scholarly journals Pain management in obstetrics and gynecology

Pain medicine ◽  
2018 ◽  
Vol 3 (3) ◽  
pp. 69-73
Author(s):  
Ye V Grigimalsky ◽  
A Y Garga
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Pain Control ◽  
Surgical Intervention ◽  
Opioid Analgesics ◽  
Multimodal Analgesia ◽  
Obstetrics And Gynecology ◽  
Negative Consequences ◽  
Acute Postoperative Pain ◽  
Regional Analgesia

The problem of acute postoperative pain is present throughout the lifetime of surgery and, unfortunately, does not lose its relevance today. Inadequate pain control in the postoperative period leads to negative consequences. Multimodal analgesia is currently the method of choice for postoperative anesthesia. The basis is the prescription of paracetamol (Infulgan®) in combination or without NSAIDs with the addition of methods of regional analgesia and, in case of insufficient effect, the use of opioid analgesics lies in the basisi of this method. Choosing one or another scheme of multimodal analgesia is determined, above all, is due to the invasiveness of the surgical intervention performed.

scholarly journals Post-operative pain management modalities employed in clinical trials for adult patients in LMIC; a systematic review

2020 ◽  
Author(s):  
Gauhar Afshan ◽  
Robyna Irshad Khan ◽  
Aliya Ahmed ◽  
Ali Sarfraz Siddiqui ◽  
Azhar Rehman ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Pain Management ◽  
Postoperative Pain ◽  
Postoperative Pain Management ◽  
Multimodal Analgesia ◽  
Adult Patients ◽  
Cochrane Library ◽  
Regional Analgesia ◽  
Post Operative Pain

Abstract Background: Unrelieved postoperative pain afflicts millions each year in low and middle income countries (LMIC). Despite substantial advances in the study of pain, this area remains neglected. Current systematic review was designed to ascertain the types of clinical trials conducted in LMIC on postoperative pain management modalities over the last decade. Methods: A comprehensive search was performed in June 2019 on PubMed, Cochrane Library, CINAHL Plus, and Web of Science databases to identify relevant trials on the management of postoperative pain in LMIC. Out of 1450 RCTs, 108 studies were reviewed for quality evidence using structured form of critical appraisal skill program. Total of 51 clinical trials were included after applying inclusion/exclusion criteria. Results:Results are charted according to the type of surgery. Eleven trials on laparoscopic cholecystectomy used multimodal analgesia including some form of regional analgesia. Different analgesic modalities were studied in 4 trials on thoracotomy, but none used multimodal approach. In 11 trials on laparotomy, multimodal analgesia was employed along with the studied modalities. In 2 trials on hysterectomy, preemptive pregabalin or gabapentin were used for reduction in rescue analgesia. In 13 trials on breast surgical procedures and 10 on orthopaedic surgery, multimodal analgesia was used with some form of regional analgesia. Conclusion: We found that over the past 10 years, clinical trials for postoperative pain modalities have evolved in LMIC according to the current postoperative pain management guidelines i.e. multi-modal approach with some form of regional analgesia. The current review shows that clinical trials were conducted using multimodal analgesia including but not limited to some form of regional analgesia for postoperative pain in LMIC however this research snapshot (of only three countries) may not exactly reflect the clinical practices in all 47 countries. Post Operative Pain Management Modalities Employed in Clinical Trials for Adult Patients in LMIC; A Systematic Review

scholarly journals Post-operative pain management modalities employed in clinical trials for adult patients in LMIC: a systematic review

2020 ◽  
Author(s):  
Gauhar Afshan ◽  
Robyna Irshad Khan ◽  
Aliya Ahmed ◽  
Ali Sarfraz Siddiqui ◽  
Azhar Rehman ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Pain Management ◽  
Postoperative Pain ◽  
Postoperative Pain Management ◽  
Multimodal Analgesia ◽  
Cochrane Library ◽  
Clinical Practices ◽  
Regional Analgesia ◽  
Rescue Analgesia

