scholarly journals Standard Multimodal Postoperative Analgesia Might Not Be Equally Effective When Comparing Anterior and Posterior Spondylodesis

2020 ◽  
Vol 4 (1) ◽  
pp. 81-89
Author(s):  
Josipa Dovranić ◽  
Matija Bagarić ◽  
Marija Karača ◽  
Vladimir Trkulja ◽  
Danijel Matek
Keyword(s):  
Anterior Approach ◽  
Posterior Approach ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Posterior Spinal Fusion ◽  
Pain Visual Analogue Scale ◽  
Pain Scores ◽  
Intravenous Morphine ◽  
Spinal Segments ◽  
Rate Ratios

Introduction. Surgical treatment of structural adolescent scoliosis, either through anterior or posterior spinal fusion, results in severe pain. Aim. In comparison with the anterior approach, the posterior approach is considered advantageous in that several spine curvatures can be corrected in a single operative act. The aim was to compare the effectiveness of a morphine-based multimodal protocol over the first 48 postoperative hours in anterior and posterior surgeries. Methods. This retrospective chart review included consecutive adolescents (10-21 years of age) treated using either the anterior (n=28) or the posterior (n=30) approach at a single hospital centre over 3 years (2015-2017). Intravenous morphine (48 mg/24 hours) was administered at hourly intervals; pain was assessed using an 11-point (higher score=worse pain) visual analogue scale on 12 occasions during the first 24 hours and on 3 occasions during the second 24 hours. Additional analgesia (non-opioid or weak opioid) was delivered on demand and/or according to medical assessment. Results. With adjustments for age and number of affected spinal segments, VAS pain scores were lower in the anterior approach, overall (48 hours) (difference = -18%, 95% CI -30 to -5), and particularly over hours 0-3 (-23%, 95% CI -36 to -7%) and hours 4-6 (-26%, 95% CI -40 to -10%) after the surgery. The rate of additional analgesic administrations was comparable throughout the observed period (rate ratios around 1.0). Conclusion. The evaluated intravenous morphinebased multimodal analgesic protocol appeared less effective in surgeries using the posterior approach, suggesting that the two approaches might require different protocols for the same level of analgesia.

Stereotactic Electroencephalography Is Associated With Reduced Pain and Opioid Use When Compared with Subdural Grids: A Case Series

2021 ◽  
Author(s):  
Jonathan P Scoville ◽  
Evan Joyce ◽  
Joshua Hunsaker ◽  
Jared Reese ◽  
Herschel Wilde ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Chart Review ◽  
Statistical Tests ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Opioid Use ◽  
Pain Scores ◽  
Surgical Methods ◽  
Significant Difference

Abstract BACKGROUND Minimally invasive surgery (MIS) has been shown to decrease length of hospital stay and opioid use. OBJECTIVE To identify whether surgery for epilepsy mapping via MIS stereotactically placed electroencephalography (SEEG) electrodes decreased overall opioid use when compared with craniotomy for EEG grid placement (ECoG). METHODS Patients who underwent surgery for epilepsy mapping, either SEEG or ECoG, were identified through retrospective chart review from 2015 through 2018. The hospital stay was separated into specific time periods to distinguish opioid use immediately postoperatively, throughout the rest of the stay and at discharge. The total amount of opioids consumed during each period was calculated by transforming all types of opioids into their morphine equivalents (ME). Pain scores were also collected using a modification of the Clinically Aligned Pain Assessment (CAPA) scale. The 2 surgical groups were compared using appropriate statistical tests. RESULTS The study identified 43 patients who met the inclusion criteria: 36 underwent SEEG placement and 17 underwent craniotomy grid placement. There was a statistically significant difference in median opioid consumption per hospital stay between the ECoG and the SEEG placement groups, 307.8 vs 71.5 ME, respectively (P = .0011). There was also a significant difference in CAPA scales between the 2 groups (P = .0117). CONCLUSION Opioid use is significantly lower in patients who undergo MIS epilepsy mapping via SEEG compared with those who undergo the more invasive ECoG procedure. As part of efforts to decrease the overall opioid burden, these results should be considered by patients and surgeons when deciding on surgical methods.

