POSTOPERATIVE ANALGESIA IN ONCOLOGIC HOSPITAL: CURRENT STATUS AND PROSPECTS

2017 ◽  
Vol 63 (1) ◽  
pp. 95-98
Author(s):  
Aleksandr Potapov ◽  
Anna Boyarkina ◽  
Igor Kostyuk ◽  
Sergey Ivanov ◽  
Vsevolod Galkin
Keyword(s):  
Postoperative Analgesia ◽  
Severe Pain ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Current Status ◽  
Regional Analgesia ◽  
Surgical Pain ◽  
Oncological Patients ◽  
Maximum Pain ◽  
Chronic Post Surgical Pain

Observational study of the postoperative analgesia efficacy with multimodal approach (acetaminophen, NSAIDs, opioids, regional analgesia) in 100 oncological patients has been conducted. On the first day after the surgery maximum pain level was 5 (3-7) points of numeric rating scale (NRS), 38% of patients experienced severe pain (NRS>6 points). After laparo-, thoracoscopic, videoassisted interventions and in cases of epidural analgesia NRS levels were 3 (1-6) and 3 (2-5) points respectively. After the surgeries with high risk of chronic post-surgical pain (thoracic, mammary gland interventions, Phan-nenstiel incision) NRS level was 6 (1-7) points. Patients in this group more often experienced severe pain than in the rest group - 56,7% vs. 32,5% (P.=0.037). Suggesting results of this study and data of current literature the perspectives of further improvement of postoperative analgesia in oncology have been formulated.

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.

scholarly journals Efficiency and safety of intrathecal morphine for analgesia after hysterectomy

2020 ◽  
Vol 148 (5-6) ◽  
pp. 322-327
Author(s):  
Milanka Tatic ◽  
Dragan Ladjinovic ◽  
Sanja Skeledzija-Miskovic ◽  
Ranko Zdravkovic ◽  
Dragana Radovanovic ◽  
...  
Keyword(s):  
Side Effects ◽  
Postoperative Pain ◽  
Postoperative Analgesia ◽  
Rating Scale ◽  
Intrathecal Morphine ◽  
Randomized Study ◽  
Numeric Rating Scale ◽  
Time Interval ◽  
Subjective Feeling ◽  
Group A

Introduction/Objective. This prospective, randomized study was done to determine the efficiency and safety of the administration of intrathecal morphine chloride combined with the local anesthetic levobupivacaine given to female patients subjected to hysterectomy to ensure postoperative analgesia. Methods. The study sample consisted of 50 patients who were to undergo hysterectomy with adnexectomy and they were divided into two groups of 25 each. The patients in group A were given the combination of 0.3 mg of morphine chloride with 1.7 ml of 0.5% levobupivacaine immediately before the surgery, whereas the patients in group B were intravenously administered 5 mg of morphine chloride before the end of surgery, and after the surgery at certain time intervals. The postoperative pain was assessed at the first, sixth, 12th, and 24th hour by Numeric Rating Scale (NRS). Side effects, such as nausea, vomiting, itching and respiratory depressions were followed as well. Results. The postoperative pain was less expressed at any time interval both at rest and on exertion in group A (p < 0.001) and therefore the need for additional analgesia was less in group A (p < 0.001). The subjective feeling of satisfaction with postoperative analgesia was statistically significant in group A (p < 0.001). Conclusion. Intrathecal administration of morphine chloride combined with levobupivacaine ensures better postoperative analgesia after hysterectomy than intravenous morphine chloride, their side effects being equally frequent..

Erector spinae plane versus paravertebral nerve blocks for postoperative analgesia after breast surgery: a randomized clinical trial

2020 ◽  
Vol 45 (4) ◽  
pp. 260-266 ◽  
Author(s):  
Matthew W Swisher ◽  
Anne M Wallace ◽  
Jacklynn F Sztain ◽  
Engy T Said ◽  
Bahareh Khatibi ◽  
...  
Keyword(s):  
Postoperative Analgesia ◽  
Safety Profile ◽  
Rating Scale ◽  
Breast Surgery ◽  
Numeric Rating Scale ◽  
Opioid Consumption ◽  
Erector Spinae ◽  
Dramatic Improvement ◽  
Nerve Blocks ◽  
Erector Spinae Plane Block

