Postoperative Pain Control in Total Joint Arthroplasty: A Prospective, Randomized Study of a Fixed-Dose, Around-the-Clock, Oral Regimen

Abstract Background: Variance in pain after total knee and hip arthroplasty may be due to a number of procedural and peripheral factors but also, in some individuals, to aberrant central pain processing as is described in conditions like fibromyalgia. To test this hypothesis, the authors conducted a prospective, observational cohort study of patients undergoing lower-extremity joint arthroplasty. Methods: Five hundred nineteen patients were preoperatively phenotyped using validated self-reported pain questionnaires, psychological measures, and health information. In addition to being assessed for factors previously found to be associated with poor outcomes in arthroplasty, participants also completed the American College of Rheumatology survey criteria for fibromyalgia. Previous studies have suggested that rather than being “present” or “absent,” features of fibromyalgia as measured by this instrument, occur over a wide continuum. Postoperative pain control was assessed by total postoperative opioid consumption. Results: Preoperatively, patients with higher fibromyalgia survey scores were younger, more likely to be female, taking more opioids, reported higher pain severity, and had a more negative psychological profile. In the multivariate analysis, the fibromyalgia survey score, younger age, preoperative opioid use, knee (vs. hip), pain severity at baseline, and the anesthetic technique were all predictive of increased postoperative opioid consumption. Conclusions: The use of the survey criteria for fibromyalgia led to the finding of distinct phenotypic differences, and the measure was independently predictive of opioid consumption. This self-report measure may provide an additional simple means of predicting postoperative pain outcomes and analgesic requirements. Future studies are needed to determine whether tailored therapies can improve postoperative pain control in this population.

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Bayesian inference for causal mechanisms with application to a randomized study for postoperative pain control

Biostatistics ◽

10.1093/biostatistics/kxx010 ◽

2017 ◽

Vol 18 (4) ◽

pp. 605-617 ◽

Cited By ~ 4

Author(s):

Michela Baccini ◽

Alessandra Mattei ◽

Fabrizia Mealli

Keyword(s):

Postoperative Pain ◽

Mediation Analysis ◽

Pain Control ◽

Randomized Study ◽

Double Blind Study ◽

Principal Stratification ◽

Self Administration ◽

Postoperative Pain Control ◽

Double Blind ◽

Effect Of Treatment

SUMMARY We conduct principal stratification and mediation analysis to investigate to what extent the positive overall effect of treatment on postoperative pain control is mediated by postoperative self administration of intra-venous analgesia by patients in a prospective, randomized, double-blind study. Using the Bayesian approach for inference, we estimate both associative and dissociative principal strata effects arising in principal stratification, as well as natural effects from mediation analysis. We highlight that principal stratification and mediation analysis focus on different causal estimands, answer different causal questions, and involve different sets of structural assumptions.

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Comparison of intravenous paracetamol vs. intramuscular diclofenac for postoperative pain control in abdominal hysterectomy

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20211132 ◽

2021 ◽

Vol 10 (4) ◽

pp. 1525

Author(s):

Poonam Bisht ◽

Geeta Jain

Keyword(s):

Postoperative Pain ◽

Pain Control ◽

Randomized Study ◽

Abdominal Hysterectomy ◽

Postoperative Pain Control ◽

Rescue Analgesia ◽

Post Operative Pain ◽

Intravenous Paracetamol ◽

The Difference ◽

Group B

Background: Abdominal hysterectomy is one of the most common gynaecological surgery conducted worldwide. It is commonly associated with post operative pain. The aim of this study was Comparison of intravenous Paracetamol versus intramuscular Diclofenac for postoperative pain control in abdominal hysterectomy. Objectives of this study were to compare the effectiveness of intravenous Paracetamol and intramuscular Diclofenac when used for post-operative pain control in abdominal hysterectomy patients and to compare the need for rescue analgesia in both the groups.Methods: It’s a prospective observational and clinically randomized study conducted in Department of Obstetrics and Gynaecology, Government Medical College Haldwani and associated Dr. Shushila Tiwari Government Hospital, Haldwani consisting of 120 patients undergoing abdominal hysterectomy. 60 patients in group A received Paracetamol 1000 mg (100ml infusion) intravenous followed by subsequent doses of 1000 mg every 8 hourly for 48 hrs and another 60 patients in group B received injection Diclofenac 75 mg intramuscular every 8 hourly for 48hrs. Pain intensity of patients was noted 2 hourly for 6 hours after giving the first dose of the drug and then at every 8 hour for next 48 hours, using VAS scoring. Patient’s hemodynamics in form of respiratory rate, heart rate, mean arterial pressure (MAP), oxygen saturation (sPO2) were monitored as per pain monitoring protocol.Results: Post-op mean VAS score at different point of time among the two treatment groups was lower for Paracetamol group as compared to Diclofenac group. The difference was found to be statistically significant at all point of time post op. Adverse effect like nausea, vomiting and dizziness was seen more among Diclofenac group as compared to Paracetamol group.Conclusions: Intravenous Paracetamol use was found to be associated with better postoperative pain relief and reduced need for rescue analgesia consumption in the postoperative period.

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Pre-emptive analgesia VS Prophylactic analgesia and its influence on postoperative pain in postoperative laparoscopic cholecystectomy patients

10.30574/ijsra.2020.1.2.0029 ◽

2020 ◽

Vol 1 (2) ◽

pp. 038-043

Author(s):

María Fernanda Maya Guerrero ◽

Fabiola María Nuccio Giordano ◽

Bernardo José Gutiérrez Sougarret ◽

Alejandro Díaz Girón Gidi

Keyword(s):

Laparoscopic Cholecystectomy ◽

Postoperative Pain ◽

Total Dose ◽

Pain Control ◽

Randomized Study ◽

Pain Scale ◽

Postoperative Pain Control ◽

Double Blind ◽

The Moment

Introduction: There are no studies on the use of dexketoprofen for postoperative pain control in patients undergoing laparoscopic cholecystectomy. Purpose: To assess if the timing of dexketoprofen administration influences the intensity of postoperative pain in patients undergoing laparoscopic cholecystectomy. Materials and methods used: Experimental, longitudinal, double-blind, randomized study. 50 mg of dexketoprofen diluted in 50 ml of 0.9% saline was administered to 50 patients divided into two groups: Pre-operative group: the substance was administered one hour before the beginning of surgery. Trans-operative group: the substance was administered at the moment when the gallbladder was separated from the liver base. The Numerical Pain Scale was evaluated and the number of doses and the total dose of tramadol that the patients received as analgesic rescue was quantified. Results: Administration of dexketoprofen before starting laparoscopic cholecystectomy tends to reduce the intensity of postoperative pain without being statistically significant. Conclusion: The timing of dexketoprofen administration has no impact on postoperative pain in patients operated for laparoscopic cholecystectomy.

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