scholarly journals Perioperative Pain Management in Primary Bone Tumors

2018 ◽  
Vol 1 (Supplement) ◽  
pp. 8
Author(s):  
A. Bratu ◽  
Z. Panti ◽  
A. Comanelea ◽  
R. Ene ◽  
C. Cîrstoiu
Keyword(s):  
Quality Of Life ◽  
Pain Management ◽  
Epidural Catheter ◽  
Bone Tumors ◽  
Tumor Resection ◽  
Perioperative Pain ◽  
Before And After ◽  
Perioperative Pain Management ◽  
Primary Bone

Abstract Introduction. The increasing number of tumor prosthesis in the last decade shows the advance in musculoskeletal oncology. Limb sparing surgery nowadays has to be the focus in surgery, maintaining the patient’s quality of life. Prognosis depends on the histological type of tumor, size, and local extension. Pain is present in almost any cases of bone tumors and can vary in intensity and character. Being the leading symptom is strongly correlated to the quality of life. The purpose of this study was to evaluate pain in patients with primary bone sarcomas before and after surgery. Material and methods. 11 patients were involved in this study over a period of 4 years (2014-2017) from the Orthopedics and Traumatology Department in the University Emergency Hospital in Bucharest. Tumor resection and reconstruction with modular prosthesis was performed in 4 cases, and tumor resection was necessary in 3 cases and amputation in 4 cases. Pain was evaluated before and after surgery using the Visual Analog Scale (VAS). Early postoperative pain control was achieved with epidural catheter, followed by opioid therapy, NSAIDs and Paracetamol in the early stages of mobilization. Results. Surface sarcomas and tumors close to the periosteum, or periosteal involvement has shown a localized and increased pain. Multimodal-analgesia was used for pain management. Within the first 48 hours, analgesia was performed with an epidural catheter by continuous infusion of ropivacaine 0.2% and fentanyl 2mcg/ ml at a rate ranging between 3-6 ml/ h, obtaining a VAS score between 0 and 3. Conclusions. Perioperative pain management has to be individualized to the localization and local soft tissue involvement of the tumor. In late stages of sarcomas or local recurrence, conventional analgesics can be inefficient. Early diagnosis and surgical removal of these tumors is the most important objective for a good prognosis.

scholarly journals Pre-Emptive and Multi-Modal Perioperative Pain Management May Improve Quality of Life in Patients Undergoing Spinal Surgery

2013 ◽  
Vol 3;16 (3;5) ◽  
pp. E217-E226
Author(s):  
Seong-Hwan Moon
Keyword(s):  
Quality Of Life ◽  
Pain Management ◽  
Postoperative Pain ◽  
Spinal Surgery ◽  
Degenerative Spine ◽  
Perioperative Pain ◽  
Related Quality ◽  
Tertiary Hospitals ◽  
Perioperative Pain Management

Background: Compared to an abundance of data on surgical techniques for degenerative spine conditions and the outcomes thereof, little is available to guide optimal perioperative pain management after spinal surgery. The aim of this study was to survey patterns of perioperative pain management after spinal surgery and to investigate the effects of perioperative pain management, such as pre-emptive analgesia and multi-modal postoperative pain management, on acute postoperative satisfaction, pain reduction, and health-related quality of life in patients undergoing spinal surgery. Study design: Non-blind multicenter prospective observational clinical series. Setting: Seventeen tertiary hospitals (14 hospitals attached to medical colleges and 3 general hospitals). Methods: Pain management protocols of 393 patients (153 men, 240 women; mean age of 67 years, ranging from 21 to 91 years) from 17 tertiary hospitals after spinal surgery for degenerative spine disease were evaluated using a self-administered questionnaire. Results: A total of 79 (20%) patients received pre-emptive analgesics, which included cyclooxygenase-2 (COX-2) inhibitors, with or without administration of anticonvulsants, immediately before surgery at the time of antibiotic prophylaxis. Postoperative pain was managed mainly by multi-modal therapy (363 cases, 92%), along with various combinations of patient controlled anesthesia (PCA), conventional nonsteroidal anti-inflammatory drugs (NSAIDs), COX2 inhibitors, and narcotics. Self-reported levels of pain were not significantly different among postoperative multiple modalities of pain management, but were different significantly for preemptive pain management regimens (P < 0.05, independent t-test). The number of patients that reported the self-administrative use of PCA was higher in the no pre-emptive pain management group compared to the pre-emptive group (P < 0.05). In regards to EQ-5D usual activity, depression/ anxiety and self-care improved significantly in the pre-emptive pain management group when measured at 2 weeks postoperative (P < 0.05). Limitations: The limitation of our study is that it is not a randomized controlled observational study. Conclusions: Pre-emptive analgesia and multi-modal pain management after spinal surgery may lead to better health-related quality of life, greater patient satisfaction, and less postoperative pain. Key words: Degenerative spine, surgery, pre-emptive, pain, management

