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.

Intraoperative Methadone for the Prevention of Postoperative Pain

2015 ◽  
Vol 122 (5) ◽  
pp. 1112-1122 ◽  
Author(s):  
Glenn S. Murphy ◽  
Joseph W. Szokol ◽  
Michael J. Avram ◽  
Steven B. Greenberg ◽  
Jesse H. Marymont ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Pain Management ◽  
Tracheal Extubation ◽  
Perceived Quality ◽  
Pain Scores ◽  
Methadone Group ◽  
Group 2 ◽  
Postoperative Morphine ◽  
Fentanyl Group

Abstract Background: The intensity of pain after cardiac surgery is often underestimated, and inadequate pain control may be associated with poorer quality of recovery. The aim of this investigation was to examine the effect of intraoperative methadone on postoperative analgesic requirements, pain scores, patient satisfaction, and clinical recovery. Methods: Patients undergoing cardiac surgery with cardiopulmonary bypass (n = 156) were randomized to receive methadone (0.3 mg/kg) or fentanyl (12 μg/kg) intraoperatively. Postoperative analgesic requirements were recorded. Patients were assessed for pain at rest and with coughing 15 min and 2, 4, 8, 12, 24, 48, and 72 h after tracheal extubation. Patients were also evaluated for level of sedation, nausea, vomiting, itching, hypoventilation, and hypoxia at these times. Results: Postoperative morphine requirements during the first 24 h were reduced from a median of 10 mg in the fentanyl group to 6 mg in the methadone group (median difference [99% CI], −4 [−8 to −2] mg; P < 0.001). Reductions in pain scores with coughing were observed during the first 24 h after extubation; the level of pain with coughing at 12 h was reduced from a median of 6 in the fentanyl group to 4 in the methadone group (−2 [−3 to −1]; P < 0.001). Improvements in patient-perceived quality of pain management were described in the methadone group. The incidence of opioid-related adverse events was not increased in patients administered methadone. Conclusions: Intraoperative methadone administration resulted in reduced postoperative morphine requirements, improved pain scores, and enhanced patient-perceived quality of pain management.

scholarly journals Comparison of Single Antibiotic Paste Nitrofurantoin and Calcium Hydroxide Paste as Intracanal Medicaments in Alleviating Post-Operative Pain in Patients with Symptomatic Irreversible Pulpitis -A Randomized Controlled Trial

2021 ◽  
pp. 484-494
Author(s):  
Hira Abbasi ◽  
Abhishek Lal ◽  
Ammara Shamim Jaffrani
Keyword(s):  
Randomized Controlled Trial ◽  
Calcium Hydroxide ◽  
Controlled Trial ◽  
Control Group ◽  
Randomized Controlled ◽  
Pain Scores ◽  
Post Operative Pain ◽  
Group 2 ◽  
Irreversible Pulpitis ◽  
Group 1

Aims: This study aims to compare the efficacy in alleviating pain between intracanal medicaments, namely Nitrofurantoin and Calcium Hydroxide Paste. Study Design:  Randomized Controlled Trial. Place and Duration of Study: Sample: Department of Operative Dentistry, Sir Syed College of Medical Sciences, Pakistan, between January 2021 and May 2021. Methodology: 60 patients were randomly divided into 3 groups, each group having 20 patients as following: Group 1: Nitrofurantoin, Group 2: Calcium Hydroxide and Group 3: Control. Preoperative pain was recorded using a numerical pain scale. After access preparation, chemomechanical preparation was performed with subsequent placement of intracanal medicaments. Pre-operative pain score was initially recorded, followed by post-operative pain at 12, 24, 48, and 72 hours, respectively. Root canal treatment was performed in single rooted teeth with patients suffering from symptomatic irreversible pulpitis Results: Majority of the patients in all 3 groups were initially presented with moderate to severe pre-operative pain. After 72 hours post-operatively, 50% patients in Group 1 reported no pain, while 5% patients in both Group 2 and 3 had no pain. Pain significantly subsided in Group 1 as compared to Group 2 and 3. Regarding age and gender, both had no significant relationship with the pain scores in all of the 3 groups Conclusion: Nitrofurantoin has been proven to be an effective intracanal medicament in alleviating immediate post-operative pain in patients with symptomatic irreversible pulpitis as compared to calcium hydroxide. While the control group with no intracanal medicament showed little reduction in pain scores. So, nitrofurantoin can be used as a substitute to currently available standard intracanal medicaments.