scholarly journals Anterior versus posterior surgical approach for lumbosacral tuberculosis

2018 ◽  
Vol 46 (7) ◽  
pp. 2569-2577 ◽  
Author(s):  
Bolong Zheng ◽  
Dingjun Hao ◽  
Hua Guo ◽  
Baorong He
Keyword(s):  
Cobb Angle ◽  
Anterior Approach ◽  
Posterior Approach ◽  
Operation Time ◽  
Analog Scale ◽  
Loss Of Correction ◽  
Pain Scores ◽  
Angle Correction ◽  
Before And After

Objective To compare two different approaches for the treatment of lumbosacral tuberculosis. Patients and Methods In total, 115 patients who were surgically treated in our department from July 2010 to July 2014 were included in this retrospective study. They were divided into the anterior and posterior approach groups. Intraoperative hemorrhage; the surgery time; the Cobb angle preoperatively, postoperatively, and at the follow-up visit (2 years postoperatively); visual analog scale (VAS) pain scores before and after surgery; and Oswestry Disability Index (ODI) scores before and after surgery were compared between the two groups. Results The Cobb angle and VAS and ODI scores were significantly improved in both groups after surgery. Significant differences were found in the operation time, intraoperative hemorrhage, Cobb angle correction, and loss of correction at the last follow-up. No significant differences were found in the VAS and ODI scores between the groups. Conclusions The posterior approach is superior to the anterior approach with respect to the surgery time, intraoperative hemorrhage, and Cobb angle postoperatively and at the last follow-up. When both approaches can be carried out for a patient with lumbosacral tuberculosis, the posterior approach should be favored over the anterior approach.

scholarly journals Conventional Thermal versus Water-Cooled Genicular Nerve Radiofrequency Lesioning: A Retrospective Chart Review

2019 ◽  
pp. 16-172
Author(s):  
Cristina Shea
Keyword(s):  
Knee Pain ◽  
Chart Review ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Pain Clinic ◽  
Fisher Exact Test ◽  
Pain Scores ◽  
Chronic Knee Pain ◽  
Significant Difference

Background: Genicular nerve radiofrequency lesioning (RFL) is an interventional approach to chronic knee pain. It is currently unknown whether conventional thermal RFL (CT-RFL) or watercooled RFL (WC-RFL) yields better outcomes. Objective: The objective of this research was to analyze and compare outcomes of genicular nerve conventional thermal radiofrequency lesioning (CT-RFL) vs water-cooled radiofrequency lesioning (WC-RFL) for the treatment of chronic knee pain. Study Design: We used retrospective chart review. Setting: The research took place in an outpatient pain clinic at a large academic medical center. Methods: Patients who participated in the study were those aged 18 and older who received genicular nerve RFL for chronic knee pain between January 1, 2014 and December 31, 2016. Random intercepts models were used to examine Visual Analog Scale (VAS) pain scores across the first year of follow-up, adjusting for age, gender, and prior history of knee surgery. Results: Overall, VAS scores were significantly reduced from baseline (mean = 6.66, standard deviation [SD] = 1.36) by 1.46 points during the first follow-up month (95% confidence interval [CI], 0.6-2.3, P = .001), 2.22 points during the second follow-up month (95% CI, 1.4-3.1, P = < .001), and 1.24 points during the sixth follow-up month (95% CI, 0.1-2.4, P = .035) but were not significantly reduced at other months during the one-year followup time period. There was no statistically significant difference in follow-up pain scores (mean difference = 0.73, 95% CI, -0.14-1.59, P = .116) or rates of complications (P = .10, 2-tailed Fisher exact test) between RFL types. Limitations: Study shortcomings include patient loss to follow-up, heterogeneity of CT-RFL techniques, and heterogeneity of study patients. Conclusions: Genicular RFL is a promising strategy for long-term management of treatment-resistant chronic knee pain. In this study, no significant difference in outcomes was detected between CT-RFL and WC-RFL techniques. Larger prospective studies are warranted to compare outcomes of these techniques and guide future care. Key words: Radiofrequency lesioning, knee pain, chronic pain, osteoarthritis, genicular, cooled radiofrequency lesioning, water-cooled radiofrequency lesioning, conventional radiofrequency lesioning

