Subcutaneous sumatriptan: association with decreases in postoperative pain and opioid use after elective cranial surgery

OBJECTIVESumatriptan, a serotonin receptor agonist, has been used in the management of primary headache disorders and has been shown to affect trigeminal dural afferents. There is limited literature on the safety and efficacy of sumatriptan for postcraniotomy pain management. This study aimed to identify whether subcutaneous sumatriptan is a safe and efficacious pain management strategy after elective craniotomy.METHODSThe authors retrospectively reviewed patients who underwent supratentorial or suboccipital craniotomy between 2016 and 2019 that was performed by a single provider at a single institution to identify patients given subcutaneous sumatriptan in the postoperative period. Pain scores and intravenous and oral opioid use were compared in patients with (n = 15) and without (n = 45) sumatriptan administration.RESULTSPatients with and without sumatriptan administration had no significant differences in baseline characteristics or surgery type. There were no sumatriptan-related complications. The average pain score decreased from 3.9 to 1.3 within 1 hour after sumatriptan administration (p = 0.014). In both adult and pediatric patients there was decreased postoperative pain (adults: pain score of 1.1 vs 7.1, p < 0.001; pediatric: 1.1 vs 3.9, p = 0.007) within the first 48 hours. There were decreases in intravenous opioid use, length of intravenous opioid use, maximum dose of intravenous opioid used, oral opioid use, length of oral opioid use, and maximum dose of oral opioid used in both adult and pediatric patients.CONCLUSIONSThe authors identified subcutaneous sumatriptan as a safe and efficacious tool for postoperative pain management after craniotomy. Large multicenter randomized controlled studies are needed to further evaluate the specific role of sumatriptan in postoperative pain management after craniotomy.

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Implications of uninterrupted preoperative transdermal buprenorphine use on postoperative pain management

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2018-100018 ◽

2019 ◽

Vol 44 (3) ◽

pp. 342-347 ◽

Cited By ~ 3

Author(s):

Yvette N Martin ◽

Amy C S Pearson ◽

John R Tranchida ◽

Toby N Weingarten ◽

Phillip J Schulte ◽

...

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Pain Score ◽

Recovery Room ◽

Severe Pain ◽

Receptor Agonist ◽

Postoperative Pain Management ◽

Opioid Use ◽

Intravenous Morphine ◽

Matched Study

Background and objectivesBuprenorphine is a partial µ-receptor agonist resistant to displacement from receptors by conventional opioids, which can block the effect of conventional opioids and may interfere with postoperative pain management. We aimed to quantify perioperative opioid use in patients receiving transdermal buprenorphine (TdBUP).MethodsWe identified patients receiving TdBUP who underwent surgery between 2004 and 2016. To compare opioid requirements (intravenous morphine equivalents (IV-MEq)), we constructed a matched study, matching each TdBUP patient with two opioid-naive patients by sex, age, and type of anesthesia and procedure.ResultsNineteen unique patients underwent 22 procedures while receiving TdBUP. Total (IQR) amounts of IV-MEq (intraoperative, recovery room, and 24 hours after recovery-room discharge) were 98 (63, 145) and 46 (30, 65) mg IV-MEq for TdBUP and opioid-naive patients, respectively (p<0.001). Postoperative IV-MEq requirements were 54 (38, 90) and 15 (3, 35) mg for TdBUP and opioid-naive patients, respectively (p<0.001). Among TdBUP patients, higher preoperative doses of TdBUP were associated with greater postoperative opioid requirements (p=0.02). Specifically, patients with a 20 µg/hour TdBUP patch required 133.8 mg IV-MEq more postoperatively than patients with a 5 µg/hour patch (p=0.002). Following discharge from the recovery room, 17 (77%) TdBUP patients and 15 (34%) opioid-naive patients reported severe pain (OR 6.6 (95% CI 2.0 to 21.3); p<0.001; adjusting for baseline pain score, 5.0 (95% CI, 1.4 to 17.8); p=0.01).ConclusionsAnalgesic management for patients receiving TdBUP therapy must account for increased opioid needs, and greater preoperative doses of TdBUP were associated with greater postoperative opioid requirements.

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Retrospective analysis of regional anesthesia techniques employed for postoperative pain management in pediatric patients undergoing pyeloplasty

Indian Journal of Pain ◽

10.4103/ijpn.ijpn_27_19 ◽

2019 ◽

Vol 33 (2) ◽

pp. 94

Author(s):

Deepak Dwivedi ◽

Sadhan Sawhney ◽

Saurabh Sud ◽

Puja Dudeja ◽

Shankar Raman ◽

...

