A Survey on Changes of Postoperative Pain of Surgical Patients according to Time Variation

Background: Most studies examining tramadol metabolism have been carried out in non-surgical patients and with oral tramadol. The aim of this study was 1) to measure concentrations of tramadol, O-demethyltramadol (ODT), and N-demethyltramadol (NDT) in the surgical patients admitted to the intensive care unit (ICU) within the first 24 postoperative hours after intravenous application of tramadol, and 2) to examine the effect of systemic inflammation on tramadol metabolism and postoperative pain.Methods: A prospective observational study was carried out in the surgical ICU in the tertiary hospital. In the group of 47 subsequent patients undergoing major abdominal surgery, pre-operative blood samples were taken for CYP2D6 polymorphism analysis. Systemic inflammation was assessed based on laboratory and clinical indicators. All patients received 100 mg of tramadol intravenously every 6 h during the first postoperative day. Postoperative pain was assessed before and 30 min after tramadol injections. Tramadol, ODT, and NDT concentrations were determined by high-performance liquid chromatography.Results:CYP2D6 analysis revealed 2 poor (PM), 22 intermediate (IM), 22 extensive (EM), and 1 ultrafast metabolizer. After a dose of 100 mg of tramadol, t1/2 of 4.8 (3.2–7.6) h was observed. There were no differences in tramadol concentration among metabolic phenotypes. The area under the concentration–time curve at the first dose interval (AUC1-6) of tramadol was 1,200 (917.9–1944.4) μg ×h ×L−1. NDT concentrations in UM were below the limit of quantification until the second dose of tramadol was administrated, while PM had higher NDT concentrations compared to EM and IM. ODT concentrations were higher in EM, compared to IM and PM. ODT AUC1-6 was 229.6 (137.7–326.2) μg ×h ×L−1 and 95.5 (49.1–204.3) μg ×h ×L−1 in EM and IM, respectively (p = 0.004). Preoperative cholinesterase activity (ChE) of ≤4244 U L−1 was a cut-off value for a prediction of systemic inflammation in an early postoperative period. NDT AUC1-6 were significantly higher in patients with low ChE compared with normal ChE patients (p = 0.006). Pain measurements have confirmed that sufficient pain control was achieved in all patients after the second tramadol dose, except in the PM.Conclusions:CYP2D6 polymorphism is a major factor in O-demethylation, while systemic inflammation accompanied by low ChE has an important role in the N-demethylation of tramadol in postoperative patients. Concentrations of tramadol, ODT, and NDT are lower in surgical patients than previously reported in non-surgical patients.Clinical Trial Registration: ClinicalTrials.gov, NCT04004481.

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Liposomal Bupivacaine Versus Immediate-Release Bupivacaine for Postoperative Pain Control

Annals of Pharmacotherapy ◽

10.1177/10600280211043554 ◽

2021 ◽

pp. 106002802110435

Author(s):

Atul Dilawri ◽

Marcia Wyman ◽

Sneha Shah

Keyword(s):

Postoperative Pain ◽

Pain Control ◽

Tertiary Care ◽

Immediate Release ◽

Opioid Consumption ◽

Surgical Patients ◽

Matched Cohort ◽

Postoperative Pain Control ◽

Liposomal Bupivacaine ◽

Analgesic Use

Background Liposomal bupivacaine (LB) is increasingly being used for postoperative pain control, but there are conflicting efficacy data when compared with immediate-release bupivacaine (IRB). Objective To evaluate the comparative efficacies of LB and IRB for postoperative pain control in order to assess the formulary status of LB at our institution. Methods A single-center, retrospective, institutional review board–approved, noninferiority matched cohort study at a tertiary care academic medical center. Adult surgical patients admitted for >24 hours who received LB or IRB were included. The primary outcome was total opioid consumption within 24 hours postoperatively. Secondary outcomes included total opioid consumption within 72 hours postoperatively, nonopioid analgesic use within 24 and 72 hours postoperatively, time to rescue analgesic use, and postoperative length of stay (LOS). Results A total of 326 patients were included in the matched cohort. Median 24-hour opioid consumption was significantly lower in the IRB group compared with the LB group (81 mg [30, 153] vs 103 mg [46, 241]; P = 0.01). Patients receiving IRB compared with LB also had a decrease in total opioid consumption 72 hours postoperatively (110 mg [45, 258] vs 165 mg [68, 402]; P = 0.005) and shorter postoperative LOS (2.8 days [1.7, 4] vs 3.3 days [2, 5.1]; P < 0.001). There was no difference in time to rescue analgesic use. Conclusion and Relevance Across a variety of surgical procedures, administration of IRB compared with LB was associated with a reduction in total opioid consumption within 24 and 72 hours postoperatively and shorter LOS in adult surgical patients.

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The efficacy of different modes of analgesia in postoperative pain management and early mobilization in postoperative cardiac surgical patients: A systematic review

Annals of Cardiac Anaesthesia ◽

10.4103/aca.aca_186_17 ◽

2018 ◽

Vol 21 (4) ◽

pp. 363 ◽

Cited By ~ 1

Author(s):

Louisa Lam ◽

Brenda Nachiyunde

Keyword(s):

Systematic Review ◽

Pain Management ◽

Postoperative Pain ◽

Early Mobilization ◽

Postoperative Pain Management ◽

Surgical Patients

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Surgical patients

10.1093/med/9780199696277.003.0011 ◽

2013 ◽

Author(s):

Martin Beed ◽

Richard Sherman ◽

Ravi Mahajan

Keyword(s):

Cardiac Surgery ◽

Postoperative Pain ◽

Bronchopleural Fistula ◽

Wound Dehiscence ◽

Surgical Patients ◽

Postoperative Sepsis ◽

Postoperative Haemorrhage ◽

Period 2 ◽

Cytokine Levels ◽

Tissue Trauma

Postoperative sepsisWound dehiscenceMajor postoperative haemorrhageHaemorrhage after cardiac surgeryTUR syndromeBronchopleural fistulaPostoperative painPatients commonly develop SIRS in the immediate postoperative period 2° to ↑cytokine levels caused by the surgical tissue trauma. This is normally a self-limiting response that subsides within 48 hours. Persistent SIRS, or the development of end-organ dysfunction, should prompt examination and investigations to elucidate the cause....

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Patient Attitudes to Postoperative Pain Relief

Anaesthesia and Intensive Care ◽

10.1177/0310057x8301100206 ◽

1983 ◽

Vol 11 (2) ◽

pp. 125-129 ◽

Cited By ~ 107

Author(s):

B. D. Donovan

Keyword(s):

Postoperative Pain ◽

Pain Relief ◽

Intravenous Infusion ◽

Surgical Patients ◽

Postoperative Pain Relief ◽

Continuous Intravenous Infusion ◽

Patient Attitudes ◽

Regional Analgesia ◽

Frequent Use

A study of the attitudes of general surgical patients to the management of their postoperative pain showed that although 86% initially expressed satisfaction with their postoperative pain relief, a quarter of these did in fact have moderate, severe or unbearable, unalleviated pain. These, together with those who expressed dissatisfaction with their pain relief, constituted one third of the total number, indicating that a problem of postoperative analgesic management existed in the hospital. As a result, techniques of continuous intravenous infusion of narcotics and more frequent use of regional analgesia have been introduced.

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