scholarly journals The Use of Preemptive Ketamine for the Prevention of Postoperative Pain in Surgical Patients

2018 ◽  
Author(s):  
Nicole Brecher
Keyword(s):  
Acute Pain ◽  
Healing Process ◽  
Pain Medication ◽  
Surgical Patients ◽  
Warning Sign ◽  
Pain Syndromes ◽  
Pain Scores ◽  
Post Operative Period ◽  
Post Operative Pain ◽  
Surgical Setting

Post-operative pain is accompanied with strong emotional and physical responses which may often discourage the healing process. Acute pain serves as a physical warning sign to the patient but when left unchecked, the acute pain process can increase nociceptor sensitivity and ultimately lead to chronic pain syndromes. Currently, it is thought that providing pain medication to block pain receptors prior to nociception might decrease the development of, or severity of, pain. Some practitioners have used ketamine as an adjunct pain medication perioperatively to decrease pain. The purpose of this review is to investigate the efficacy of Ketamine administered in a pre-hospital or pre-surgical setting on the overall pain management of surgical patients A literature search was performed on PubMed and Medline and using the PRISMA flowchart, and appropriate studies were identified. Each study was critically appraised and organized into tables to organize related variables and results. Variables included ketamine dosing, route of administration, the use of opioid or local anesthetic for comparison, type of surgery, and the length of duration into the post-operative period that pain scores were recorded. This systematic review supports that preemptive ketamine reduces acute pain in the immediate post-operative period.

P91 Post-operative pain in neurosurgery

2019 ◽  
Vol 90 (3) ◽  
pp. e46.1-e46
Author(s):  
PM Haigh ◽  
F Al-Hatimi ◽  
H Stewart ◽  
S Rajagopal ◽  
S Khalifa ◽  
...  
Keyword(s):  
Pain Score ◽  
Spinal Surgery ◽  
Foramen Magnum ◽  
P Value ◽  
Inflammatory Agent ◽  
Pain Scores ◽  
Post Operative Period ◽  
Post Operative Pain ◽  
Significant Difference ◽  
The Mean

ObjectivesAre the analgesic guidelines for those neurosurgical operations associated with major and complex major pain consistently followed? Is there a correlation between adherence and post-operative pain?DesignPatients undergoing spinal surgery and foramen magnum decompressions were visited on the first post-operative day (D1). They provided their pain score subjectively (0=nil; 10=worst ever experienced); objectively we recorded whether they could move in/out of bed without pain limitation.Subjectsn=57 consecutive patients undergoing elective major and complex major pain neurosurgery between April and June 2018 at the NHNN, Queen Square.MethodsA proforma was completed on D1. The patients consented to take part and answered three questions. We examined what (if any) analgesics they were admitted on, and what had been prescribed to cover the post-operative period. This was compared against the appropriate guideline for that category of operation.ResultsGuidelines were only followed in 16/57 (28.1%) cases; not followed in 41/57 (71.9%). On an unpaired T-test: 2-tailed P value=0.0195. Where guidelines were followed, the mean pain score reported was: 3.75 (SD 2.72) Where not followed, the mean pain score was 5.46 (SD 2.29). So with a 95% confidence interval −3.41 to −0.29, there is a significant difference between the pain in those prescribed according to the guidelines and those that were not.ConclusionsThe pain guidelines are not routinely followed. Most commonly this was due to no prescription for a non-steroidal anti-inflammatory agent. We suggest regular sessions of education of the guidelines. Cycle 2 closed the loop of the audit. We re-reviewed adherence and pain scores and found guidelines were followed in 34% of cases, which represented a 6% improvement. On a paired two-tailed P value=0.0794. The mean pain score where guidelines were followed=3.42 (SD1.62) against a mean=4.74 (SD 1.89) where guidelines were not followed.

