2017 and November 2017 to January 2018). In the first phase, surgeons continued their usual postoperative analgesia prescribing patterns. In the second phase, a standardized prescription was implemented. Patients were contacted by telephone and a questionnaire was completed for both phases of the study. The primary outcome was the quantity of opioids prescribed and consumed. Results: In the first phase, 166 patients who underwent LC or LA were recruited. The median number of prescribed opioid tablets was 20 and the median number consumed was 2. Ninety-five percent of patients reported satisfaction with their analgesia. Based on these results, a standardized prescription for multimodal analgesia was implemented for the second phase, consisting of 10 opioid tablets. In the second phase, 129 patients who underwent LA or LC were recruited. There was a significant decrease in the median number of opioid pills filled (10) and consumed (0), with no difference in reported satisfaction with analgesia. Conclusion: Patients are prescribed an excess of opioids after LA or LC. Implementation of a standardized prescription based on a quality improvement intervention was effective at decreasing the number of opioids prescribed and consumed.

scholarly journals Efficacy and Outcomes of Intrathecal Analgesia as Part of an Enhanced Recovery Pathway in Colon and Rectal Surgical Patients

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Amit Merchea ◽  
Jenna K. Lovely ◽  
Adam K. Jacob ◽  
Dorin T. Colibaseanu ◽  
Scott R. Kelley ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Enhanced Recovery ◽  
Single Injection ◽  
Anesthetic Management ◽  
Multimodal Analgesia ◽  
Surgical Patients ◽  
Enhanced Recovery Pathway ◽  
Pain Scores ◽  
Blood Patch ◽  
Intrathecal Analgesia

Purpose. Multimodal analgesia is an essential component of an enhanced recovery pathway (ERP). An ERP that includes the use of single-injection intrathecal analgesia (IA) has been shown to decrease morbidity and cost and shorten length of stay (LOS). Limited data exist on safety, feasibility, and the optimal IA regimen. Our objective was to characterize the efficacy, safety, and feasibility of IA within an ERP in a cohort of colorectal surgical patients. Methods. We performed a retrospective review of all consecutive patients aged ≥ 18 years who underwent open or minimally invasive colorectal surgery from October 2012 to December 2013. All patients were enrolled in an institutional ERP that included the use of single-injection IA. Demographics, anesthetic management, efficacy (pain scores and opiate consumption), postoperative ileus (POI), adverse effects, and LOS are reported. Results. 601 patients were identified. The majority received opioid-only IA (91%) rather than a multimodal regimen. Median LOS was 3 days. Overall rate of ileus was 16%. Median pain scores at 4, 8, 16, 24, and 48 hours were 3, 2, 3, 4, and 3, respectively. There was no difference in postoperative pain scores, LOS, or POI based on intrathecal medication or dose received. Overall, development of respiratory depression (0.2%) or pruritus (1.2%) was rare. One patient required blood patch for postdural headache. Conclusion. Intrathecal analgesia is safe, feasible, and efficacious in the setting of ERP for colorectal surgery. All regimens and doses achieved a short LOS, low pain scores, and a low incidence of POI. This trial is registered with Clinicaltrails.gov NCT03411109.

scholarly journals Increasing the use of multimodal analgesia during adult surgery in a tertiary academic anaesthesia department

2021 ◽  
Vol 10 (3) ◽  
pp. e001320
Author(s):  
Andrea V Olmos ◽  
Sasha Steen ◽  
Christy K Boscardin ◽  
Joyce M Chang ◽  
Genevieve Manahan ◽  
...  
Keyword(s):  
Quality Improvement ◽  
General Anaesthesia ◽  
Multimodal Analgesia ◽  
Surgical Patients ◽  
Project Implementation ◽  
Opioid Use ◽  
Pain Scores ◽  
Baseline Group ◽  
Analgesic Medication ◽  
Group 1

ObjectiveMultimodal analgesia pathways have been shown to reduce opioid use and side effects in surgical patients. A quality improvement initiative was implemented to increase the use of multimodal analgesia in adult patients presenting for general anaesthesia at an academic tertiary care centre. The aim of this study was to increase adoption of a perioperative multimodal analgesia protocol across a broad population of surgical patients. The use of multimodal analgesia was tracked as a process metric. Our primary outcome was opioid use normalised to oral morphine equivalents (OME) intraoperatively, in the postanaesthesia care unit (PACU), and 48 hours postoperatively. Pain scores and use of antiemetics were measured as balancing metrics.MethodsWe conducted a quality improvement study of a multimodal analgesia protocol implemented for adult (≥18 and≤70) non-transplant patients undergoing general anaesthesia (≥180 min). Components of multimodal analgesia were defined as (1) preoperative analgesic medication (acetaminophen, celecoxib, diclofenac, gabapentin), (2) regional anaesthesia (peripheral nerve block or catheter, epidural catheter or spinal) or (3) intraoperative analgesic medication (ketamine, ketorolac, lidocaine infusion, magnesium, acetaminophen, dexamethasone ≥8 mg, dexmedetomidine). We compared opioid use, pain scores and antiemetic use for patients 1 year before (baseline group—1 July 2018 to 30 June 2019) and 1 year after (implementation group—1 July 2019 to 30 June 2020) project implementation.ResultsUse of multimodal analgesia improved from 53.9% in the baseline group to 67.5% in the implementation group (p<0.001). There was no significant difference in intraoperative OME use before and after implementation (β0=44.0, β2=0.52, p=0.875). OME decreased after the project implementation in the PACU (β0=34.4, β2=−3.88, p<0.001) and 48 hours postoperatively (β0=184.9, β2=−22.59, p<0.001), while pain scores during those time points were similar.ConclusionA perioperative pragmatic multimodal analgesic intervention was associated with reduced OME use in the PACU and 48 hours postoperatively.

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