scholarly journals Association of Perioperative Regional Analgesia with Postoperative Patient-Reported Pain Outcomes and Opioid Requirements: Comparing 22 Different Surgical Groups in 23,911 Patients from the QUIPS Registry

2021 ◽  
Vol 10 (10) ◽  
pp. 2194
Author(s):  
Marcus Komann ◽  
Alexander Avian ◽  
Johannes Dreiling ◽  
Hans Gerbershagen ◽  
Thomas Volk ◽  
...  
Keyword(s):  
Pain Intensity ◽  
Pain Treatment ◽  
Opioid Use ◽  
Preoperative Pain ◽  
Regional Analgesia ◽  
Primary Surgery ◽  
Pain Scores ◽  
Patient Reported ◽  
Pain Outcomes ◽  
Open Nephrectomy

(1) Background: In many surgical procedures, regional analgesia (RA) techniques are associated with improved postoperative analgesia compared to systemic pain treatment. As continuous RA requires time and experienced staff, it would be helpful to identify settings in which continuous RA has the largest benefit. (2) Methods: On the basis of 23,911 data sets from 179 German and Austrian hospitals, we analyzed the association of perioperative RA with patient-reported pain intensity, functional impairment of movement, nausea and opioid use for different surgeries. Regression analyses adjusted for age, sex and preoperative pain were performed for each surgery and the following groups: patients receiving continuous RA (surgery and ward; RA++), RA for surgery only (RA+−) and patients receiving no RA (RA−−). (3) Results: Lower pain scores in the RA++ compared to the RA−− group were observed in 13 out of 22 surgeries. There was no surgery where pain scores for RA++ were higher than for RA−−. If maximal pain, function and side effects were combined, the largest benefit of continuous RA (RA++) was observed in laparoscopic colon and sigmoid surgery, ankle joint arthrodesis, revision (but not primary) surgery of hip replacement, open nephrectomy and shoulder surgery. The benefit of RA+− was lower than that of RA++. (4) Discussion: The additional benefit of RA for the mentioned surgeries is larger than in many other surgeries in clinical routine. The decision to use RA in a given surgery should be based on the expected pain intensity without RA and its additional benefits.

scholarly journals Participants with mild, moderate, or severe pain following total hip arthroplasty. A sub-study of the PANSAID trial on paracetamol and ibuprofen for postoperative pain treatment

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Luma Mahmoud Issa ◽  
Kasper Højgaard Thybo ◽  
Daniel Hägi-Pedersen ◽  
Jørn Wetterslev ◽  
Janus Christian Jakobsen ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Severe Pain ◽  
Pain Treatment ◽  
Opioid Analgesic ◽  
Opioid Use ◽  
Mild Pain ◽  
Total Hip ◽  
Pain Scores

AbstractObjectivesIn this sub-study of the ‘Paracetamol and Ibuprofen in Combination’ (PANSAID) trial, in which participants were randomised to one of four different non-opioids analgesic regimen consisting of paracetamol, ibuprofen, or a combination of the two after planned primary total hip arthroplasty, our aims were to investigate the distribution of participants’ pain (mild, moderate or severe), integrate opioid use and pain to a single score (Silverman Integrated Approach (SIA)-score), and identify preoperative risk factors for severe pain.MethodsWe calculated the proportions of participants with mild (VAS 0–30 mm), moderate (VAS 31–60 mm) or severe (VAS 61–100 mm) pain and the SIA-scores (a sum of rank-based percentage differences from the mean rank in pain scores and opioid use, ranging from −200 to 200%). Using logistic regression with backwards elimination, we investigated the association between severe pain and easily obtainable preoperative patient characteristics.ResultsAmong 556 participants from the modified intention-to-treat population, 33% (95% CI: 26–42) (Group Paracetamol + Ibuprofen (PCM + IBU)), 28% (95% CI: 21–37) (Group Paracetamol (PCM)), 23% (95% CI: 17–31) (Group Ibuprofen (IBU)), and 19% (95% CI: 13–27) (Group Half Strength-Paracetamol + Ibuprofen (HS-PCM + IBU)) experienced mild pain 6 h postoperatively during mobilisation. Median SIA-scores during mobilisation were: Group PCM + IBU: −48% (IQR: −112 to 31), Group PCM: 40% (IQR: −31 to 97), Group IBU: −5% (IQR: −57 to 67), and Group HS-PCM + IBU: 6% (IQR: −70 to 74) (overall difference: p=0.0001). Use of analgesics before surgery was the only covariate associated with severe pain (non-opioid: OR 0.50, 95% CI: 0.29–0.82, weak opioid 0.56, 95% CI: 0.28–1.16, reference no analgesics before surgery, p=0.02).ConclusionsOnly one third of participants using paracetamol and ibuprofen experienced mild pain after total hip arthroplasty and even fewer experienced mild pain using each drug alone as basic non-opioid analgesic treatment. We were not able, in any clinically relevant way, to predict severe postoperative pain. A more extensive postoperative pain regimen than paracetamol, ibuprofen and opioids may be needed for a large proportion of patients having total hip arthroplasty. SIA-scores integrate pain scores and opioid use for the individual patient and may add valuable information in acute pain research.