The effect of a scheduled regimen of acetaminophen and ibuprofen on opioid use following cesarean delivery

2020 ◽  
Vol 48 (2) ◽  
pp. 153-156
Author(s):  
Dijana Poljak ◽  
Joseph Chappelle
Keyword(s):  
Cesarean Delivery ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Primary Objective ◽  
Opioid Consumption ◽  
Opioid Use ◽  
Time Intervals ◽  
Pain Scores ◽  
Pain Medications ◽  
Post Operative Pain

AbstractObjectiveThe primary objective was to evaluate if the administration of ibuprofen and acetaminophen at regularly scheduled intervals impacts pain scores and total opioid consumption, when compared to administration based on patient demand.MethodsA retrospective chart review was performed comparing scheduled vs. as-needed acetaminophen and ibuprofen regimens, with 100 women included in each arm. Demographics and delivery characteristics were collected in addition to pain scores and total ibuprofen, acetaminophen and oxycodone use at 24, 48 and 72 h postoperatively.ResultsThe scheduled dosing group was found to have a statistically significant decrease in pain scores at all time intervals. Acetaminophen and ibuprofen usage were also noted to be higher in this group while narcotic use was reduced by 64%.ConclusionScheduled dosing of non-narcotic pain medications can substantially decrease opioid usage after cesarean delivery and improve post-operative pain.

scholarly journals An Interprofessional Approach to Chronic Pain Management and Education

2022 ◽  
Vol 54 (1) ◽  
pp. 47-53
Author(s):  
Nida S. Awadallah ◽  
Vanessa Rollins ◽  
Alvin B. Oung ◽  
Miriam Dickinson ◽  
Dionisia de la Cerda ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Chart Review ◽  
Pain Treatment ◽  
Retrospective Chart Review ◽  
Training Methods ◽  
Chronic Pain Management ◽  
Training Experience ◽  
Community Based ◽  
Pain Scores

Background and Objectives: The opioid epidemic highlights the importance of evidence-based practices in the management of chronic pain and the need for improved resident education focused on chronic pain treatment and controlled substance use. We present the development, implementation, and outcomes of a novel, long-standing interprofessional safe prescribing committee (SPC) and resulting policy, protocol, and longitudinal curriculum to address patient care and educational gaps in chronic pain management for residents in training. Methods: The SPC developed and implemented an opioid prescribing policy, protocol, and longitudinal curriculum in a single, community-based residency program. We conducted a postcurriculum survey for resident graduates to assess impact of knowledge gained. We conducted a retrospective chart review for patients on chronic opioid therapy to assess change in morphine equivalent dosing (MED) and pain scores pre- and postintervention. Results: A postcurriculum survey was completed by 20/26 (77%) graduates; 18/20 (90%) felt well-equipped to manage chronic pain based on their residency training experience. We completed a retrospective chart review on 57 patients. We found a significant decrease in MED (-20.34 [SE 5.12], P&lt;.0001) at intervention visit with MED reductions maintained through the postintervention period (-9.43 per year additional decrease [SE 5.25], P=.073). We observed improvement in postintervention pain scores (P=.017). Conclusions: Our study illustrates the effectiveness of an interprofessional committee in lowering prescribed opioid doses and enhancing chronic pain education in a community-based residency setting.

scholarly journals Use of parecoxib by continuous subcutaneous infusion for cancer pain in a hospice population

2017 ◽  
Vol 8 (1) ◽  
pp. 25-29 ◽  
Author(s):  
Peter Armstrong ◽  
Pauline Wilkinson ◽  
Noleen K McCorry
Keyword(s):  
Cancer Pain ◽  
Cancer Diagnosis ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Subcutaneous Infusion ◽  
Opioid Dose ◽  
Local Site ◽  
Pain Scores ◽  
Continuous Subcutaneous Infusion ◽  
Sparing Effect

