scholarly journals The Effect of Preoperative Opioid Dosage on Postoperative Outcomes in Patients Undergoing Knee Surgery

2020 ◽  
Vol 1;23 (1;1) ◽  
pp. 73-85
Author(s):  
Bohan Xing
Keyword(s):  
Postoperative Pain ◽  
Postoperative Complications ◽  
Pain Control ◽  
Dose Group ◽  
Low Dose ◽  
Knee Surgery ◽  
High Dose ◽  
Postoperative Pain Control ◽  
Opioid Dose ◽  
Ed Visits

Background: Opioid prescription before knee replacement surgery is associated with longer hospital stays, more postsurgical pain, and a higher rate of complications. Despite the growing evidence against opioids, they remain popular preoperative pain management prescriptions. Objectives: The purpose of this study was to examine the effects of dosage of preoperative opioid use on orthopedic knee surgery pain control and postoperative outcomes and complications. Study Design: Observational, retrospective evaluation. Setting: University of Wisconsin Madison hospitals. Methods: The patients underwent orthopedic knee surgery between May 1, 2014 and April 30, 2015. We randomly selected 197 patients and divided them into 2 groups that had preoperative opioid dosages of either low dose ≤ 120 mEq morphine (MME) or high dose >120 MME. Of 197 patients, 100 were in the low dose morphine group, whereas 97 were high dose. The cutoff at 120 MME was calculated to be the median dosage across all patients. The primary outcomes were compared, differences in postoperative pain control, and range of motion (ROM). Secondary outcomes included anesthetic complications, length of hospital stay, postoperative opioid dose, and postoperative complications. Results: There were no statistically significant differences between the groups with regard to postoperative pain control, ROM, and immediate postoperative complications. Both groups showed similar length of hospitalization (2.199 to 2.304 days; P = 0.374), rate of postoperative infection, and joint intervention. The high dose group was more likely to have postoperative hemarthrosis and emergency department (ED) visits. However, the low dose group was more likely to have hypertension concurrently. Limitations: Because the study length was restricted to one year, the lack of data on longer term prognosis may limit extrapolation of data. Subjectivity of pain is difficult to measure and compare objectively. This study was not randomized prospectively, which may bias certain results due to unobserved differences. Conclusions: Preoperative opioid dose did not affect postoperative pain control or ROM in patients who received knee surgeries. Higher preoperative opioid doses were associated with more hemarthrosis and ED visits. Further exploration into quality of life indices and surgical complications such as need for revision may be a fruitful avenue. Key words: Opioids, analgesic, knee pain, total knee replacement, knee surgery, preoperative opioids, knee outcomes

scholarly journals Is a Single Low Dose of Intrathecal Morphine a Useful Adjunct to Patient-Controlled Analgesia for Postoperative Pain Control Following Lumbar Spine Surgery? A Preliminary Report

2015 ◽  
Vol 20 (3) ◽  
pp. 129-132 ◽  
Author(s):  
David Yen ◽  
Kim Turner ◽  
David Mark
Keyword(s):  
Lumbar Spine ◽  
Postoperative Pain ◽  
Respiratory Depression ◽  
Spine Surgery ◽  
Pain Control ◽  
Low Dose ◽  
Intrathecal Morphine ◽  
Lumbar Spine Surgery ◽  
Patient Controlled Analgesia ◽  
Postoperative Pain Control

BACKGROUND: Several studies addressing intrathecal morphine (ITM) use following spine surgery have been published either involving the pediatric population, using mid- to high-dose ITM, or not in conjunction with morphine patient-controlled analgesia (PCA).OBJECTIVES: To determine whether low-dose ITM is a useful adjunct to PCA for postoperative pain control following elective lumbar spine surgery in adults.METHODS: Thirty-two patients were enrolled in a double-blinded randomized controlled trial, and received either ITM or intrathecal placebo. Postoperatively, all patients were given a PCA pump and observed for the first 24 h in a step-down unit. Measurements of: total PCA morphine consumed in the first 24 h; intensity of pain; pruritus; nausea at 4 h, 8 h and 24 h; time to first ambulation; length of hospital stay; and occurrences of respiratory depression were recorded.RESULTS: The total PCA use was significantly lower in the ITM group. There were lower average pain scores in the ITM group, which increased to that of the intrathecal placebo group over 24 h; however, this failed to attain statistical significance. There were no differences in nausea, pruritus, time to first ambulation or hospital length stay. There were no cases of respiratory depression in either group.CONCLUSIONS: ITM may be a useful adjunct to PCA, but did not decrease time to ambulation or length of stay.