scholarly journals The Association between Implementation an Enhanced Recovery after Cesarean Pathway with Standardized Discharge Prescriptions and Opioid Use and Pain Experience after Cesarean Delivery

2021 ◽  
Author(s):  
Jennifer A. McCoy ◽  
Sarah Gutman ◽  
Rebecca F. Hamm ◽  
Sindhu K. Srinivas
Keyword(s):  
Cesarean Delivery ◽  
Pain Control ◽  
Enhanced Recovery ◽  
Median Number ◽  
Baseline Survey ◽  
Quality Improvement Initiative ◽  
Opioid Use ◽  
Pain Scores ◽  
Patient Reported ◽  
Hospital Patients

Objective This study was aimed to evaluate opioid use after cesarean delivery (CD) and to assess implementation of an enhanced recovery after CD (ERAS-CD) pathway and its association with inpatient and postdischarge pain control and opioid use. Study Design We conducted a baseline survey of women who underwent CD from January to March 2017 at a single, urban academic hospital. Patients were called 5 to 8 days after discharge and asked about their pain and postdischarge opioid use. An ERAS-CD pathway was implemented as a quality improvement initiative, including use of nonopioid analgesia and standardization of opioid discharge prescriptions to ≤25 tablets of oxycodone of 5 mg. From November to January 2019, a postimplementation survey was conducted to assess the association between this initiative and patients' pain control and postoperative opioid use, both inpatient and postdischarge. Results Data were obtained from 152 women preimplementation (PRE) and 137 women post-implementation (POST); complete survey data were obtained from 102 women PRE and 98 women POST. The median inpatient morphine milligram equivalents consumed per patient decreased significantly from 141 [range: 90–195] PRE to 114 [range: 45–168] POST (p = 0.002). On a 0- to 10-point scale, median patient-reported pain scores at discharge decreased significantly (PRE: 7 [range: 5–8] vs. POST 5 [range: 3–7], p < 0.001). The median number of pills consumed after discharge also decreased significantly (PRE: 25 [range: 16–30] vs. POST 17.5 [range: 4–25], p = 0.001). The number of pills consumed was significantly associated with number prescribed (p < 0.001). The median number of leftover pills and number of refills did not significantly differ between groups. Median patient-reported pain scores at the week after discharge were lower in the POST group (PRE: 4 [range: 2–6] vs. POST 3[range: 1–5], p = 0.03). Conclusion Implementing an ERAS-CD pathway was associated with a significant decrease in inpatient and postdischarge opioid consumption while improving pain control. Our data suggest that even fewer pills could be prescribed for some patients. Key Points

The problem of pain in lupus: an explication of the role of biopsychosocial mechanisms

