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.

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 Perioperative analgesia in obese patients

2021 ◽  
Vol 17 (5) ◽  
pp. 18-26
Author(s):  
S.I. Vorotyntsev
Keyword(s):  
Pain Management ◽  
Improve Patient Safety ◽  
Multimodal Analgesia ◽  
The Body ◽  
Obese Patients ◽  
Perioperative Analgesia ◽  
Perioperative Pain ◽  
Opioid Sparing ◽  
Perioperative Pain Management ◽  
Altered Physiology

Obesity in general and morbid obesity (MO) in particular are becoming more common around the world. MO is associated with altered physiology of the body and increased number of comorbidities, which can make perioperative pain control particularly difficult in such patients. Given the higher incidence of respiratory disorders, traditional opioid-oriented treatment of pain in patients with MO can often lead to ventilation disorders and increased morbidity and/or mortality. Multimodal analgesia strategies based on a step-by-step, according to the pain severity, opioid-sparing approach can improve patient safety and treatment outcomes. Further progress in understanding the mechanisms of acute pain forces doctors to actively detect and treat both its nociceptive and pro-nociceptive components (hyperalgesia, etc.). Such multimodal analgesia protocols should be standardized and implemented in perioperative care of patients with MO. In addition to standardizing the treatment of postoperative pain, regardless of used regimen of anesthesia and analgesia, some patients with MO require enhanced respiratory monitoring to prevent possible airway side effects. This review briefly describes the physiological changes in obese patients, the pathophysiology of pain, and the evidence-based clinical updates for pain management in MO. Also, the role of opioid-sparing pharmacological adjuvants is discussed and future directions of research in the field of perioperative pain management in patients with MO are highlighted.

Opioid-Induced Hyperalgesia, Tolerance, and Chronic Postsurgical Pain: A Dilemma Complicating Postoperative Pain Management

2018 ◽  
Author(s):  
Dalia H. Elmofty
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Surgical Techniques ◽  
Cyclooxygenase Inhibitors ◽  
Opioid Tolerance ◽  
Postsurgical Pain ◽  
Perioperative Pain ◽  
Chronic Postsurgical Pain ◽  
Opioid Induced Hyperalgesia ◽  
Perioperative Pain Management

Perioperative pain management continues to be a challenge for physicians. Postoperative pain can compromise patient progress and lead to poor outcomes or chronic pain. Opioid medications, the mainstay of treatment for perioperative pain, can cause opioid-induced hyperalgesia and opioid tolerance. Attempts should be made to modify factors that increase the risk for chronic postsurgical pain. Certain patient factors and anesthetic and surgical techniques have been implicated. Incorporating multimodal methods for perioperative pain management using nonconventional opioids, such as methadone, cyclooxygenase inhibitors, NMDA antagonists, and regional techniques can improve outcomes and prevent opioid-induced hyperalgesia, opioid tolerance, and chronic postsurgical pain in patients on long-term opioid therapy.

The Expanding Role of Multimodal Analgesia in Acute Perioperative Pain Management

2013 ◽  
Vol 31 (1) ◽  
pp. 119-136 ◽  
Author(s):  
Edward R. Mariano ◽  
Brett Miller ◽  
Francis V. Salinas
Keyword(s):  
Pain Management ◽  
Multimodal Analgesia ◽  
Perioperative Pain ◽  
Perioperative Pain Management

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 Major lower limb amputation audit – introduction and implementation of a multimodal perioperative pain management guideline

2018 ◽  
Vol 12 (4) ◽  
pp. 230-237 ◽  
Author(s):  
Hafiz Aladin ◽  
Adrian Jennings ◽  
Max Hodges ◽  
Alifia Tameem
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Lower Limb ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
National Guidelines ◽  
Management Guideline ◽  
Perioperative Pain ◽  
Pain Scores ◽  
Perioperative Pain Management

Lower limb amputation is a frequent surgical intervention. It is well known to be associated with postoperative pain. Optimisation of perioperative pain has been shown to reduce the risk of chronic pain. There are no national guidelines for the perioperative pain management of lower limb amputations. Following a baseline audit, we devised a multimodal perioperative pain management guideline, which included the insertion of a local anaesthetic perineural catheter. All patients undergoing an elective or emergency above, through and below knee amputation were reviewed prior and following the implementation of this guideline. Patient postoperative pain scores and opiate usage were analysed. One hundred and twenty-four patients were reviewed (68 patients prior to the implementation of the guideline and 56 patients following the guideline introduction). Following the implementation of the guideline, a greater proportion of patient’s pain scores were reported as 0 (i.e. no pain) compared to patients prior to its implementation (78% vs 61%). Pain scores were lower at all time intervals 6 days postoperatively following the guideline introduction. Statistically significant (Kendall’s tau-b analysis) (p < 0.05) reduction in pain scores was found upon admission to the ward, 6, 12, 24 hours and 2 days postoperatively. Fewer patients required the use of opioid patient controlled of analgesia after the guideline was introduced (26% vs 4%). The implementation of a perioperative pain management guideline improved pain scores and reduced opioid consumption in patients undergoing lower limb amputations. We suggest a holistic and collaborative, multimodal pathway towards the perioperative pain management of lower limb amputations.

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

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