ObjectivesTo characterise the use of the parenteral non-steroidal anti-inflammatory drug parecoxib when given by continuous subcutaneous infusion (CSCI) in a hospice population. Clinical experience suggests parecoxib CSCI may be of benefit in this population, but empirical evidence in relation to its safety and efficacy is lacking.MethodsRetrospective chart review of patients with a cancer diagnosis receiving parecoxib CSCI from 2008 to 2013 at the Marie Curie Hospice, Belfast. Data were collected on treatment regime, tolerability and, in patients receiving at least 7 days treatment, baseline opioid dose and changes in pain scores or opioid rescue medication requirements.ResultsParecoxib CSCI was initiated in 80 patients with a mean administration of 17.9 days (median 11, range 1–94). When used for a period of 7 days, there was a statistically significant reduction in pain scores (p=0.002) and in the number of rescue opioid doses required (p=0.001), but no statistically significant opioid-sparing effect (p=0.222). It was generally well tolerated, although gastrointestinal, renal adverse effects and local site irritation were reported.ConclusionsParecoxib may have a valuable place in the management of cancer pain, especially towards the end of life when oral administration is no longer possible and CSCI administration is relied on. Further studies into the efficacy and tolerability of parecoxib CSCI are merited.

scholarly journals Evaluating IV Acetaminophen for Pain Management After Cardiac Surgery: A Retrospective Chart Review

2019 ◽  
Author(s):  
Jason Wilhelm
Keyword(s):  
Cardiac Surgery ◽  
Pain Management ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Management Approach ◽  
Pain Scores ◽  
Post Operative Pain ◽  
Alternative Techniques ◽  
Group 2 ◽  
Group 1

Pain after surgery is one of greatest complaints patients have in the surgical process. It is important to decrease pain after surgery to promote a quicker recovery and minimize complications. Opioids alone have been used to manage post-operative pain in cardiac surgery; However, recently multimodal approaches to pain management are now being explored. This approach involves using multiple medications with varying mechanisms of action for pain relief in addition to decreased adverse effects. Ofirmev (IV acetaminophen) is a relatively new medication for use in cardiac surgery that has few contraindications and side effects. The purpose of this study was to investigate if utilizing the current pain management approach in addition to Ofirmev impacted pain scores in post-operative cardiothoracic patients in a non-experimental retrospective chart review. A two group comparative chart review was conducted for a total of 30 charts to meet inclusion criteria. Group 1 (n=15) received opioid only for pain management were compared to Group 2 (n=15) who received Ofirmev and opioids for pain management after cardiac surgery. Results showed that pain scores at hour 6 and 24 showed significance in favor of Group 2, the Ofirmev group. Results also showed Group 2, the Ofirmev group, consumed less morphine on average than Group 1, opioid only. Unexpectedly, length of stay was on average longer for the Ofirmev group than the non- ofirmev group. The research supports the need to utilize multimodal pain management and alternative techniques to manage pain. This study shows there is a need for further research for pain management with a multimodal approach in cardiac surgery.

scholarly journals Transversus Abdominis Plane Block as a Treatment Modality for Chronic Abdominal Pain

2020 ◽  
Vol 4;23 (7;4) ◽  
pp. 405-412
Author(s):  
Alaa Abd-Elsayed
Keyword(s):  
Abdominal Pain ◽  
Pain Management ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Chronic Abdominal Pain ◽  
Transversus Abdominis Plane Block ◽  
Emergency Department Visits ◽  
Transversus Abdominis ◽  
Transversus Abdominis Plane ◽  
Pain Scores