A comparison of LISA versus insure: A single center experience

2021 ◽  
pp. 1-7
Author(s):  
T. Queliz Pena ◽  
J.A. Perez ◽  
M.J. Corrigan
Keyword(s):  
Replacement Therapy ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Less Invasive ◽  
Surfactant Replacement ◽  
Single Center Experience ◽  
Surfactant Replacement Therapy ◽  
Group 2 ◽  
Respiratory Outcomes ◽  
Group 1

BACKGROUND: Less invasive surfactant replacement therapy (SRT) methods have been linked to better respiratory outcomes. The primary aim of this study was to determine if Less Invasive Surfactant Administration (LISA) altered the rate of bronchopulmonary dysplasia (BPD) in preterm infants. Secondary objectives were to determine if LISA compared to Intubation Surfactant Extubation (InSurE) resulted in different respiratory outcomes and hospital course. METHODS: In this retrospective chart review, outcomes were compared in two preterm infant groups (25–32 weeks gestation). Infants in Group 1 received surfactant replacement therapy (SRT) via InSurE method, while infants in Group 2 received SRT via LISA method. RESULTS: Regardless of SRT method utilized, there were no significant differences in rates of BPD between the two groups in infants born at 25–32 weeks gestation (30.6% vs 33.3% ; P = 0.47). CONCLUSIONS: Despite using LISA method rather than InSurE for SRT, premature infants continue to be at high risk for BPD. LISA shows promise as a safe, noninvasive SRT alternative to invasive methods like InSurE.

scholarly journals RATIONAITY AND INTERVENTION EFFICIENCY OF CLINICAL PHARMACIST IN USAGE PAINKILLERS AFTER OPERATION

2021 ◽  
Vol 62 (3) ◽  
Author(s):  
Bui Dang Phuong Chi ◽  
Bui Dang Minh Tri ◽  
Bui Tung Hiep ◽  
Tran Nhat Anh
Keyword(s):  
Adverse Effects ◽  
General Surgery ◽  
Pain Treatment ◽  
Pain Scores ◽  
Post Operative Pain ◽  
The Mean ◽  
Group 2 ◽  
Surgery Department ◽  
Mean Time ◽  
Group 1

Objectives: To evaluate the rationality and effectiveness of clinical pharmacist’s intervention in the use of painkillers for post-operative pain treatment at the General Surgery Department of Cai Nuoc General Hospital. Objects and methods: Cross-sectional descriptive study on 172 patients (patients) undergoing surgery at General Surgery Department, Cai Nuoc General Hospital. Results: There were 38.95% of patients studied with adverse effects when using painkillers. The average duration of painkiller use after surgery was 5.6 ± 4.0 days. The differences in the mean time to take the drug between the 2 groups were statistically significant. VAS pain scores of the study samples tended to decrease gradually over 1, 3, 5, 7 days after surgery. On 2 research groups, in general, the average VAS score after 1 day surgery was 4.2 ± 1.9 points and after 7 days was 1.1 ± 0.8 points. Increase the reasonable rate in choosing drugs group 2 with reasonable rate was had a reasonable rate of 68.18%, much higher than group 1 with 46.43%. Conclusion: The incidence of adverse effects was low. The differences in the mean time to take the drug 70.45%, much higher than group 1 with 42.86%; drug dose, group 2 had reasonable rate was 82.95%, much higher than group 1 with 55.95%; the rationality of drug use, group 2 between the 2 groups were statistically significant. VAS pain scores of the study samples tended to decrease gradually over 1, 3, 5, 7 days after surgery. Increase the rationality of drug selection, drug dosage, and general rationality of post-operative pain treatment.