BackgroundParavertebral nerve blocks (PVBs) are frequently used to treat pain during and following breast surgery, but have various undesirable risks such as pneumothorax. The erector spinae plane block (ESPB) also provides perioperative breast analgesia, but is purported to be easier to administer with a favorable safety profile. However, it remains unknown if the new ESPB provides comparable analgesia as the decades-old PVB technique.MethodsSubjects undergoing unilateral or bilateral non-mastectomy breast surgery were randomized to a single-injection ESPB or PVB in a subject-blinded fashion (ropivacaine 0.5% with epinephrine; 20 mL unilateral or 16 mL/side for bilateral). We hypothesized that (1) analgesia would be non-inferior in the recovery room as measured on a Numeric Rating Scale (NRS) with ESPB, and (2) opioid consumption would be non-inferior in the operating and recovery rooms with ESPB.ResultsBoth pain scores and opioid consumption were higher in subjects with ESPBs (n=50) than PVBs (n=50; median NRS 3.0 vs 0; 95% CI −3.0 to 0; p=0.0011; and median morphine equivalents 2.0 vs 1.5 mg; 95% CI −1.2 to −0.1; p=0.0043). No block-related adverse events occurred in either group.ConclusionsPVBs provided superior analgesia and reduced opioid requirements following non-mastectomy breast surgery. To compare the relatively rare complications between the techniques will require a sample size 1–2 orders of magnitude greater than the current investigation; however, without a dramatic improvement in safety profile for ESPBs, it appears that PVBs are superior to ESPBs for postoperative analgesia after non-mastectomy breast surgery.Trial registration numberNCT03549234.

Pain after Cardiac Surgery

2006 ◽  
Vol 105 (4) ◽  
pp. 794-800 ◽  
Author(s):  
Pasi Lahtinen ◽  
Hannu Kokki ◽  
Markku Hynynen
Keyword(s):  
Cardiac Surgery ◽  
Postoperative Pain ◽  
Scale Score ◽  
Severe Pain ◽  
Rating Scale ◽  
Artery Bypass ◽  
Numeric Rating Scale ◽  
Persistent Pain ◽  
Numeric Rating Scale Score ◽  
Numeric Rating

Background Persistent chest pain may originate from cardiac surgery. Conflicting results have been reported on the incidence of persistent poststernotomy pain with considerable discrepancies between the retrospective reports and the one prospective study conducted to assess this pain. Therefore, the authors conducted a follow-up survey for the first 12 months after cardiac surgery in 213 patients who had a sternotomy. Methods The authors performed a prospective inquiry of acute and chronic poststernotomy pain both before and after cardiac surgery. Two hundred thirteen coronary artery bypass patients received a questionnaire preoperatively, 4 days postoperatively, and 1, 3, 6, and 12 months postoperatively. All patients were asked about their expectations, their preferences, and the location and intensity of postoperative pain. Results The return rates for the postal questionnaires were 203 (95%) and 186 (87%) after 1 and 12 months, respectively. Patients experienced more pain postoperatively at rest than they had expected to preoperatively. At rest, the worst actual postoperative pain was 6 (0-10), and the worst expected pain as assessed preoperatively was 5 (0-10) (P = 0.013). The worst reported postoperative pain was severe (numeric rating scale score 7-10) in 49% at rest, in 78% during coughing, and in 62% of patients on movement. One year after the operation, 26 patients (14%) reported mild chronic poststernotomy pain at rest, 1 patient (1%) had moderate pain, and 3 patients (2%) had severe pain. Upon movement, persistent pain was even more common: 45 patients (24%) had mild, 5 patients (3%) had moderate, and 7 patients (4%) had severe pain. Patients who experienced moderate to severe acute postoperative pain also reported any chronic poststernotomy pain (numeric rating scale score 1-10) more frequently. Conclusions Although common, the incidence of persistent pain after sternotomy was lower than previously reported. Also, reassuringly, 1 year after surgery this pain was mostly mild in nature both at rest and on movement.

scholarly journals Serratus anterior plane versus paravertebral nerve blocks for postoperative analgesia after non-mastectomy breast surgery: a randomized controlled non-inferiority trial

2021 ◽  
pp. rapm-2021-102785
Author(s):  
Rodney A Gabriel ◽  
Matthew W Swisher ◽  
Jacklynn F Sztain ◽  
Brian P Curran ◽  
Engy T Said ◽  
...  
Keyword(s):  
Postoperative Analgesia ◽  
Recovery Room ◽  
Rating Scale ◽  
Breast Surgery ◽  
Statistical Significance ◽  
Numeric Rating Scale ◽  
Opioid Consumption ◽  
Dramatic Improvement ◽  
Serratus Anterior ◽  
Nerve Blocks

