Faculty Opinions recommendation of Postoperative multimodal analgesia pain management with nonopioid analgesics and techniques: A review.

2017 ◽  
Author(s):  
Yuguang Huang ◽  
Xiaohan Xu
Keyword(s):  
Pain Management ◽  
Multimodal Analgesia ◽  
Nonopioid Analgesics

Review of nonopioid multimodal analgesia for surgical and trauma patients

2020 ◽  
Vol 77 (24) ◽  
pp. 2052-2063
Author(s):  
Stephy George ◽  
Meagan Johns
Keyword(s):  
Pain Management ◽  
Adverse Effects ◽  
Multimodal Analgesia ◽  
Transitions Of Care ◽  
Dose Titration ◽  
Patient Specific ◽  
Therapeutic Effects ◽  
Trauma Patients ◽  
Opioid Use ◽  
Nonopioid Analgesics

Abstract Purpose Pain is a frequent finding in surgical and trauma patients, and effective pain control remains a common challenge in the hospital setting. Opioids have traditionally been the foundation of pain management; however, these agents are associated with various adverse effects and risks of dependence and diversion. Summary In response to the rising national opioid epidemic and the various risks associated with opioid use, multimodal pain management through use of nonopioid analgesics such as acetaminophen, nonsteroidal anti-inflammatory drugs, α 2 agonists, N-methyl-d-aspartate (NMDA) receptor antagonists, skeletal muscle relaxants, sodium channel blockers, and local anesthetics has gained popularity recently. Multimodal analgesia has synergistic therapeutic effects and can decrease adverse effects by enabling use of lower doses of each agent in the multimodal regimen. This review discusses properties of the various nonopioid analgesics and encourages pharmacists to play an active role in the selection, initiation, and dose-titration of multimodal analgesia. The choice of nonopioid agents should be based on patient comorbidities, hemodynamic stability, and the agents’ respective adverse effect profiles. A multidisciplinary plan for management of pain should be formulated during transitions of care and is an area of opportunity for pharmacists to improve patient care. Conclusion Multimodal analgesia effectively treats pain while decreasing adverse effects. There is mounting evidence to support use of this strategy to decrease opioid use. As medication experts, pharmacists can play a key role in the selection, initiation, and dose-titration of analgesic agents based on patient-specific factors.

Postoperative Multimodal Analgesia Pain Management With Nonopioid Analgesics and Techniques

JAMA Surgery ◽  
2017 ◽  
Vol 152 (7) ◽  
pp. 691 ◽  
Author(s):  
Elizabeth C. Wick ◽  
Michael C. Grant ◽  
Christopher L. Wu
Keyword(s):  
Pain Management ◽  
Multimodal Analgesia ◽  
Nonopioid Analgesics

Beyond Opioids for Pain Management in Adult Critically Ill Patients

2019 ◽  
Vol 32 (3) ◽  
pp. 256-270 ◽  
Author(s):  
Chelsea R. Wampole ◽  
Kathryn E. Smith
Keyword(s):  
Intensive Care Unit ◽  
Pain Management ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Multimodal Analgesia ◽  
Opioid Therapy ◽  
Pain Response ◽  
Nonopioid Analgesics ◽  
Inflammatory Drugs ◽  
Experience Pain

Critically ill patients commonly experience pain, and the provision of analgesia is an essential component of intensive care unit (ICU) care. Opioids are the mainstay of pain management in the ICU but are limited by their adverse effects, risk of addiction and abuse, and recent drug shortages of injectable formulations. A multimodal analgesia approach, utilizing nonopioid analgesics as adjuncts to opioid therapy, is recommended since they may modulate the pain response and reduce opioid requirements by acting on multiple pain mediators. Nonopioid analgesics discussed in detail in this article are acetaminophen, α-2 receptor agonists, gabapentinoids, ketamine, lidocaine, and nonsteroidal anti-inflammatory drugs. This literature review describes the clinical pharmacology, supportive ICU and relevant non-ICU data, and practical considerations associated with the administration of nonopioid analgesics in critically ill adult patients.