scholarly journals A Randomized Trial Comparing the Safety and Efficacy of Intravenous Ibuprofen versus Ibuprofen and Acetaminophen in Knee or Hip Arthroplasty

2016 ◽  
Vol 6;19 (6;7) ◽  
pp. 349-356 ◽  
Author(s):  
Anita Gupta
Keyword(s):  
Adverse Events ◽  
Surgical Procedures ◽  
Hip Arthroplasty ◽  
Orthopedic Surgery ◽  
Single Center ◽  
Safety And Efficacy ◽  
Pain Scores ◽  
Post Operative Pain ◽  
Group 2 ◽  
Group 1

Background: All surgical procedures are associated with a degree of pain. The experience of uncontrolled post-operative pain can have significant implications on health care costs. Recent studies have demonstrated that intravenous (IV) ibuprofen is an effective, safe, well-tolerated analgesic when administered for both abdominal hysterectomy and orthopedic surgery. The use of ibuprofen leads to a reduction in pain severity at rest and with movement and also decreases narcotic consumption. IV acetaminophen has also been shown to be effective in alleviating pain for surgical procedures. Given the established safety and efficacy of IV ibuprofen and IV acetaminophen for perioperative pain, we were interested in determining if any potential synergies are afforded by the simultaneous administration of both medications in orthopedic surgery patients. Objectives: Compare the safety and efficacy of the perioperative administration of IV ibuprofen alone and in combination with IV acetaminophen in total knee or hip arthroplasty. Study Design: Randomized, single center, trial. Setting: Tertiary care center in Philadelphia, Pennsylvania, United States. Methods: Seventy-eight patients undergoing elective knee or hip arthroplasty were randomized into 2 groups. Group 1 received 800 mg of IV ibuprofen at induction, and 800 mg of IV ibuprofen every 6 hours until discharge or for up to 5 days. Group 2 received 800 mg IV ibuprofen at induction and 1000 mg IV acetaminophen at closure, and 800 mg IV ibuprofen plus 1000 mg IV acetaminophen every 6 hours until discharge for up to 5 days. The primary endpoint was demonstrated using the visual analog scale (VAS) pain scores. Secondary endpoints included opioid requirements, quality of recovery scale (QoR), length of post-anesthesia care unit (PACU) stay, antiemetic consumption, opioid consumption, and opioid related adverse events. Results: Patients in Group 2 had lower VAS scores (P < 0.002) by day 3 only. Opioid requirements and adverse events were significantly less in Group 2 which was also statistically significant. Time to discharge from the PACU for Group 1 on average was 55 minutes and 38 minutes for Group 2 (P = 0.178) which was not statistically significant although may have clinical significance. Length of hospital stay was also evaluated; however, no statistical significance was noted between the 2 groups (P = 0.138). There was no significant difference in QoR scores which were 177 (SD = 15.44) for Group 1 (n = 35) and 179.5 (SD = 16.30) for Group 2 (n = 39). Limitations: The study is a single center study with the attendant risk of convenience bias. The total number of patients is also small and may call into question the reproducibility of the results. No cost analysis was undertaken as part of this study. Further research should aim at prospectively designed multi-center double blinded randomized control trials with an analysis of the pharmacoeconomics of the use of these agents. Conclusion: IV ibuprofen combined with IV acetaminophen demonstrated additional benefit in terms of improved pain scores on post-operative day 3 only, fewer potential adverse events related to opioid use, and decreased use of opioids when compared to IV ibuprofen alone. Key Words: Acute pain, post-operative pain, randomized controlled trial, surgery, NSAID, analgesia, acetaminophen

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.

Are aromatase inhibitors in boys with predicted short stature and/or rapidly advancing bone age effective and safe?