BackgroundParavertebral and serratus plane blocks are both used to treat pain following breast surgery. However, it remains unknown if the newer serratus block provides comparable analgesia to the decades-old paravertebral technique.MethodsSubjects undergoing unilateral or bilateral non-mastectomy breast surgery were randomized to a single-injection serratus or paravertebral block in a subject-masked fashion (ropivacaine 0.5%; 20 mL unilateral; 16 mL/side bilateral). We hypothesized that (1) analgesia would be non-inferior in the recovery room with serratus blocks (measurement: Numeric Rating Scale), and (2) opioid consumption would be non-inferior with serratus blocks in the operating and recovery rooms. In order to claim that serratus blocks are non-inferior to paravertebral blocks, both hypotheses must be at least non-inferior.ResultsWithin the recovery room, pain scores for participants with serratus blocks (n=49) had a median (IQR) of 4.0 (0–5.5) vs 0 (0–3.0) for those with paravertebral blocks (n=51): 0.95% CI −3.00 to −0.00; p=0.001. However, the difference in morphine equivalents did not reach statistical significance for superiority with the serratus group consuming 14 mg (10–19) vs 10 mg (10–16) for the paravertebral group: 95% CI −4.50 to 0.00, p=0.123. Since the 95% CI lower limit of −4.5 was less than our prespecified margin of −2.0, we failed to conclude non-inferiority of the serratus block with regard to opioid consumption.ConclusionsSerratus blocks provided inferior analgesia compared with paravertebral blocks. Without a dramatic improvement in safety profile for serratus blocks, it appears that paravertebral blocks are superior to serratus blocks for postoperative analgesia after non-mastectomy breast surgery.Trial registration numberNCT03860974.

Postoperative Pain and Age: A Retrospective Cohort Association Study

2021 ◽  
Author(s):  
Jacqueline F. M. van Dijk ◽  
Ruth Zaslansky ◽  
Regina L. M. van Boekel ◽  
Juanita M. Cheuk-Alam ◽  
Sara J. Baart ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Retrospective Cohort ◽  
Severe Pain ◽  
Rating Scale ◽  
Pain Treatment ◽  
The Elderly ◽  
Numeric Rating Scale ◽  
Opioid Administration ◽  
Patient Reported ◽  
Numeric Rating

Background As the population ages, the number of elderly people undergoing surgery increases. Literature on the incidence and intensity of postoperative pain in the elderly is conflicting. This study examines associations between age and pain-related patient reported outcomes and perioperative pain management in a dataset of surgical patients undergoing four common surgeries: spinal surgery, hip or knee replacement, or laparoscopic cholecystectomy. Based on the authors’ clinical experience, they hypothesize that pain scores are lower in older patients. Methods In this retrospective cohort, study data were collected between 2010 and 2018 as part of the international PAIN OUT program. Patients filled out the International Pain Outcomes Questionnaire on postoperative day 1. Results A total of 11,510 patients from 26 countries, 59% female, with a mean age of 62 yr, underwent one of the aforementioned types of surgery. Large variation was detected within each age group for worst pain, yet for each surgical procedure, mean scores decreased significantly with age (mean Numeric Rating Scale range, 6.3 to 7.3; β = –0.2 per decade; P ≤ 0.001), representing a decrease of 1.3 Numeric Rating Scale points across a lifespan. The interference of pain with activities in bed, sleep, breathing deeply or coughing, nausea, drowsiness, anxiety, helplessness, opioid administration on the ward, and wish for more pain treatment also decreases with age for two or more of the procedures. Across the procedures, patients reported being in severe pain on postoperative day one 26 to 38% of the time, and pain interfered moderately to severely with movement. Conclusions The authors’ findings indicate that postoperative pain decreases with increasing age. The change is, however, small and of questionable clinical significance. Additionally, there are still too many patients, at any age, undergoing common surgeries who suffer from moderate to severe pain, which interferes with function, supporting the need for tailoring care to the individual patient. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

scholarly journals Pain Intensity on the First Day after Surgery

2013 ◽  
Vol 118 (4) ◽  
pp. 934-944 ◽  
Author(s):  
Hans J. Gerbershagen ◽  
Sanjay Aduckathil ◽  
Albert J. M. van Wijck ◽  
Linda M. Peelen ◽  
Cor J. Kalkman ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Intensity ◽  
Surgical Procedures ◽  
Severe Pain ◽  
Rating Scale ◽  
Pain Treatment ◽  
Numeric Rating Scale ◽  
Treatment Needs ◽  
Pain Scores ◽  
Numeric Rating

