Post-Operative Nausea, Vomiting and Pain Score in Post Anesthesia Care Unit (PACU) at Jordan University Hospital

Abstract Background Current principles of postoperative pain management are primarily based on the types and extent of surgical intervention. This clinical study measured patient’s self-anticipated pain score before surgery, and correlated the scores with the pain levels and analgesic requirements after surgery. Methods This prospective observational study recruited consecutive patients who received elective surgery in the E-Da Hospital, Taiwan from June to August 2018. Patients were asked to subjectively rate their highest anticipated pain level (numerical rating scale, 0-10) for the scheduled surgical interventions during their preoperative anesthesia assessment. After the operation, the actual pain intensity (NRS 0-10) experienced by the patient in the post-anesthesia care unit and the total dose of opioids administered during the perioperative period were recorded. Results A total of 996 patients were included in the study. Most of the patients (86%) received general anesthesia and 73.9% of them had a history of previous operation. Younger patients (<40 years) (P=0.042) and those took regular benzodiazepine at bedtime (P=0.043) anticipated significantly higher pain levels. Male patients anticipated significantly lower pain intensities than females (odd ratio 1.710; 95% CI 1.254-2.331, P=0.001). Patients who scheduled for laparotomies (P=0.037), orthopedic surgeries (P=0.040) or long procedures (P<0.001) reported higher anticipated pain. Although higher anticipated pain scores were associated with higher postoperative pain levels (P=0.021) and higher total equivalent opioid dose (P=0.001) for acute pain management during the perioperative period, these surgical patients actually experienced less pain than they anticipated at the post-anesthesia care unit. Conclusion This observational study found that patients who are female, younger age (<40 years), use regular benzodiazepines at bedtime and scheduled for long procedures (>2 h), laparotomies or orthopedic surgeries anticipate significantly higher surgery-related pain. Therefore, appropriate preoperative counseling for analgesic control and the management of exaggerated pain expectation in these patients is necessary to improve the quality of anesthesia delivered and patient’s satisfaction.

Download Full-text

Language-Related Disparities in Pain Management in the Post-Anesthesia Care Unit for Children Undergoing Laparoscopic Appendectomy

Children ◽

10.3390/children7100163 ◽

2020 ◽

Vol 7 (10) ◽

pp. 163

Author(s):

Anjali A. Dixit ◽

Holly Elser ◽

Catherine L. Chen ◽

Marla Ferschl ◽

Solmaz P. Manuel

Keyword(s):

Pain Management ◽

Pain Score ◽

Language Proficiency ◽

Laparoscopic Appendectomy ◽

English Language ◽

Recovery Period ◽

English Language Proficiency ◽

Anesthesia Care ◽

Post Anesthesia Care Unit ◽

Opioid Medication

Race and ethnicity are associated with disparities in pain management in children. While low English language proficiency is correlated with minority race/ethnicity in the United States, it is less frequently explored in the study of health disparities. We therefore investigated whether English language proficiency influenced pain management in the post-anesthesia care unit (PACU) in a cohort of children who underwent laparoscopic appendectomy at our pediatric hospital in San Francisco. Our primary exposure was English language proficiency, and our primary outcome was administration of any opioid medication in the PACU. Secondary outcomes included the amount of opioid administered in the PACU and whether any pain score was recorded during the patient’s recovery period. Statistical analysis included adjusting for demographic covariates including race in estimating the effect of language proficiency on these outcomes. In our cohort of 257 pediatric patients, 57 (22.2%) had low English proficiency (LEP). While LEP and English proficient (EP) patients received the same amount of opioid medication intraoperatively, in multivariable analysis, LEP patients had more than double the odds of receiving any opioid in the PACU (OR 2.45, 95% CI 1.22–4.92). LEP patients received more oral morphine equivalents (OME) than EP patients (1.64 OME/kg, CI 0.67–3.84), and they also had almost double the odds of having no pain score recorded during their PACU recovery period (OR 1.93, CI 0.79–4.73), although the precision of these estimates was limited by small sample size. Subgroup analysis showed that children over the age of 5 years, who were presumably more verbal and would therefore undergo verbal pain assessments, had over triple the odds of having no recorded pain score (OR 3.23, CI 1.48–7.06). In summary, English language proficiency may affect the management of children’s pain in the perioperative setting. The etiology of this language-related disparity is likely multifactorial and should be investigated further.