The debate continues: a prospective, randomised, single-blind study comparing Coblation and bipolar tonsillectomy techniques

2017 ◽  
Vol 132 (3) ◽  
pp. 240-245 ◽  
Author(s):  
D Wiltshire ◽  
M Cronin ◽  
N Lintern ◽  
K Fraser-Kirk ◽  
S Anderson ◽  
...  
Keyword(s):  
Normal Activity ◽  
Normal Diet ◽  
Pain Level ◽  
Single Institution ◽  
Common Procedure ◽  
Pain Scores ◽  
Post Operative Period ◽  
Post Operative Pain ◽  
Single Blind ◽  
Analgesic Use

AbstractObjectives:Tonsillectomy is a common procedure with significant post-operative pain. This study was designed to compare post-operative pain, returns to a normal diet and normal activity, and duration of regular analgesic use in Coblation and bipolar tonsillectomy patients.Methods:A total of 137 patients, aged 2–50 years, presenting to a single institution for tonsillectomy or adenotonsillectomy were recruited. Pain level, diet, analgesic use, return to normal activity and haemorrhage data were collected.Results:Coblation tonsillectomy was associated with significantly less pain than bipolar tonsillectomy on post-operative days 1 (p= 0.005), 2 (p= 0.006) and 3 (p= 0.010). Mean pain scores were also significantly lower in the Coblation group (p= 0.039). Coblation patients had a significantly faster return to normal activity than bipolar tonsillectomy patients (p< 0.001).Conclusion:Coblation tonsillectomy is a less painful technique compared to bipolar tonsillectomy in the immediate post-operative period and in the overall post-operative period. This allows a faster return to normal activity and decreased analgesic requirements.

scholarly journals The magnitude and associated factors of post-operative pain at Debre Tabor compressive specialized hospital, Debre Tabor Ethiopia, 2018

2021 ◽  
Vol 9 ◽  
pp. 205031212110147
Author(s):  
Abebe Tiruneh ◽  
Tadese Tamire ◽  
Simegnew Kibret
Keyword(s):  
Logistic Regression ◽  
Associated Factors ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Skin Incision ◽  
Surgical Patients ◽  
Post Operative Period ◽  
Post Operative Pain ◽  
Debre Tabor ◽  
Numeric Rating

Objectives: Post-operative pain is a form of acute pain following surgical intervention. And it is due to skin incision, tissue dissection, manipulation, and traction during the surgical procedure. The magnitude may reach up to 85.5% globally. Age, gender, duration of surgery, and length of skin incision were the common factors for post-operative pain. This study aims to assess the magnitude and associated factors of post-operative pain among surgical patients. Methods: Institutional-based cross-sectional study design was used. The study was conducted on a total of 159 surgical patients aged 8 years and above. The data were collected using chart review and recording the status of post-operative pain by the result of the Numeric Rating Scale at 1, 6, 12, 24, and 72 h of the post-operative period. Descriptive statistics, bivariate, and multivariable logistic regression were used. An adjusted odds ratio with a 95% confidence interval was used to determine the association. A p-value of less than 0.05 was used to declare statistical significance. Results: The majority (58.5%) of the study participants were females. The percentage of moderate to severe post-operative pain (Numeric Rating Scale: 4 and above) was between 37.7% within 1 h and 76.7% at 6 h of post-operative period. On multivariable logistic regression being female gender, preoperative pain and large skin incision were significantly associated with post-operative pain. Conclusions: Post-operative pain is still high which needs the attention of health professionals working on surgical patients and considering factors associated with post-operative pain.