Abstract Background: Unrelieved postoperative pain afflicts millions each year in low and middle income countries (LMIC). Despite substantial advances in the study of pain, this area remains neglected. Current systematic review was designed to ascertain the types of clinical trials conducted in LMIC on postoperative pain management modalities over the last decade. Methods: A comprehensive search was performed in June 2019 on PubMed, Cochrane Library, CINAHL Plus, and Web of Science databases to identify relevant trials on the management of postoperative pain in LMIC. Out of 1450 RCTs, 108 studies were reviewed for quality evidence using structured form of critical appraisal skill program. Total of 51 clinical trials were included after applying inclusion/exclusion criteria. Results: Results are charted according to the type of surgery. Eleven trials on laparoscopic cholecystectomy used multimodal analgesia including some form of regional analgesia. Different analgesic modalities were studied in 4 trials on thoracotomy, but none used multimodal approach. In 11 trials on laparotomy, multimodal analgesia was employed along with the studied modalities. In 2 trials on hysterectomy, preemptive pregabalin or gabapentin were used for reduction in rescue analgesia. In 13 trials on breast surgical procedures and 10 on orthopaedic surgery, multimodal analgesia was used with some form of regional analgesia. Conclusion: We found that over the past 10 years, clinical trials for postoperative pain modalities have evolved in LMIC according to the current postoperative pain management guidelines i.e. multi-modal approach with some form of regional analgesia. The current review shows that clinical trials were conducted using multimodal analgesia including but not limited to some form of regional analgesia for postoperative pain in LMIC however this research snapshot (of only three countries) may not exactly reflect the clinical practices in all 47 countries.

scholarly journals Post-operative pain management modalities employed in clinical trials for adult patients in LMIC; a systematic review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Gauhar Afshan ◽  
Robyna Irshad Khan ◽  
Aliya Ahmed ◽  
Ali Sarfraz Siddiqui ◽  
Azhar Rehman ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Pain Management ◽  
Postoperative Pain ◽  
Postoperative Pain Management ◽  
Multimodal Analgesia ◽  
Adult Patients ◽  
Cochrane Library ◽  
Regional Analgesia ◽  
Post Operative Pain

Abstract Background Unrelieved postoperative pain afflicts millions each year in low and middle income countries (LMIC). Despite substantial advances in the study of pain, this area remains neglected. Current systematic review was designed to ascertain the types of clinical trials conducted in LMIC on postoperative pain management modalities over the last decade. Methods A comprehensive search was performed in June 2019 on PubMed, Cochrane Library, CINAHL Plus, and Web of Science databases to identify relevant trials on the management of postoperative pain in LMIC. Out of 1450 RCTs, 108 studies were reviewed for quality evidence using structured form of critical appraisal skill program. Total of 51 clinical trials were included after applying inclusion/exclusion criteria. Results Results are charted according to the type of surgery. Eleven trials on laparoscopic cholecystectomy used multimodal analgesia including some form of regional analgesia. Different analgesic modalities were studied in 4 trials on thoracotomy, but none used multimodal approach. In 11 trials on laparotomy, multimodal analgesia was employed along with the studied modalities. In 2 trials on hysterectomy, preemptive pregabalin or gabapentin were used for reduction in rescue analgesia. In 13 trials on breast surgical procedures and 10 on orthopaedic surgery, multimodal analgesia was used with some form of regional analgesia. Conclusion We found that over the past 10 years, clinical trials for postoperative pain modalities have evolved in LMIC according to the current postoperative pain management guidelines i.e. multi-modal approach with some form of regional analgesia. The current review shows that clinical trials were conducted using multimodal analgesia including but not limited to some form of regional analgesia for postoperative pain in LMIC however this research snapshot (of only three countries) may not exactly reflect the clinical practices in all 47 countries. Post Operative Pain Management Modalities Employed in Clinical Trials for Adult Patients in LMIC; A Systematic Review.

scholarly journals The Impact of Preventative Multimodal Analgesia on Postoperative Opioid Requirement and Pain Control in Patients Undergoing Lumbar Fusions

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Sharad Rajpal ◽  
Steven L Hobbs ◽  
Ewell Lee Nelson ◽  
Alan T Villavicencio ◽  
Christopher Zielenski ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Patient Group ◽  
Pain Control ◽  
Reference Group ◽  
Intrathecal Morphine ◽  
Lumbar Fusion ◽  
Multimodal Analgesia ◽  
Duration Of Surgery ◽  
The Impact