2020 ◽  
pp. jrheum.200595
Author(s):  
Titilola Falasinnu ◽  
Cristina Drenkard ◽  
Gaobin Bao ◽  
Sean Mackey ◽  
S. Sam Lim
Keyword(s):  
Disease Activity ◽  
Pain Intensity ◽  
Lupus Erythematosus ◽  
Negative Impact ◽  
Organ Damage ◽  
Sensitivity Analyses ◽  
Behavioral Factors ◽  
Patient Reported ◽  
Pain Outcomes ◽  
The Relationship

Objective To define biopsychosocial mechanisms of pain that go above and beyond disease activity and organ damage in systemic lupus erythematosus (SLE). Methods We conducted a cross-sectional analysis of patient-reported data in a population-based registry of 766 people with SLE. Predictors of pain intensity and interference were examined using hierarchical linear regression. We built two main hierarchical regression models: pain intensity regressed on disease activity and organ damage; and pain interference regressed on disease activity and organ damage. For each model, we sought to establish the relationship between pain outcomes and the primary exposures using sequential steps comprising the inclusion of each construct in six stages: demographic, socioeconomic, physical, psychological, behavioral and social factors. We also conducted sensivity analyses eliminating all overt aspects of pain in the disease activity measure and reestimated the models. Results Disease activity and organ damage explained 32-33% of the variance in pain intensity and interference. Sociodemographic factors accounted for an additional 4-9% of variance in pain outcomes, while psychosocial/behavioral factors accounted for the final 4% of variance. In the sensitivity analyses, we found that disease activity and organ damage explained 25% of the variance in pain outcomes. Conclusion Disease activity only explained 33% of the variance of pain outcomes. However, there was an attenuation in these associations after accounting for psychosocial/behavioral factors, highlighting their roles in modifying the relationship between disease activity and pain. These findings suggest that multilevel interventions may be needed to tackle the negative impact of pain in SLE.

Medicaid Payer Status Is a Predictor of Early Postoperative Pain Following Upper Extremity Procedures

Hand ◽  
2020 ◽  
pp. 155894472091256
Author(s):  
Michael T. Scott ◽  
Allison L. Boden ◽  
Stephanie A. Boden ◽  
Lauren M. Boden ◽  
Kevin X. Farley ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Upper Extremity ◽  
Private Insurance ◽  
Insurance Status ◽  
Preoperative Pain ◽  
Pain Scores ◽  
Patient Reported ◽  
Before And After ◽  
Subjective Pain

Background: The purpose of this study was to investigate the relationship between insurance status and patient-reported pain both before and after upper extremity surgical procedures. We hypothesized that patients with Medicaid payer status would report higher levels of pre- and postoperative pain and report less postoperative pain relief. Methods: In all, 376 patients who underwent upper extremity procedures by a single surgeon at an academic ambulatory surgery center were identified. Patient information, including insurance status and Visual Analog Scale pain score (VAS-pain) at baseline, 2 weeks, and 1, 3, and 6 months, were collected. VAS-pain scores were compared with t-tests and linear regression. Results: Preoperatively and at 2-week, 1-month, and 3-month follow-up, Medicaid patients reported statistically significant higher pain levels than patients with Private insurance, finding a mean adjusted increase of 0.51 preoperatively, 0.39 at 1 month, and 0.79 at 3 months. Preoperatively and at 3-month follow-up, Medicaid patients reported statistically significant higher pain than patients with Medicare, finding increases in VAS-pain of 0.99 preoperatively and 0.94 at 3 months. There was no difference in pain improvement between any insurance types at any time point (all P values > .05). Conclusions: Patients with Medicaid report higher levels of preoperative pain and early postoperative pain, but reported the same improvement in pain as patients with other types of insurance. As healthcare systems are becoming increasingly dependent on patient-reported outcomes, including pain, it is important to consider that differences may exist in subjective pain depending on insurance status.

scholarly journals Towards Opioid-Free Elective Spine Surgery: A Prospective Cohort Study

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Ahilan Sivaganesan ◽  
Amanda Wright ◽  
Regis W Haid ◽  
Praveen V Mummaneni ◽  
Richard Berkman
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Spine Surgery ◽  
Prospective Cohort ◽  
Multivariate Regression ◽  
Opioid Use ◽  
Pain Scores ◽  
Patient Reported ◽  
Average Pain ◽  
Student’S T