Basics of Acute Postoperative Pain

2018 ◽  
Vol 1 (2) ◽  
pp. 9-15
Author(s):  
Alaa Ali M. Elzohry MD ◽  
Ali M. El Foli
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Acute Pain ◽  
Postoperative Period ◽  
Surgical Patients ◽  
Acute Postoperative Pain ◽  
Patient Dissatisfaction ◽  
Post Operative Pain ◽  
Essential Components

Acute pain is an important fear for most patients and influences their recovery and overall experience. Poorly treated, it could lead to undesirable effects and patient dissatisfaction. Hence, it is important to understand, assess and treat acute pain effectively. Pain management has been transferred from intraoperative into per operative period throughout the emergence of modern anesthesiology. Pain management in postoperative period is one of the most essential components of sufficient post-surgical patients care. The objective of this review is to define and demonstrate the risks and different sequelae of acute post operative pain.

scholarly journals Comparison of post operative pain in tonsillectomy: a three year prospective study

2020 ◽  
Vol 6 (12) ◽  
pp. 2189
Author(s):  
Akshay Jain ◽  
Smruti Milan Tripathy
Keyword(s):  
Prospective Study ◽  
Pain Scale ◽  
Visual Analogue Pain Scale ◽  
Bipolar Cautery ◽  
Visual Analogue Pain ◽  
Pain Scores ◽  
Post Operative Period ◽  
Post Operative Pain ◽  
Significant Difference ◽  
Cold Dissection

<p><strong>Background:</strong> Tonsillectomy is the oldest surgery performed by otorhinolaryngologists worldwide. Through ages different techniques have been tried to improve the post surgical outcome and reduce morbidity among patients. Aim of the current study was to compare the post-operative pain among the patients undergoing tonsillectomy by cold dissection, bipolar cautery dissection and coblation dissection.</p><p><strong>Methods:</strong> 142 Patients undergoing tonsillectomy in ENT department of TMMC during the period of 3 year were included in the study. Patients were randomly distributed to undergo different techniques of tonsillectomy. The post-operative pain in patients was assessed using the pre-standardized visual analogue pain scale and results were analyzed.</p><p><strong>Results:</strong> No statistically significant difference was found among the groups undergoing tonsillectomy by cold dissection, bipolar dissection and coblator dissection as the p&gt;0.05. The immediate post-operative pain was found to be slightly higher among the group undergoing tonsillectomy by coblator dissection and the analgesics dose needed in the post-operative period remained the same for all for patients of all the three groups.</p><p><strong>Conclusions:</strong> No statistically significant difference was found in the post-operative pain scores of patients undergoing tonsillectomy by CD, BD and CBD techniques.</p>

scholarly journals OPIOID USE IN ADOLESCENTS FOLLOWING HIP AND KNEE ARTHROSCOPY

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0008
Author(s):  
S. Clifton Willimon ◽  
Michael Busch ◽  
Melissa Christino ◽  
Belinda Schaafsma ◽  
Crystal Perkins
Keyword(s):  
Risk Factors ◽  
Pain Control ◽  
Knee Arthroscopy ◽  
Medication Use ◽  
Pain Medication ◽  
Opioid Use ◽  
Pain Scores ◽  
Pain Medications ◽  
Post Operative Pain ◽  
Opioid Medications