Psychological Factors Affecting Pain Response in Critically Ill Patients

2021 ◽  
Vol 1 (2) ◽  
pp. 32-34
Author(s):  
Rani Iswara
Keyword(s):  
Pain Management ◽  
Sleep Deprivation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Psychological Factors ◽  
Multimodal Analgesia ◽  
Traumatic Experience ◽  
Factors Affecting ◽  
Control Pain ◽  
Harmful Effects

Pain is a traumatic experience and discomfort for all patients, especially critically ill patients; if not treated properly, it can have harmful effects. Critical illnesses are usually painful, both because of the underlying source of the disease and the necessary procedures performed to monitor and care for these patients. Pain induces anxiety, sleep deprivation, disorientation, agitation, delirium, and often become chronic depression. Psychological factors (sleep deprivation, anxiety, and delirium) can also increase the perception of pain. Pain assessment is required for proper pain management. Opioids are commonly used in pain management, but acetaminophen, dexmedetomidine, and gabapentin have more advantages. The recent trend is multimodal analgesia, which uses a combination of analgesic drugs with different mechanisms of action. Another trend is the increasing use of pain relievers, which can control pain and relieve anxiety.

scholarly journals Multimodal Analgesia in Perioperative Settings: Improvement Perspectives / Multimodāla Analgēzija Perioperatīvajā Periodā: Uzlabošanas Iespējas

2014 ◽  
Vol 68 (5-6) ◽  
pp. 222-227
Author(s):  
Iveta Golubovska ◽  
Aleksejs Miščuks ◽  
Ēriks Rudzītis
Keyword(s):  
Pain Management ◽  
Lower Extremity ◽  
Pain Intensity ◽  
Severe Pain ◽  
Rating Scale ◽  
Multimodal Analgesia ◽  
Numeric Rating Scale ◽  
Plexus Brachialis ◽  
Single Shot ◽  
Maximum Pain

Abstract The aim of this study was to evaluate the intensity of pain in orthopaedic hospital patients and to identify unsatisfactory pain management and possibilities for improvements in the future. Data collection included Numeric Rating Scale (NRS) scores, which characterised the intensity of pain. Maximum pain on the day of surgery, mean pain on the day of surgery (D0), and mean pain on first (D1) and second (D2) postoperative days were documented. The pain of an intensity from 0 to 3 was defined as mild pain, 4 to 6 as moderate pain, and 6 to 10 as severe pain. Maximum severe pain intensity on the day of surgery was experienced by 20.5% of patients, moderate by 45.8%, and mild by 33.6%. The reported mean pain intensity according to type of surgery was as follows: hip replacement- 2.79 ± 1.6 (D0), 2.09 ± 1.4 (D1), and 1.35 ± 1.2 (D2); knee replacement - 3.39 ± 1.7 (D0), 2.98 ± (D1), 1.82 ± 1.36, and (D2); upper extremity surgery - 3.59 ± 1.9 (D0), 3.4 ± 1.7 (D1), and 2.1 ± 1.5 (D2); lower extremity surgery - 4.1 ± 2.1 (D0), 3.49 ± 1.42 (D1), and 2.58 ± 1.4 (D2); spine surgery - 3.31 ± 1.58 (D0), 2.88 ± 1.96 (D1), and 1.83 ± 1.74 (D2). Patients in the lower extremity group experienced unacceptable mean pain. The maximum pain intensity on day of surgery was experienced by patients after single-shot plexus brachialis block anaesthesia (5.24 ± 2.4). Well-designed multimodal analgesia with special attention to single shot techniques may improve pain management and functional outcomes after orthopaedic surgery.

Pharmacologic and Technological Innovations in Pain Medicine

2016 ◽  
Author(s):  
Anita Gupta ◽  
Hawa Abubakar
Keyword(s):  
Pain Management ◽  
Disease Process ◽  
Multimodal Analgesia ◽  
Underlying Disease ◽  
Antiinflammatory Drug ◽  
Treatment Modalities ◽  
Technological Innovations ◽  
Duration Of Action ◽  
Key Words Pain ◽  
Opioid Receptor Antagonists

