Acute Pain Management in Infants and Children—Part 2: Intravenous Opioids, Intravenous Nonsteroidal Anti-Inflammatory Drugs, and Managing Adverse Effects

2014 ◽  
Vol 43 (7) ◽  
pp. e169-e175 ◽  
Author(s):  
Joseph D. Tobias
Keyword(s):  
Pain Management ◽  
Adverse Effects ◽  
Acute Pain ◽  
Infants And Children ◽  
Acute Pain Management ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
In Infants And Children

scholarly journals Opioid Use among Same-Day Surgery Patients: Prevalence, Management and Outcomes

2015 ◽  
Vol 20 (6) ◽  
pp. 300-304 ◽  
Author(s):  
Jennifer LC Wilson ◽  
Patricia A Poulin ◽  
Robert Sikorski ◽  
Howard J Nathan ◽  
Monica Taljaard ◽  
...  
Keyword(s):  
General Population ◽  
Acute Pain ◽  
Day Surgery ◽  
Emergency Room Visits ◽  
Opioid Use ◽  
Acute Pain Management ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Long Acting ◽  
Expert Recommendations

OBJECTIVES: To determine whether the prevalence of opioid use among patients requiring elective same-day admission (SDA) surgery is greater than the 2.5% prevalence found in the general population. Secondary objectives were to assess compliance with expert recommendations on acute pain management in opioid-tolerant patients and to examine clinical outcomes.METHODS: A retrospective review of 812 systematically sampled adult SDA surgical cases between April 1, 2008 and March 31, 2009 was conducted.RESULTS: Among 798 eligible patients, 148 (18.5% [95% CI 15.9% to 21.2%]) were prescribed opioids, with 4.4% prescribed long-acting opioids (95% CI 3.0% to 5.8%). Use of opioids was most prevalent among orthopedic and neurosurgery patients. Among the 35 patients on long-acting opioids who had a high likelihood of being tolerant, anesthesiologists correctly identified 33, but only 13 (37%) took their usual opioid preoperatively while 22 (63%) had opioids continued postoperatively. Acetaminophen, nonsteroidal anti-inflammatory drugs and pregabalin were ordered preoperatively in 18 (51%), 15 (43%) and 18 (51%) cases, respectively, while ketamine was used in 15 (43%) patients intraoperatively. Acetaminophen, nonsteroidal anti-inflammatory drugs and pregabalin were ordered postoperatively in 31 (89%), 15 (43%) and 17 (49%) of the cases, respectively. No differences in length of stay, readmissions and emergency room visits were found between opioid-tolerant and opioid-naïve patients.CONCLUSION: Opioid use is more common in SDA surgical patients than in the general population and is most prevalent within orthopedic and neurosurgery patients. Uptake of expert opinion on the management of acute pain in the opioid tolerant patient population is lacking.

Multimodal Approach to Acute Pain Management after Nuss Bar Placement and Other Pain Scenarios

2018 ◽  
Author(s):  
Christina D. Diaz ◽  
Steven J. Weisman
Keyword(s):  
Pain Management ◽  
Acute Pain ◽  
Behavioral Modification ◽  
Patient Controlled Analgesia ◽  
Acute Pain Management ◽  
Nerve Blocks ◽  
Pain Medications ◽  
Oral Pain ◽  
Inflammatory Drugs ◽  
Oral Pain Medication

Acute pain management can involve regional blocks with local anesthetics, neuraxial blocks such as caudal blocks and epidurals, oral and intravenous opioids, and nonsteroidal anti-inflammatory drugs. Other pain management modalities include neuropathic pain medications, muscle relaxants, antidepressants, acupuncture, techniques for stress relief, and behavioral modification therapy. While there are many options for treating a patient’s pain, the best approach is to understand the symptoms, attempt to determine the cause of the pain, and understand the patient’s goals with regard to treatment. This chapter discusses the multimodal acute pain management for a case of Nuss bar placement, utilizing an epidural, patient-controlled analgesia, and oral pain medication. The chapter has an additional scenario discussing neuraxial analgesia and nerve blocks for a hypospadias repair in an infant. Finally, the third case-based discussion focuses on the treatment of common types of headaches.

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