Abstract INTRODUCTION The opioid crisis is a national emergency. We conducted a prospective cohort study to determine whether elective spine surgery can be performed without any opioids whatsoever. METHODS Every consecutive elective spine surgery performed by author R.A.B. between January 1st and December 31st of 2018 was included. For cohort A, between January and April 15th, opioids were minimized but PRN doses were given. For cohort B, between April 15th and December, the goal was to eliminate opioids altogether. Pain scores were collected at discharge, 1 wk, and 1-mo follow-up. Patient-reported outcomes (PRO) were collected at baseline and at 3 mo for lumbar procedures. Emergency room visits and readmissions were tracked. Student's t-tests were used to compare pain scores and PROs, and multivariate regression analyses were performed to understand drivers of opioid use. RESULTS A total of 158 patients were included. In cohort A, 37.9% of patients took no opioids between PACU and 1 mo. Average pain scores were 5.2 in PACU and 2.5 at 1 mo. In cohort B, 86.7% took no opioids after PACU. Average pain scores were 4.2 in PACU and 2.5 at 1 mo. Both cohorts had equivalent improvements in PROs. Multivariate regression revealed that, adjusting for case mix differences, cohort B had lower odds of opioid use after PACU (P < .0001). Moreover, preoperative opioid use is a driver of postoperative opioid use (P = .02), whereas procedure type/invasiveness is not. CONCLUSION We have shown that opioid-free spine surgery, including lumbar fusions, is feasible and effective. In all 87% of patients in our opioid-elimination cohort took no opioids from PACU until 1 mo after surgery, and 94% were taking none at the 1-mo visit. Pain scores and PROs were favorable. We have also shown that preoperative opioids are a driver of postoperative opioid use, however procedural invasiveness is not.

scholarly journals Acceptance and Commitment Therapy Delivered via a Mobile Phone Messaging Robot to Decrease Postoperative Opioid Use in Patients With Orthopedic Trauma: Randomized Controlled Trial (Preprint)

2020 ◽  
Author(s):  
Chris A Anthony ◽  
Edward Octavio Rojas ◽  
Valerie Keffala ◽  
Natalie Ann Glass ◽  
Apurva S Shah ◽  
...  
Keyword(s):  
Mobile Phone ◽  
Pain Intensity ◽  
Acceptance And Commitment Therapy ◽  
Intervention Group ◽  
Control Group ◽  
Orthopedic Trauma ◽  
Opioid Use ◽  
Acceptance And Commitment ◽  
Patient Reported ◽  
The Mean

BACKGROUND Acceptance and commitment therapy (ACT) is a pragmatic approach to help individuals decrease avoidable pain. OBJECTIVE This study aims to evaluate the effects of ACT delivered via an automated mobile messaging robot on postoperative opioid use and patient-reported outcomes (PROs) in patients with orthopedic trauma who underwent operative intervention for their injuries. METHODS Adult patients presenting to a level 1 trauma center who underwent operative fixation of a traumatic upper or lower extremity fracture and who used mobile phone text messaging were eligible for the study. Patients were randomized in a 1:1 ratio to either the intervention group, who received twice-daily mobile phone messages communicating an ACT-based intervention for the first 2 weeks after surgery, or the control group, who received no messages. Baseline PROs were completed. Two weeks after the operative intervention, follow-up was performed in the form of an opioid medication pill count and postoperative administration of PROs. The mean number of opioid tablets used by patients was calculated and compared between groups. The mean PRO scores were also compared between the groups. RESULTS A total of 82 subjects were enrolled in the study. Of the 82 participants, 76 (38 ACT and 38 controls) completed the study. No differences between groups in demographic factors were identified. The intervention group used an average of 26.1 (SD 21.4) opioid tablets, whereas the control group used 41.1 (SD 22.0) tablets, resulting in 36.5% ([41.1-26.1]/41.1) less tablets used by subjects receiving the mobile phone–based ACT intervention (<i>P</i>=.004). The intervention group subjects reported a lower postoperative Patient-Reported Outcome Measure Information System Pain Intensity score (mean 45.9, SD 7.2) than control group subjects (mean 49.7, SD 8.8; <i>P</i>=.04). CONCLUSIONS In this study, the delivery of an ACT-based intervention via an automated mobile messaging robot in the acute postoperative period decreased opioid use in selected patients with orthopedic trauma. Participants receiving the ACT-based intervention also reported lower pain intensity after 2 weeks, although this may not represent a clinically important difference. CLINICALTRIAL ClinicalTrials.gov NCT03991546; https://clinicaltrials.gov/ct2/show/NCT03991546