Background: This study describes the use of transversus abdominis plane (TAP) blocks to treat and manage chronic abdominal pain (CAP) in patients who have exhausted other treatment options. Typically, this is a procedure prescribed for treating acute abdominal pain following abdominal surgery. Here we evaluate the use of TAP blocks for longer relief from CAP. Objectives: To assess the efficacy of TAP blocks for pain control in patients with CAP. Study Design: This was a retrospective chart review and analysis of TAP blocks performed over 5 years. This project qualified for institutional review board exemption. Setting: This study was completed at an academic institution. Methods: We reviewed the charts of 92 patients who received TAP blocks for CAP after previous treatment was ineffective. Some patients underwent multiple TAP blocks, with a total of 163 individual procedures identified. For most blocks, a solution of 0.25% bupivacaine and triamcinolone was injected into the TAP. Efficacy of the injection was measured using pain scores, percent improvement, and duration of relief from pain. Results: TAP blocks were associated with a statistically significant (P ≤ 0.05) improvement in abdominal pain scores in 81.9% of procedures. Improvement was 50.3% ± 39.0% with an average duration of 108 days after procedures with ongoing pain relief at time of follow-up were removed. There was a significant reduction in emergency department visits for abdominal pain before and after the procedure (P ≤ 0.05). Limitations: This was a retrospective chart review with lack of a control group. Conclusions: TAP blocks can be extrapolated for treating abdominal pain beyond acute settings. TAP injections can be considered as a treatment option for patients with somatosensory CAP refractory to other forms of pain management. Key words: Abdominal pain, transversus abdominis plane block, chronic pain, chronic abdominal pain, pain management, somatosensory pain, transversus abdominis plane, steroid injection

scholarly journals Cooled Radiofrequency Ablation of the Articular Sensory Branches of the Obturator and Femoral Nerves using Fluoroscopy and Ultrasound Guidance: A Large Retrospective Study

2021 ◽  
pp. E611-E617
Keyword(s):  
Retrospective Study ◽  
Radiofrequency Ablation ◽  
Pain Relief ◽  
Anterior Approach ◽  
Chart Review ◽  
Hip Pain ◽  
Average Decrease ◽  
Pain Scores ◽  
Radiofrequency Denervation ◽  
Large Retrospective Study

BACKGROUND: We previously reported on a combined technique and initial data of hip denervation using an anterior approach and cooled radiofrequency. OBJECTIVES: A large retrospective study to evaluate the long-term effectiveness of cooled radiofrequency ablation (CRFA) in the general chronic hip pain population. STUDY DESIGN: Retrospective electronic chart review. SETTING: A single specialty private practice. METHODS: Retrospective chart review of 235 consecutive (CRFA) in 136 patients with chronic hip pain. RESULTS: Out of 235 CRFA, 178 (96 initial procedures and 82 repeats) were performed in 84 patients with 12 or more months follow-up. The average decrease in visual analog scale (VAS) pain scores was 7.3 ± 1.3 to 2.3 ± 1.5 and 2.48 ± 1.5 for the first and second diagnostic block, respectively, and was statistically significant (P < 0.001). Similarly, the average decrease in VAS pain scores at 6 and 12 months after CRFA denervation was 3.44 ± 2.5 and 4.23 ± 2.5, respectively; P < 0.001. Out of the 96 initial procedures in 84 patients, 66 procedures (69%) provided more than 50% relief at 6 months, and 50 (52%) at 12 months. There were 82 repeat denervations in 36 patients. Repeated procedures in the same patients provided a similar degree of pain relief with no statistically significant difference in the median pain scores (2.8 ± 2.1 cm vs 3.1 ± 1.7 cm ; P = 0.197) or time interval of pain relief (12.7 ± 10.9 vs 10.3 ± 4.7; P = 0.508). There were 3 minor complications. LIMITATIONS: Retrospective nature of the study. CONCLUSION: Improvements in pain scores and longevity of pain relief from chronic hip pain using a simple, anterior approach to radiofrequency denervation of the lateral obturator and lateral femoral nerves justifies further randomized prospective trials. Repeated CRFAs demonstrated consistency in pain relief and absolute safety of repeated denervation. KEY WORDS: Hip denervation, degenerative joint disease, chronic hip pain, radiofrequency denervation, lateral obturator nerve, lateral femoral nerve

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