Background: The use and misuse of opioid medications has been declared an epidemic and public health emergency by the Centers for Disease Control. From 1999 – 2016, there was a 5-fold increase in overdose deaths secondary to opioids1. Pain control is an important component of post-operative care following orthopaedic surgery and opioid medications are commonly prescribed. The purpose of this study is to describe the average opioid use among adolescents following hip and knee arthroscopy. Methods: All patients less than 21 years of age undergoing ACL reconstruction, simple knee arthroscopy (plica and fat pad debridement, loose body removal, partial meniscectomy, or chondroplasty), and hip arthroscopy for femoroacetabular impingement were prospectively enrolled in this IRB-approved study. This is an interim report for an ongoing study with anticipated completion of enrollment in December 2018. All patients received hydrocodone-acetaminophen 5-325 mg for post-operative pain control. The number of pills prescribed was based on physician preference and was not dictated by the study. Patients and their families completed a medication logbook to track all doses of pain medication and associated pain scores. Risk factors for hydrocodone use following surgery were analyzed, including age, sex, race, pre-operative use of narcotic pain medications, surgical factors, and post-operative VAS pain scores. Results: A total of 65 patients were enrolled and completed the medication logbook, including 37 females and 28 males with a mean age of 15.6 years (range 7 – 20 years). Patients received a prescription for an average of 28 hydrocodone tablets (range 10 – 60) and 64 patients (98%) filled the prescription. The mean number and range of hydrocodone tablets consumed and remaining at the end of treatment and VAS pain scores at the time the patients consumed the pain medication are listed in the figure below. Forty-two patients (65%) reported one or more side effects from the hydrocodone, with the most common being drowsiness and constipation. There were no risk factors that predicted increased use of hydrocodone following ACL reconstruction or knee arthroscopy. Female sex and higher post-operative VAS pain scores predicted greater use of hydrocodone in patients following hip arthroscopy. Conclusions: Opioid medication use in adolescents following hip and knee arthroscopy is significantly less than the quantity of tablets prescribed, with 60% of the medication we prescribed remaining unused in the post-operative period. We recommend orthopaedic surgeons responsibly prescribe pain medications using evidence-based data or the results of their own experience monitoring medication consumption. Additionally, and important in the setting of the “opioid epidemic,” physicians must counsel patients and families of post-operative pain expectations and appropriate medication use. This study will provide the framework for the future development of educational resources regarding prescribing and use of pain medications for healthcare providers, patients, and caregivers. Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2017 [Table: see text]

COMPARING ORAL PARACETAMOL DOSES IN PAEDIATRICS WITH THE NEW BNF-C DOSING

2016 ◽  
Vol 101 (9) ◽  
pp. e2.8-e2
Author(s):  
Nour Ajjan ◽  
Sian Shenton
Keyword(s):  
Acute Pain ◽  
Surgical Patients ◽  
Medical Patients ◽  
Acute Pain Management ◽  
Post Operative Pain ◽  
Maximum Daily Dose ◽  
Daily Dose ◽  
Medical Wards ◽  
Age Range ◽  
Reason For Admission

The BNF-C 2014–20151 highlighted some key changes to the dosing of paracetamol in paediatrics, including a change in maximum daily dosage of oral paracetamol from 90 mg/kg/day to 75 mg/kg/day for post-operative pain, and inclusion of age-banded dosing for pain and pyrexia.The local Trust Paediatric Acute Pain Management Manual2 has acknowledged this change, but advised a maximum daily dose of 80 mg/kg/day. This audit was undertaken to determine whether national proposed changes were implemented in practice, in comparison with local guidelines.AimsThe aims and objectives of the audit were to compare oral paracetamol dosing in both medical and surgical settings with the new BNF-C dosing.MethodData were collected over a two week period in September 2014, from two medical and two surgical paediatric wards. The criteria for data collection included paediatric patients above the age of one month and up to 18 years, prescribed oral paracetamol for pain or pyrexia.The following data were collected:▸ Initials of patients and age (for identification purposes and to prevent duplications)▸ Weight (to assess appropriate and safe prescribing)▸ Reason for admission (to distinguish between medical and surgical settings).ResultsData were collected from 24 medical and 48 surgical patients (age range 1 month–16 years).The key findings were:19/24 medical patients were dosed according to the BNF-C age banded guidelines; 5/24 were dosed according to weight: 3 followed the Trust Manual; 1/24 followed the BNF-C, and 1 miscellaneous. No patients had a dose exceeding 80 mg/kg/day.87% of surgical patients were dosed according to the weight based calculation, 69% of whom were within the maximum daily dose of 75 mg/kg. Of the 31% whose daily dose exceeded 75 mg/kg, all were less than 80 mg/kg/day.The Trust Pain Manual does not include the dose banding as per the BNF-C but recommends 20 mg/kg 6 hourly (max 80 mg/kg/day) for acute pain in this age group.ConclusionChildren on the medical wards were prescribed paracetamol following age banded dosing as per BNF-C, whereas surgical wards were more likely to dose by weight following the Trust Pain Manual.The Trust Pain Manual differs from the BNF-C and recommends a maximum daily dose of 80 mg/kg/day for acute severe pain, to ensure adequate pain control and minimise calculation errors. Despite the new guidance in the BNF-C, it was found that many patients were prescribed a maximal daily dose greater than 75 mg/kg/day; however no patient's daily dose exceeded 80 mg/kg/day as indicated in the Manual.The main finding from the audit was that prescribers were not aware of the change in maximal daily dose of oral paracetamol. To highlight this important point, a poster was designed and distributed amongst the medical and surgical staff on the wards, highlighting that the dose should not exceed 75 mg/kg in a 24 hour period.