Role of pre-operative serum magnesium (Mg) concentration on post-operative pain intensity and opioid usage in gynecologic surgery.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20673-e20673
Author(s):  
Laleh Azari ◽  
Sundae Stelts ◽  
Joseph T Santoso ◽  
Mehmet Kocak
Keyword(s):  
Pain Intensity ◽  
Serum Magnesium ◽  
Rank Correlation ◽  
University Hospital ◽  
Gynecologic Surgery ◽  
Opioid Use ◽  
Spearman’S Rank Correlation ◽  
Pain Scores ◽  
Post Operative Pain

e20673 Background: Hypomagnesemia is a common problem, occurring in nearly 12% of hospitalized patients. Due to the link of hypomagnesemia with surgery and the potential antinociceptive effects of Mg multiple trials have been conducted. Unfortunately, the role of IV and epidural Mg supplementation in pain management perioperatively remains controversial. An unanswered question from the literature to date is whether low serum Mg concentrations correlate with pain intensity. This review of patients undergoing gynecological surgeries examines whether pre-operative serum Mg level can affect pain scores and opioid use postoperatively. Methods: This was a retrospective study of the electronic medical record at Methodist University Hospital from October 1st, 2011 to July 31st, 2012. Included for analysis are all cases that underwent a gynecologic surgery and were performed under one attending surgeon. Each patient included in the study had perioperative serum Mg levels, resting and moving pain intensity scores, and amount of opioids used. Patients were excluded for any of the following criteria: missing data, discharge in less than 24 hours, robotic surgery, and use of ketamine in anesthesia. Statistical analysis included descriptive statistics, Spearman’s rank correlation coefficient, and logistic regression. Results: The analysis included 121 patients; 54% were Caucasian, the mean age was 51.7 years and 89% of surgeries were for oncologic indications. Pre-operative serum Mg level was not significantly associated with resting or moving pain intensity scores on post operative day (POD) 1 (p=0.66; p=0.68) or POD 2 (p=0.58, p=0.83). Pre-operative Mg level was not significantly associated with opioid use on POD 1 or 2. Two variables had a possible correlation with opioid usage, on average older patients used a lower level of opioid on average and patients with higher BMI used a higher level of opioids. Conclusions: Preoperative magnesium level has no correlation with pain scores or opioid use. While repletion maybe warranted and magnesium supplementation has minimal toxicity and cost, effect on post-operative pain is uncertain. Larger randomized trials may be warranted.

Effect of abiraterone acetate (AA) on patient-reported pain in metastatic castration-resistant prostate cancer (mCRPC) post-docetaxel: Results of longitudinal sensitivity analyses.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 9618-9618 ◽  
Author(s):  
Yanni Hao ◽  
Charles S. Cleeland ◽  
Dennis Gagnon ◽  
Derek Espindle ◽  
Arturo Molina ◽  
...  
Keyword(s):  
Missing Data ◽  
Pain Intensity ◽  
Short Form ◽  
Mixed Effects ◽  
Pain Interference ◽  
Sensitivity Analyses ◽  
Repeated Measure ◽  
Patient Reported ◽  
Pain Outcomes ◽  
The Impact