Abstract Background: Severe pain after surgery remains a major problem, occurring in 20–40% of patients. Despite numerous published studies, the degree of pain following many types of surgery in everyday clinical practice is unknown. To improve postoperative pain therapy and develop procedure-specific, optimized pain-treatment protocols, types of surgery that may result in severe postoperative pain in everyday practice must first be identified. Methods: This study considered 115,775 patients from 578 surgical wards in 105 German hospitals. A total of 70,764 patients met the inclusion criteria. On the first postoperative day, patients were asked to rate their worst pain intensity since surgery (numeric rating scale, 0–10). All surgical procedures were assigned to 529 well-defined groups. When a group contained fewer than 20 patients, the data were excluded from analysis. Finally, 50,523 patients from 179 surgical groups were compared. Results: The 40 procedures with the highest pain scores (median numeric rating scale, 6–7) included 22 orthopedic/trauma procedures on the extremities. Patients reported high pain scores after many “minor” surgical procedures, including appendectomy, cholecystectomy, hemorrhoidectomy, and tonsillectomy, which ranked among the 25 procedures with highest pain intensities. A number of “major” abdominal surgeries resulted in comparatively low pain scores, often because of sufficient epidural analgesia. Conclusions: Several common minor- to medium-level surgical procedures, including some with laparoscopic approaches, resulted in unexpectedly high levels of postoperative pain. To reduce the number of patients suffering from severe pain, patients undergoing so-called minor surgery should be monitored more closely, and postsurgical pain treatment needs to comply with existing procedure-specific pain-treatment recommendations.

Subarachnoid block with continuous TAP catheter analgesia produces less chronic pain and better functional outcome after inguinal hernioplasty: a randomized controlled observer-blinded study

2019 ◽  
Vol 44 (2) ◽  
pp. 228-233 ◽  
Author(s):  
Sivashanmugam Thiyagarajan ◽  
Jaya Velraj ◽  
M I Hussain Ahmed ◽  
Ravishankar Murugesan
Keyword(s):  
Functional Outcome ◽  
Postoperative Analgesia ◽  
Central Sensitization ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Inguinal Hernioplasty ◽  
Regional Analgesia ◽  
Subarachnoid Block ◽  
Chronic Postsurgical Pain ◽  
Transverse Abdominis

Background and objectivesThe major concern after inguinal hernioplasty is chronic postsurgical pain and impaired quality of life due to central sensitization. Preoperative, intraoperative, and postoperative pre-emptive analgesia using regional techniques may help prevent the development of central sensitization. This study evaluated the effect of regional anesthesia followed by continuous regional analgesia on postoperative pain and functional outcome following inguinal hernioplasty.MethodsSeventy-two consecutive patients scheduled to undergo open mesh inguinal hernioplasty were randomly allocated to one of three groups: subarachnoid block alone (group SAB), general anesthesia alone (group GA), or subarachnoid block combined with a continuous transverse abdominis plane block (group TAP). Pain and functional outcome was assessed before and 6 months following the surgery using the Core Outcome Measures Index score adapted for patients with hernia (COMI-hernia). During the first 72 hours postoperatively, pain was assessed at rest and during five different activities using the numerical rating scale.ResultsSix months following the surgery, the COMI-hernia score was lower in group TAP than in group GA or group SAB (0.54±0.41 vs 0.88±0.43 and 1.00±0.54, respectively; p<0.02). Pain at rest (p<0.02) and during activities (p<0.001) was lowest in group TAP during the first 72 hours postoperatively.ConclusionsA subarachnoid block combined with continuous postoperative analgesia via a transverse abdominis plane catheter provided better pain control and functional outcome 6 months following inguinal hernioplasty as well as better postoperative analgesia.Clinical trial registrationCTRI/2016/09/007238.

scholarly journals Effectiveness of rapid titration with intravenous administration of oxycodone injection in advanced cancer patients with severe pain

2019 ◽  
Vol 49 (11) ◽  
pp. 1061-1064
Author(s):  
Nobuhisa Nakajima
Keyword(s):  
Pain Relief ◽  
Adverse Effects ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Severe Pain ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Advanced Cancer Patients ◽  
Morphine Group ◽  
Time Required

Abstract Some cancer patients suddenly develop severe, excruciating pain that requires rapid management using opioid medication. This study aimed to evaluate the effectiveness of rapid titration using oxycodone injection. Study subjects were advanced cancer patients who experienced severe pain (numeric rating scale ≥7) and needed prompt pain relief. Primary endpoint was (i) time required for the initial sign of significant analgesia to become evident. Secondary endpoints were (ii) pain relief stabilization success rate and (iii) adverse effects. Groups treated with oxycodone (oxycodone group) and morphine (morphine group) were retrospectively compared. The oxycodone group had 33 cases and the morphine group had 32 cases: (i) 15.6 ± 4.3 min in the oxycodone group and 19.3 ± 4.7 min in the morphine group (P = 0.001); (ii) 70 and 63% within 24 hours, and 88 and 84% within 48 hours in the oxycodone group and the morphine group, respectively (P = 0.36, 0.48). Although (iii) adverse effects appeared in both groups in the form of respiratory suppression, etc., the effects were mild. Rapid titration using oxycodone injections may be considered a beneficial choice.

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