The experience of pain is subjective, and treatment modalities should aim at providing the greatest amount of pain relief while minimizing adverse effects. Pharmacologic and technological innovations are making this possible. By taking advantage of new manufacturing processes, the pharmaceutical industry is retooling old and effective drugs. SoluMatrix diclofenac uses nanotechnology to address the need for an effective nonsteroidal antiinflammatory drug at the lowest possible dose to minimize risks associated with cardiac, renal, and gastrointestinal side effects. Intravenous acetaminophen provides an additional alternative in multimodal analgesia in instances when the oral or rectal route of delivery is not desirable. Liposomal bupivacaine uses liposomal encapsulated, resulting in a local anesthetic with a prolonged duration of action that can be used effectively in the management of postoperative pain. With the recognition that opioid therapy still remains a mainstay in pain management, advances in science have allowed for the development of peripherally acting mu opioid receptor antagonists such as naloxegol, which minimize the bothersome side effect of opioid-induced constipation. In terms of interventional pain management, advances in radiofrequency ablation (RFA) technology have resulted in cooled RFA, which allows for the creation of larger spherical lesions, thereby alleviating pain by interfering with neurotransmission. Advances in stem cell research have led to the application of multipotent cells with the aim of treating the underlying disease process and thereby eliminating pain. Finally, pharmacogenetics testing and smart drugs provide an avenue via which issues surrounding how medication is consumed, determination of effectiveness, and ensuring compliance and adherence can be optimized. Key words: Pain, Pharmacology, Medications, Technology, Innovation, Smart Pills, Personalized Medicine, Biotechnology, Device, Surgery, Multimodal

2022 ISFM Consensus Guidelines on the Management of Acute Pain in Cats

2021 ◽  
Vol 24 (1) ◽  
pp. 4-30
Author(s):  
Paulo V Steagall ◽  
Sheilah Robertson ◽  
Bradley Simon ◽  
Leon N Warne ◽  
Yael Shilo-Benjamini ◽  
...  
Keyword(s):  
Pain Management ◽  
Acute Pain ◽  
Pain Assessment ◽  
Multimodal Analgesia ◽  
Evidence Base ◽  
Pharmacological Therapy ◽  
Assessment Tools ◽  
Mental Wellbeing ◽  
Team Approach ◽  
Analgesic Drugs

Practical relevance: Increases in cat ownership worldwide mean more cats are requiring veterinary care. Illness, trauma and surgery can result in acute pain, and effective management of pain is required for optimal feline welfare (ie, physical health and mental wellbeing). Validated pain assessment tools are available and pain management plans for the individual patient should incorporate pharmacological and non-pharmacological therapy. Preventive and multimodal analgesia, including local anaesthesia, are important principles of pain management, and the choice of analgesic drugs should take into account the type, severity and duration of pain, presence of comorbidities and avoidance of adverse effects. Nursing care, environmental modifications and cat friendly handling are likewise pivotal to the pain management plan, as is a team approach, involving the cat carer. Clinical challenges: Pain has traditionally been under-recognised in cats. Pain assessment tools are not widely implemented, and signs of pain in this species may be subtle. The unique challenges of feline metabolism and comorbidities may lead to undertreatment of pain and the development of peripheral and central sensitisation. Lack of availability or experience with various analgesic drugs may compromise effective pain management. Evidence base: These Guidelines have been created by a panel of experts and the International Society of Feline Medicine (ISFM) based on the available literature and the authors’ experience. They are aimed at general practitioners to assist in the assessment, prevention and management of acute pain in feline patients, and to provide a practical guide to selection and dosing of effective analgesic agents.

scholarly journals The efficacy of pre-emptive analgesia on pain management in total knee arthroplasty: a mini-review

Arthroplasty ◽  
2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Jianda Xu ◽  
Huan Li ◽  
Chong Zheng ◽  
Bin Wang ◽  
Pengfei Shen ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Pain Management ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Physiological Mechanism ◽  
Cost Effective ◽  
Postoperative Pain Management ◽  
Multimodal Analgesia ◽  
Total Knee ◽  
End Stage

Abstract Total knee arthroplasty (TKA) is considered a cost-effective and efficacious treatment for patients with end-stage knee arthritis. Meanwhile, TKA has been regarded as one of the most painful orthopaedic surgeries. Pain control after TKA remains a challenging task. Many analgesic innovations are used to reduce the level of pain, but none has been proven to be the optimum choice till now. Multimodal analgesia incorporates the use of analgesic adjuncts with different mechanisms of action to enhance postoperative pain management. This approach is a preferable choice in relieving postoperative pain with minimum side effects. This paper aims to review pre-emptive analgesia for pain management in TKA. We reviewed the application of pre-emptive analgesia, its physiological mechanism, and the techniques.

Sign in / Sign up

Export Citation Format

Share Document