Abstract INTRODUCTION Preventive multimodal analgesia (PMA) addresses multiple sources and pathways of acute and chronic pain by interfering with peripheral and central sensitization and should provide a way to achieve safer and more effective pain management with reduced opioid medication use. The main objectives of this study were to determine the impact of PMA on postoperative opioid requirements and analgesic effectiveness in patients undergoing lumbar fusion surgery. METHODS A prospective observational study with a historical reference group was performed. The study compared the postoperative opioid requirement and analgesic effect in a total of 103 patients undergoing elective, one- or two-level transforaminal lumbar interbody fusion (TLIF) surgeries for symptomatic lumbar degenerative disc diseases. The PMA patient group included 52 consecutive patients who received 1000 mg of acetaminophen, 300 consecutive patients receiving 900 mg of gabapentin, and 200 consecutive patients receiving 400 mg of celecoxib 1 h before the procedure. The reference group included 51 patients who received 15 mg of morphine-equivalent dose (MED) preoperatively. Multiple linear regression was used to evaluate the influence of PMA on pain, MED, and acetaminophen use over 4 postoperative days (PODs), while controlling for all variables likely to influence these outcomes, including age, gender, baseline opioid use, duration of surgery, postoperative intrathecal morphine use, and administration of muscle relaxants and anticonvulsants. RESULTS The differences in opioid requirement and postoperative pain scores were statistically significant on all 4 postoperative days. The effect size varied from –0.54 to –0.99 for the postoperative opioid requirement and from –0.59 to –1.16 for postoperative pain, indicating that these measures were reduced by about ½ to 1 standard deviation in the PMA patient group. CONCLUSION PMA is a highly effective method for postoperative pain management in patients undergoing lumbar fusion surgeries, which not only improves pain control, but also reduces the opioid requirement.

scholarly journals Current Trends and New Strategies in Acute Postoperative Pain Management in Children

2021 ◽  
Vol 9 (9) ◽  
Author(s):  
Eduardo Pérez ◽  
Gonzalo Lizama ◽  
Victor Cárdenas
Keyword(s):  
Postoperative Pain ◽  
Behavioral Therapy ◽  
Postoperative Pain Management ◽  
Multimodal Analgesia ◽  
Treatment Modalities ◽  
Acute Postoperative Pain ◽  
Regional Analgesia ◽  
Current Trends ◽  
Chronic Postsurgical Pain ◽  
Short And Long Term

Acute postoperative pain in children is common. Nearly 40 percent of pediatric patients suffer from moderate to severe pain after surgery. Inadequate pain prevention and treatment has been associated with short and long-term consequences. Different treatment modalities have evolved lately, and multimodal analgesia has become the treatment of choice not only involving a pharmacological approach but also non-pharmacological approaches (eg, regional analgesia, rehabilitation, cognitive behavioral therapy, virtual reality). The aim of this article is to show current trends and strategies in the management of acute postoperative pain in children and how an inadequate treatment of it can lead to the development of chronic postsurgical pain.

scholarly journals Acute postoperative pain

2016 ◽  
Vol 11 (3) ◽  
pp. 231-233
Author(s):  
Adriana Alexandra BRĂDIŞ ◽  
◽  
Adrian Daniel TULIN ◽  
Erick NESTIANU ◽  
Ioana Anca BĂDĂRĂU ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Postoperative Pain ◽  
Postoperative Morbidity ◽  
Emotional Experience ◽  
Multimodal Analgesia ◽  
Postoperative Recovery ◽  
Psychological Effects ◽  
Acute Postoperative Pain ◽  
Pain Scales

Acute postoperative pain is a personal unpleasant sensory and emotional experience with negative physiological and psychological effects. Severe acute pain may increase postoperative morbidity and mortality and is a risk factor for chronic pain incidence. We evaluate pain intensity using pain scales. Pain management includes preventive analgesia who interacts and modulates central sensitization response and multimodal analgesia which uses two or more different analgesic mechanisms agents for a superior analgesic effect. Effective pain management provide early postoperative recovery and decrease the incidence of chronic pain.

scholarly journals PREEMPTIVE ANALGESIA IN ANORECTAL SURGERY: STUDY PROTOCOL FOR A PROSPECTIVE, RANDOMIZED, DOUBLE-BLIND TRIAL