Implementation of a Standardized Perioperative Pain Management Protocol to Reduce Opioid Prescriptions in Otolaryngologic Surgery

2022 ◽  
pp. 019459982110711
Author(s):  
Michael T. Chang ◽  
M. Lauren Lalakea ◽  
Kimberly Shepard ◽  
Micah Saste ◽  
Amanda Munoz ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Lower Amount ◽  
Opioid Use ◽  
Protocol Implementation ◽  
Perioperative Pain ◽  
Management Protocol ◽  
Before And After ◽  
Perioperative Pain Management ◽  
Low Levels

Objective To evaluate the efficacy of implementing a standardized multimodal perioperative pain management protocol in reducing opioid prescriptions following otolaryngologic surgery. Study Design Retrospective cohort study. Setting County hospital otolaryngology practice. Methods A perioperative pain management protocol was implemented in adults undergoing otolaryngologic surgery. This protocol included preoperative patient education and a postoperative multimodal pain regimen stratified by pain level: mild, intermediate, and high. Opioid prescriptions were compared between patient cohorts before and after protocol implementation. Patients in the pain protocol were surveyed regarding pain levels and opioid use. Results We analyzed 210 patients (105 preprotocol and 105 postprotocol). Mean ± SD morphine milligram equivalents (MMEs) prescribed decreased from 132.5 ± 117.8 to 53.6 ± 63.9 ( P < .05) following protocol implementation. Mean MMEs prescribed significantly decreased ( P < .05) for each procedure pain tier: mild (107.4 to 40.5), intermediate (112.8 to 48.1), and high (240.4 to 105.0). Mean MMEs prescribed significantly decreased ( P < .05) for each procedure type: endocrine (105.6 to 44.4), facial plastics (225.0 to 50.0), general (160.9 to 105.7), head and neck oncology (138.6 to 77.1), laryngology (53.8 to 12.5), otology (77.5 to 42.9), rhinology (142.2 to 44.4), and trauma (288.0 to 24.5). Protocol patients reported a mean 1-week postoperative pain score of 3.4, used opioids for a mean 3.1 days, and used only 39% of their prescribed opioids. Conclusion Preoperative counseling and standardization of a multimodal perioperative pain regimen for otolaryngology procedures can effectively lower amount of opioid prescriptions while maintaining low levels of postoperative pain.

scholarly journals Neurophysiological Mechanisms Related to Pain Management in Bone Tumors

2020 ◽  
Vol 18 ◽  
Author(s):  
Pablo Romero-Morelos ◽  
Erika Ruvalcaba-Paredes ◽  
David Garciadiego-Cázares ◽  
Martín PérezSantos ◽  
Samuel Reyes-Long ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pain Management ◽  
Cancer Pain ◽  
Bone Tumors ◽  
Bone Cancer ◽  
Bone Cancer Pain ◽  
Peripheral Sensitization ◽  
Related Factor ◽  
Common Symptom

Background: Primary and metastatic bone tumor incidence has increased in the last years. Pain is a common symptom and is one of the most important related factor to the decrease of quality of life in these patients. Different pain management strategies are not completely effective and many patients afflicted by cancer pain cannot be controlled properly. In this sense we need to elucidate the neurophysiology of cancer-induced pain contemplating other quality of life components such as inflammation, neuropathies and cognitive components regarding bone tumors, and thus pave the way for novel therapeutic approaches in this field. Aim: Identify the neurophysiology of the mechanisms related to pain management in bone tumors. Method: Advanced searches were performed in scientific databases: PubMed, ProQuest, EBSCO, and the Science Citation index to get information about the neurophysiology mechanisms related to pain management in bone tumors. Results: The central and peripheral mechanisms that promote bone cancer pain are poorly understood. Studies have shown that bone cancer could be related to neurochemicals produced by tumor and inflammatory cells, coupled with peripheral sensitization due to nerve compression and injury caused by tumor growth. Activity of mesolimbic dopaminergic neurons, substance P, cysteine/glutamate antiporter, and other neurochemical dynamic’s brings us putative strategies to suggest better and efficient treatments against pain in cancer patients. Conclusion: Cancer-induced bone pain could include neuropathic and inflammatory pain, but with different modifications to the periphery tissue, nerves and neurochemical changes in different neurological levels. In this sense, here we explore opportunity areas in pharmacological and non-pharmacological pain management, according to pain-involved mechanisms.