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Retrospective Analysis ◽

Regional Anesthesia ◽

Pediatric Patients ◽

Postoperative Pain Management

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Ketamine Improves the Management of Exaggerated Postoperative Pain Observed in Perioperative Fentanyl-treated Rats

Anesthesiology ◽

10.1097/00000542-200502000-00028 ◽

2005 ◽

Vol 102 (2) ◽

pp. 421-428 ◽

Cited By ~ 95

Author(s):

Philippe Richebé ◽

Cyril Rivat ◽

Jean-Paul Laulin ◽

Pierre Maurette ◽

Guy Simonnet

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Weight Bearing ◽

Experimental Studies ◽

Postoperative Pain Management ◽

Opioid Use ◽

Short Term ◽

Postoperative Rehabilitation ◽

Pain Hypersensitivity ◽

Plantar Incision

Background Although opioids are unsurpassed analgesics, experimental and clinical studies suggest that opioids activate N-methyl-d-aspartate pronociceptive systems leading to pain hypersensitivity and short-term tolerance. Because it is difficult in humans to differentiate pain from hyperalgesia during the postoperative period, the authors performed experimental studies with fentanyl using the rat incisional pain model for evaluating relations between hyperalgesia and short-term tolerance. Because N-methyl-d-aspartate receptor antagonists oppose both pain hypersensitivity and tolerance induced by opioids, the authors examined the capability of ketamine for improving exaggerated postoperative pain management. Methods During halothane anesthesia, a hind paw plantar incision was performed in rats receiving four fentanyl subcutaneous injections (100 microg/kg per injection, every 15 min). In some groups, three subcutaneous ketamine injections (10 mg/kg per injection, every 5 h) were performed in saline- or fentanyl-treated rats. One day after surgery, the analgesic effect of morphine (2 mg/kg subcutaneous) was tested. Analgesia, mechanical hyperalgesia, tactile allodynia, and pain score were assessed for several days using the paw pressure vocalization test, the von Frey application test, and the postural disequilibrium test. Results Fentanyl induced analgesia but also produced exaggerated postoperative pain as indicated by the enhancement of hyperalgesia, allodynia, and weight-bearing decrease after hind paw plantar incision. Ketamine pretreatment prevented such a fentanyl-induced enhancement of postoperative pain and improved its management by morphine. Conclusions By opposing postoperative pain hypersensitivity and subsequent short-term tolerance induced by perioperative opioid use, ketamine not only improves exaggerated postoperative pain management but also provides better postoperative rehabilitation.

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Patient education and engagement in postoperative pain management decreases opioid use following knee replacement surgery

Patient Education and Counseling ◽

10.1016/j.pec.2018.09.001 ◽

2019 ◽

Vol 102 (2) ◽

pp. 383-387 ◽

Cited By ~ 19

Author(s):

Meghana Yajnik ◽

Jonay N. Hill ◽

Oluwatobi O. Hunter ◽

Steven K. Howard ◽

T. Edward Kim ◽

...

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Patient Education ◽

Knee Replacement ◽

Postoperative Pain Management ◽

Opioid Use ◽

Knee Replacement Surgery ◽

Replacement Surgery

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Safety and Tolerability of Lidocaine Infusions as a Component of Multimodal Postoperative Analgesia in Children

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-24.1.34 ◽

2019 ◽

Vol 24 (1) ◽

pp. 34-38 ◽

Cited By ~ 2

Author(s):

Katherine Lemming ◽

Gary Fang ◽

Marcia L. Buck

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Adverse Effects ◽

Dose Reduction ◽

Postoperative Analgesia ◽

Pediatric Patients ◽

Pediatric Population ◽

Postoperative Pain Management ◽

Nuss Procedure ◽

The Mean

OBJECTIVES Use of lidocaine as part of a multimodal approach to postoperative pain management has increased in adults; however, limited information is available regarding safety and tolerability in pediatrics. This study's primary objective was to evaluate the incidence of adverse effects related to lidocaine infusions in a sample of pediatric patients. METHODS A retrospective analysis was conducted in pediatric patients receiving lidocaine infusion for the management of postoperative analgesia at the University of Virginia Health System. RESULTS A total of 50 patients with 51 infusions were included in the final analysis. The median patient age was 14 years (range, 2–17 years). The most frequent surgeries were spinal fusion (30%), Nuss procedure for pectus excavatum (16%), and nephrectomy (6%). The mean ± SD starting rate was 13.6 ± 6.5 mcg/kg/min. The mean infusion rate during administration was 15.2 ± 6.3 mcg/kg/min, with 14.4 ± 6.2 mcg/kg/min at discontinuation. The mean length of therapy was 30.6 ± 22 hours. A total of 12 infusions (24%) were associated with adverse effects, primarily neurologic ones, including paresthesias in the upper extremities (10%) and visual disturbances (4%). The average time to onset was 16.2 ± 15.2 hours. Seven infusions were discontinued, whereas the remaining infusions resulted in either dose reduction or continuation without further incident. No patients experienced toxicity requiring treatment with lipid emulsion. CONCLUSIONS In this sample, lidocaine was a well-tolerated addition to multimodal postoperative pain management in the pediatric population. Although adverse effects were common, they were mild and resolved with either dose reduction or discontinuation.

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