2017 ◽  
Vol 30 (3) ◽  
Author(s):  
Jessica A. Ferris ◽  
Mitchell E. Geffner
Keyword(s):  
Short Stature ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Tanner Stage ◽  
Bone Age ◽  
Long Term Study ◽  
Group 2 ◽  
Endocrinology Clinic ◽  
Group 1

AbstractBackground:The aim of this study was to assess aromatase inhibitor (AI) efficacy in increasing predicted adult height (PAH) and to describe clinical and biochemical safety profiles of AI-treated boys.Methods:A retrospective chart review was conducted at an academic children’s hospital endocrinology clinic. Twenty-one boys with predicted short stature and/or rapidly advancing bone age, divided as Tanner stage (TS) I–III Group 1 (G1, n=9) and TS IV–V Group 2 (G2, n=12), were treated with AIs, either letrozole or anastrozole (mean duration, G1: 2.4 years and G2: 0.9 years). Primary outcomes included PAH, hormonal/biochemical analytes, and clinical data.Results:PAH did not significantly change in either group. Mean peak testosterone significantly increased from baseline to 650±458 ng/dL (p=0.008) in G1 and to 1156±302 ng/dL (p=0.002) in G2. Estradiol did not significantly change in either group. Compared to baseline, G2 showed increased mean FSH (p=0.002), LH (p=0.002), hematocrit (p=0.0001), body mass index (BMI) z-score (p=0.0005), and acne (p=0.01).Conclusions:AIs did not increase PAH, regardless of TS. Boys in late puberty had significant increases in testosterone, gonadotropins, hematocrit, acne, and BMI, but no reduction in estradiol. The potential consequences of these findings are concerning and require long-term study, especially if AIs are started in late puberty.

Liposomal Bupivacaine Utilization in Total Knee Replacement Does Not Decrease Length of Hospital Stay

2018 ◽  
Vol 32 (09) ◽  
pp. 934-939 ◽  
Author(s):  
Grace Schumer ◽  
John W. Mann ◽  
Matthew David Stover ◽  
John F. Sloboda ◽  
Carol Sue Cdebaca ◽  
...  
Keyword(s):  
Pain Management ◽  
Total Knee Replacement ◽  
Wound Infiltration ◽  
Liposomal Bupivacaine ◽  
Pain Scores ◽  
Perioperative Pain Management ◽  
Total Knee ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

AbstractLiposomal bupivacaine has reportedly been used as an adjunct for perioperative pain management in total knee replacement (TKR). The purpose of our single-blind, prospective study is to show that wound infiltration with long-acting liposomal bupivacaine during TKR will shorten length of stay (LOS) as compared with standard bupivacaine injection and spinal anesthetic with or without spinal narcotic. A total of 195 patients were randomized into three groups: wound infiltration with bupivacaine and a spinal with narcotic (Group 1, N = 65), wound infiltration with liposomal bupivacaine and a spinal without narcotic (Group 2, N = 67), and bupivacaine wound infiltration with a spinal without narcotic (Group 3, N = 64). The groups were then compared with look for any benefit in using the liposomal bupivacaine with regard to LOS, pain control, function, and complications. There was a trend toward a decreased LOS (days) in the liposomal bupivacaine (Group 2) with a mean LOS of 1.83 as compared with wound infiltration with bupivacaine with spinal narcotic LOS of 2.04 (Group 1) and without spinal narcotic LOS of 1.94 (Group 3). These results were not statistically significant (p = 0.37). Patient-reported pain scores were no different between the three groups. The daily narcotic usage (morphine equivalents) during the hospitalization was statistically highest in the liposomal bupivacaine group at 77.2 versus 55.0 in Group 1 and 68.1 in Group 3 (p = 0.025). Nausea or vomiting was most common in Group 1 at 42%, followed by 28% in Group 2 and 22% in Group 3. Pruritus was most common in the spinal narcotic group at 38% versus Group 2 at 14% and Group 3 at 11%.Liposomal bupivacaine showed a trend toward a decreased LOS, but this was not statistically significant. There was no difference in pain scores reported by these patients. In conclusion, we cannot justify the extra cost of liposomal bupivacaine as compared with plain bupivacaine as an adjunct for perioperative pain management in TKR patients.

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

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