Perioperative Pain Management in Patients Undergoing Skull Base Tumor Resection

Skull Base ◽  
2007 ◽  
Vol 16 (S 1) ◽  
Author(s):  
W. Scott Jellish ◽  
John Leonetti ◽  
Sam Marzo ◽  
Douglas Anderson
Keyword(s):  
Pain Management ◽  
Skull Base ◽  
Tumor Resection ◽  
Skull Base Tumor ◽  
Perioperative Pain ◽  
Perioperative Pain Management

scholarly journals Multimodal analgesia in primary bone tumors

2021 ◽  
Vol 4 (1) ◽  
pp. 30-37
Author(s):  
Angelica Bratu ◽  
Adrian Cursaru ◽  
Adina Comanelea ◽  
Bogdan Şerban ◽  
Cătălin Cîrstoiu
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Epidural Analgesia ◽  
General Anesthesia ◽  
Bone Tumors ◽  
Multimodal Analgesia ◽  
Mean Value ◽  
Perioperative Pain ◽  
Continuous Epidural Analgesia ◽  
Perioperative Pain Management

Abstract Introduction: A worrying increase in the number of bone tumors that appear at younger ages justifies the efforts aimed at optimizing perioperative management practices in orthopedic tumor surgery. Pain control is critical in the prognosis and postoperative outcome of these procedures. Material and methods: Our study included a group of 11 patients diagnosed with bone malignancies. These patients were hospitalized in the Orthopedic Clinic of the University Emergency Hospital Bucharest. Under our supervision, they underwent surgical treatment of the tumor under combined general anesthesia and epidural anesthesia for the pelvic limb, and general anesthesia only for the upper limb. We performed perioperative pain management with multimodal analgesia (continuous epidural analgesia with ropivacaine 0,2% and fentanyl 2 mcg/ml in association with systemic analgesics). Following this procedure, we measured the intensity of the postoperative pain at intervals of 48 hours and one week after surgery and compared with preoperative pain intensity using the visual analogue pain scale (VAS). Results: Multimodal analgesia (epidural analgesia associated with systemic analgesics – paracetamol, COX2 inhibitor, gabapentinoids) was performed well in the postoperative pain of the tumor prosthesis, with a significant decrease in VAS from a mean value of 7.63 preoperatively to an average of 3 in the first 48 hours postoperatively. After the removal of the epidural catheter, which also coincided with patient mobilization, the level of pain registered a slight increase to a mean value of 3.23. Conclusions: Multimodal analgesia is currently considered the gold standard in perioperative pain management. The use of multimodal analgesia during perioperative period in patients with bone tumors has been shown to decrease the length of hospital stay, improve surgical outcome, reduce the number of systemic complications, and improve the long-term prognosis of the patient. Efficacy of analgesia correlates with tumor site and vascularization.

scholarly journals Improved Quality of Recovery from Ambulatory Shoulder Surgery After Implementation of a Multimodal Perioperative Pain Management Protocol

Pain Medicine ◽  
2018 ◽  
Vol 20 (5) ◽  
pp. 1012-1019 ◽  
Author(s):  
Nabil M Elkassabany ◽  
Anthony Wang ◽  
Jason Ochroch ◽  
Matthew Mattera ◽  
Jiabin Liu ◽  
...  
Keyword(s):  
Pain Management ◽  
Shoulder Surgery ◽  
Quality Of Recovery ◽  
Perioperative Pain ◽  
Management Protocol ◽  
Perioperative Pain Management

scholarly journals Quality of Life in Patients with Acromegaly before and after Transsphenoidal Surgical Resection

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Jing Gu ◽  
Shiyuan Xiang ◽  
Min He ◽  
Meng Wang ◽  
Yanfang Gu ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Somatostatin Analogs ◽  
Tumor Resection ◽  
Repeated Measurements ◽  
Sf 36 ◽  
Before And After ◽  
Discordant Group

Objective. We aimed to determine the perioperative changes in the quality of life (QoL) in patients with acromegaly and to reveal the relationship between biochemical indicators and quality of life change after tumor resection. Methods. Patients with acromegaly were enrolled from a tertiary pituitary center. SF-36 scale and AcroQoL scale were used to determine the QoL before and after surgery. We analyzed changes in QoL using a generalized linear model for repeated measurements. We compared the changes in QoL among three groups (remission, active, and discordant group) based on postoperative growth hormone (GH) and insulin-like growth factor-1. Results. 151 patients (75 males and 76 females) diagnosed with acromegaly were included. The average age was 43.9 ± 12.3 years. The median total SF-36 scale was 65.3% (IQR: 63.2%–69.2%). Overall AcroQoL score at baseline was 59.1% (IQR: 51.8%–71.8%). Nadir GH levels (coefficient −0.08, p=0.047), T3 levels (coefficient 2.8, p=0.001), and testosterone levels (coefficient −0.20, p=0.033) in males were independent predictive factors of the total SF-36 score. During the follow-up, the median overall SF-36 score increased to 66.1% at 3 months and 75.3% at 6 months (p<0.001) after surgery. The median overall AcroQoL score increased to 74.5% at 3 months and 77.3% at 6 months (p<0.001) after surgery. At 6-month follow-up, median scores were still less than 70% in appearance, vitality, and mental health dimensions. The QoL after surgery were similar among the three groups, although higher GH and more preoperative somatostatin analogs usage were observed in the active group. Conclusion. In conclusion, acromegalic patients were associated with low QoL, which could be reversed partially by surgery. The improvement was independent of the endocrine remission. Appearance, vitality, and mental health were three major aspects that warrant further attention from physicians and caregivers after surgery.

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