Effective Low Dose of Buprenorphine in Continuous Epidural Administration for Postoperative Pain Control

1999 ◽  
Vol 36 (4) ◽  
pp. 691
Author(s):  
Sung Keun Lee ◽  
Chong Kweon Chung ◽  
Dong Ho Park ◽  
Jeong Uk Han ◽  
Tae Jung Kim ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Control ◽  
Low Dose ◽  
Epidural Administration ◽  
Postoperative Pain Control

Intensive Initial Oral Anticoagulation and Shorter Heparin Treatment in Deep Vein Thrombosis

1984 ◽  
Vol 52 (03) ◽  
pp. 276-280 ◽  
Author(s):  
Sam Schulman ◽  
Dieter Lockner ◽  
Kurt Bergström ◽  
Margareta Blombäck
Keyword(s):  
Deep Vein Thrombosis ◽  
Oral Anticoagulation ◽  
Dose Group ◽  
Low Dose ◽  
Clinical Signs ◽  
Coagulation Factor ◽  
High Dose ◽  
Vein Thrombosis ◽  
Heparin Treatment ◽  
Deep Vein

SummaryIn order to investigate whether a more intensive initial oral anticoagulation still would be safe and effective, we performed a prospective randomized study in patients with deep vein thrombosis. They received either the conventional regimen of oral anticoagulation (“low-dose”) and heparin or a more intense oral anticoagulation (“high-dose”) with a shorter period of heparin treatment.In the first part of the study 129 patients were randomized. The “low-dose” group reached a stable therapeutic prothrombin complex (PT)-level after 4.3 and the “high-dose” group after 3.3 days. Heparin was discontinued after 6.0 and 5.0 days respectively. There was no difference in significant hemorrhage between the groups, and no clinical signs of progression of the thrombosis.In the second part of the study another 40 patients were randomized, followed with coagulation factor II, VII, IX and X and with repeated venograms. A stable therapeutic PT-level was achieved after 4.4 (“low-dose”) and 3.7 (“high-dose”) days, and heparin was discontinued after 5.4 and 4.4 days respectively. There were no clinical hemorrhages, the activity of the coagulation factors had dropped to the same level in both groups at the time when heparin was discontinued and no thromboembolic complications occurred.Our oral anticoagulation regimen with heparin treatment for an average of 4.4-5 days seems safe and reduces in-patient costs.

Written Prescription for Over-the-Counter Nonopioid Pain Medications Does Not Increase the Likelihood of Use after Ambulatory Hand and Upper Extremity Surgery

2020 ◽  
Author(s):  
Daniel J. Lynch ◽  
James S. Lin ◽  
Kanu S. Goyal
Keyword(s):  
Postoperative Pain ◽  
Soft Tissue ◽  
Upper Extremity ◽  
Pain Control ◽  
Control Program ◽  
Postoperative Pain Control ◽  
Over The Counter ◽  
Unequal Variance ◽  
Pain Medications ◽  
Medication Consumption

Abstract Introduction This study looked to determine how providing written prescriptions of nonopioids affected postoperative pain medication usage and pain control. Materials and Methods Patients undergoing hand and upper-extremity surgery (n = 244) were recruited after the implementation of a postoperative pain control program encouraging nonopioids before opioids. Patients were grouped based on procedure type: bone (n = 66) or soft tissue (n = 178). Patients reported postoperative medication consumption and pain control scores. Two-tailed t-tests assuming unequal variance were performed to look for differences in postoperative pain control and medication consumption between those who were and were not given written prescriptions for nonopioids. Results For both soft tissue and bone procedure patients, a written prescription did not significantly affect patients’ postoperative pain control or medication consumption. Regardless of receiving a written prescription, patients who underwent soft tissue procedures consumed significantly more daily nonopioids than opioids. Conclusion Receiving written prescriptions for nonopioids may not have a significant effect on postoperative pain control or medication consumption. Patients undergoing soft tissue hand and upper extremity procedures may be more likely to consume more daily nonopioids than opioids postoperatively compared to bone procedure patients regardless of whether they receive a written prescription for nonopioids.

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