9618 Background: The COU-AA-301 phase 3 trial showed that AA + prednisone (P) improved overall survival in mCRPC patients (pts) post-docetaxel. Compared with P alone, AA + P also had significant benefits on patient-reported pain. Here we describe post hoc sensitivity analyses of pain data from that trial, using different methods to compensate for the potential impact of missing data. Methods: Pts with mCRPC progressing after docetaxel-based chemotherapy were randomized 2:1 to AA + P or placebo + P. Pain intensity and interference of pain with daily activities were assessed with the Brief Pain Inventory-Short Form (BPI-SF) questionnaire at baseline, Day 15 of Cycle 1, and Day 1 of each 28-day treatment cycle thereafter until treatment discontinuation. The effect of treatment on BPI-SF scores was analyzed using repeated measure mixed-effects (RMM) models, piecewise linear mixed-effects (PWLME) models, and joint mixed-effects and log time-to-dropout (JMEL) models. RMM and PWMLE models assumed missing data (due to death, study dropout, or administrative issues) to be missing at random, the JMEL model to be missing not at random. Model results were compared between treatment arms. Results: 797 pts were randomized to AA + P, and 398 to P only. RMM model estimates suggested statistically significant (p < 0.05) differences in change from baseline for pain intensity and pain interference scores in favor of AA + P at the majority of study visits through cycle 11. PWLME models yielded significantly smaller areas under the curve (AUCs) for AA + P vs P for pain intensity (p = 0.0031) and pain interference (p = 0.0006); smaller AUCs reflect better pain outcomes. Results using JMEL models were nearly identical to those with PWLME models, with AUCs for AA + P significantly smaller than for P alone for pain intensity (p = 0.0031) and pain interference (p = 0.0007). Conclusions: Using various modeling methods that assess the impact of missing data, AA + P showed superior patterns of pain outcomes over time compared with P only in mCRPC pts refractory to docetaxel. These results support the previously reported pain benefits of AA + P over P alone from the same trial. Clinical trial information: NCT00638690.

scholarly journals The Impact of NSAID Use After Lumbar Fusion Surgery on Fusion Rate and Complications: A Meta-Analysis

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Yahya Othman ◽  
Avani Vaishnav ◽  
Steven Mcanany ◽  
Sravisht Iyer ◽  
Todd Albert ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Spine Surgery ◽  
Spinal Surgery ◽  
Meta Analysis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Opioid Use ◽  
Pain Scores ◽  
Patient Reported ◽  
The Impact

Abstract INTRODUCTION The purpose of this study is to compile data presented in literature regarding the efficacy of incorporating NSAIDs in the postoperative course for patients undergoing spine surgery, in particular its impact on pain levels, opioid use, complications, and hospital length of stay METHODS This is a meta-analysis and systematic review. A literature search was conducted using the backbone search [spinal surgery] [Nsaid] [complications]. Criteria for inclusion are as follows: use of NSAIDs for postoperative pain management of spinal surgery, comparison between NSAID and NSAID-free cohort, and reporting on any of pain scores, hospital opioid use, hospital length of stay, complications rate, and operative outcomes. RESULTS Out of 799 studies, 19 studies met the inclusion criteria. A total of 1522 patient were included in this analysis. The studies included randomized controlled trials, Prospective and retrospective cohorts. Operations included discectomies, laminectomies, and fusions. Most commonly regimens included the NSAID Ketorelac, as in injection given immediately postoperatively. Patients that received NSAID analgesia postoperatively had significantly lower VAS pain scores at 1 and 12 h postoperatively. This group also had a significantly lower opioid consumption and shorter hospital length of stay. A total of 7 fusion studies reported on arthrodesis, showing a significantly lower odds of fusion after NSAIDs use, however after subgrouping according to smoking, this difference proves to be no longer significant. CONCLUSION Incorporation of NSAIDs into the postoperative regimen for analgesia in patients undergoing spine surgery is an effective approach in reducing hospital length of stay, patient reported pain scores, hospital opioid use, and has no increased risk of complications. Furthermore, use of NSAIDs in the nonsmoking population does not seem to affect arthrodesis rates in patients undergoing spine surgery.

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