Dissection tonsillectomy: pattern of post-operative pain, medication and resumption of normal activity

1998 ◽  
Vol 112 (1) ◽  
pp. 41-44 ◽  
Author(s):  
P. Murthy ◽  
M. R. Laing
Keyword(s):  
Visual Analogue Scale ◽  
Return To Work ◽  
Prospective Study ◽  
Analogue Scale ◽  
Normal Activity ◽  
Pain Medication ◽  
Pain Scores ◽  
Normal Swallowing ◽  
Post Operative Pain ◽  
A Prospective Study

AbstractA prospective study of 99 adults undergoing tonsillectomy was carried out to determine the pattern of post-operative pain, intake of medication and timing of return to work and normal swallowing. The differences in the pain scores, as measured by a visual analogue scale, between every third consecutive day following post-operative day four were found to be highly significant (p<0.001). Sixty-six patients (66.6 per cent) required medication in the form of analgesics and/or antibiotics after the first post-operative day. Sixty-four out of a total of 82 patients (78.2 per cent) returned to work within 14 days of surgery. Ninety-six patients (97 per cent) reported normal swallowing within 14 days of surgery. These results suggest that the majority of adult patients undergoing tonsillectomy can be appropriately advised pre-operatively regarding the probable pattern and duration of post-operative pain and the timescales they can expect to return to work and normal swallowing.

scholarly journals Comparison of the analgesic effects of Post-operative Morphine, Pre-emptive and Post-operative Paracetamol in Septorhinoplasty Surgery

2015 ◽  
Vol 4 (2) ◽  
pp. 121-25
Author(s):  
Shoja-Al-hagh Taregh ◽  
Mohammad Reza Hadavi ◽  
Shahriyar Omidvari ◽  
Mohammad Ali Daneshforouz
Keyword(s):  
Pain Score ◽  
Acute Pain ◽  
Recovery Room ◽  
Nausea And Vomiting ◽  
Control Group ◽  
Analgesic Effects ◽  
Post Operative Period ◽  
Post Operative Pain ◽  
Total Pain ◽  
Significant Difference

Background: According to previous studies there are some different opinions on the pre-emptive effects of paracetamol in controlling post-operative pain, we aimed to compare the analgesic effects of pre-emptive paracetamol with post-operative paracetamol and morphine in patients undergoing septorhinoplasty.Materials and methods: A hundred and six patients aged 15 to 50 were divided into 3 groups. One received 1 g paracetamol 30 minutes before the operation, another group received 1 g paracetamol after the surgery and the control group received 3 mg morphine sulfate in the recovery room after the surgery. The pain severity was recorded for each patient using a 10 slot table. Any signs of nausea and vomiting (N/V) or apnea were closely observed and recorded. Patients with pain score 5 or more received 2 mg morphine intravascularly.Results: There was not any significant difference between the groups in total pain score and N/V (p>0.05). Post-operative morphine intake was significantly lower in pre-emptive group (P<0.05). None of the patients experienced apnea during the study. Conclusion: We concluded that pre-emptive paracetamol can lower the opium consumption in post-operative period but pre-emptive paracetamol cannot reduce the post-operative acute pain noticeably.

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