2021 ◽  
pp. 5-12
Author(s):  
T. N. Garmanova ◽  
D. R. Markaryan ◽  
E. A. Kazachenko ◽  
A. M. Lukianov ◽  
M. A. Agapov
Keyword(s):  
Postoperative Pain ◽  
Spinal Anesthesia ◽  
Pain Control ◽  
Opioid Analgesics ◽  
Life Time ◽  
Multimodal Analgesia ◽  
Preemptive Analgesia ◽  
Anorectal Surgery ◽  
Double Blind ◽  
Opioid Administration

Aim: To assess the efficiency of preemptive analgesia with Ketoprofen 10 mg 2 hours before procedure per os with spinal anesthesia to decrease postoperative pain and the amount of used analgesics.Methods: Patients of our clinic who meet the following inclusion criteria are included: they must be diagnosed with anorectal disease and planned anorectal procedure. After signing the consent all participants are randomly divided into 2 groups: the first one gets a tablet with 10 mg Ketoprofen, the second one gets a tablet containing starch per os 2 hours before surgery (72 participants per arm). Patients of both arms receive spinal anesthesia and undergo open hemorrhoidectomy. Following the procedure the primary and secondary outcomes are evaluated: opioid administration intake, the pain at rest and during defecation, duration and frequency of other analgesics intake, readmission rate, overall quality of life, time from the procedure to returning to work and the complications rate.Discussion: Multimodality pain management has been shown to improve pain control and decrease opioid intake in patients after anorectal surgery in several studies. Gabapentin can be considered as an alternative approach to pain control as NSAIDs have limitative adverse effects. Systemic admission of ketorolac with local anesthetics also showed significant efficacy in patients undergoing anorectal surgery. We hope to prove the efficacy of multimodal analgesia including preemptive one for patients undergoing anorectal procedure that will help to hold postoperative pain level no more than 3-4 points on VAS with minimal consumption of opioid analgesics.

Pain Management in the Patient with Substance Use Disorder

2018 ◽  
Author(s):  
Thomas Hickey ◽  
Jessica Feinleib
Keyword(s):  
Substance Use ◽  
Pain Management ◽  
Side Effects ◽  
Postoperative Pain ◽  
Respiratory Depression ◽  
Substance Use Disorder ◽  
Multimodal Analgesia ◽  
Surgical Patient ◽  
Acute Postoperative Pain ◽  
Aggressive Communication

Managing pain in the patient with substance use disorder can be challenging. This chapter describes those challenges and provides strategies to address them. Specifically it discusses the prevalence and specific considerations for commonly abused substances, the need for aggressive communication among perioperative clinicians, and a strategy to decrease acute postoperative pain and associated complications using opioid-sparing, multimodal analgesia. It includes a discussion of the concept of equianalgesic opioid doses and management of opioid-related side effects including respiratory depression, with regard to buprenorphine, naltrexone, and methadone. Specific consideration is given to the surgical patient treated with buprenorphine, and a defined clinical plan is outlined.

scholarly journals The role of regional analgesia in personalized postoperative pain management

2020 ◽  
Vol 73 (5) ◽  
pp. 363-371 ◽  
Author(s):  
Shruti S. Chitnis ◽  
Raymond Tang ◽  
Edward R. Mariano
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Regional Anesthesia ◽  
Nerve Block ◽  
Enhanced Recovery ◽  
Postoperative Pain Management ◽  
Multimodal Analgesia ◽  
Regional Analgesia ◽  
Perioperative Pain Management ◽  
Personalized Approach

Pain management plays a fundamental role in enhanced recovery after surgery pathways. The concept of multimodal analgesia in providing a balanced and effective approach to perioperative pain management is widely accepted and practiced, with regional anesthesia playing a pivotal role. Nerve block techniques can be utilized to achieve the goals of enhanced recovery, whether it be the resolution of ileus or time to mobilization. However, the recent expansion in the number and types of nerve block approaches can be daunting for general anesthesiologists. Which is the most appropriate regional technique to choose, and what skills and infrastructure are required for its implementation? A multidisciplinary team-based approach for defining the goals is essential, based on each patient's needs, and incorporating patient, surgical, and social factors. This review provides a framework for a personalized approach to postoperative pain management with an emphasis on regional anesthesia techniques.

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