Download Full-text

Capnography Monitoring to Reduce Adverse Events in the Pediatric Post-Anesthesia Care Unit

PEDIATRICS ◽

10.1542/peds.137.supplement_3.189a ◽

2016 ◽

Vol 137 (Supplement 3) ◽

pp. 189A-189A

Author(s):

Melissa L. Langhan ◽

Fangyong Li ◽

Lance Lichtor

Keyword(s):

Adverse Events ◽

Anesthesia Care ◽

Post Anesthesia Care Unit

Download Full-text

Comparison of the ToFscan and TetraGraph During Recovery of Neuromuscular Function in the Post Anesthesia Care Unit

Case Medical Research ◽

10.31525/ct1-nct03920670 ◽

2019 ◽

Author(s):

Keyword(s):

Neuromuscular Function ◽

Anesthesia Care ◽

Post Anesthesia Care Unit

Download Full-text

The effects of intraoperative brain activity monitoring on post-anesthesia care unit length of stay: A systematic review

JBI Library of Systematic Reviews ◽

10.11124/jbisrir-2010-722 ◽

2010 ◽

Vol 8 (Supplement) ◽

pp. 1-10

Keyword(s):

Systematic Review ◽

Length Of Stay ◽

Brain Activity ◽

Unit Length ◽

Activity Monitoring ◽

Anesthesia Care ◽

Post Anesthesia Care Unit

Download Full-text

Effects of pre-emptive pregabalin and multimodal anesthesia on postoperative opioid requirements in patients undergoing robot-assisted laparoscopic prostatectomy

BMC Urology ◽

10.1186/s12894-021-00785-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

K. Sisa ◽

S. Huoponen ◽

O. Ettala ◽

H. Antila ◽

T. I. Saari ◽

...

Keyword(s):

Postoperative Nausea And Vomiting ◽

Multimodal Analgesia ◽

Opioid Consumption ◽

Anesthesia Induction ◽

Anesthesia Care ◽

Post Anesthesia Care Unit ◽

Robot Assisted ◽

Ctrl Group ◽

Laparoscopic Prostatectomy ◽

The Impact

Abstract Background Previous findings indicate that pre-emptive pregabalin as part of multimodal anesthesia reduces opioid requirements compared to conventional anesthesia in patients undergoing robot-assisted laparoscopic prostatectomy (RALP). However, recent studies show contradictory evidence suggesting that pregabalin does not reduce postoperative pain or opioid consumption after surgeries. We conducted a register-based analysis on RALP patients treated over a 5-year period to evaluate postoperative opioid consumption between two multimodal anesthesia protocols. Methods We retrospectively evaluated patients undergoing RALP between years 2015 and 2019. Patients with American Society of Anesthesiologists status 1–3, age between 30 and 80 years and treated with standard multimodal anesthesia were included in the study. Pregabalin (PG) group received 150 mg of oral pregabalin as premedication before anesthesia induction, while the control (CTRL) group was treated conventionally. Postoperative opioid requirements were calculated as intravenous morphine equivalent doses for both groups. The impact of pregabalin on postoperative nausea and vomiting (PONV), and length of stay (LOS) was evaluated. Results We included 245 patients in the PG group and 103 in the CTRL group. Median (IQR) opioid consumption over 24 postoperative hours was 15 (8–24) and 17 (8–25) mg in PG and CTRL groups (p = 0.44). We found no difference in postoperative opioid requirement between the two groups in post anesthesia care unit, or within 12 h postoperatively (p = 0.16; p = 0.09). The length of post anesthesia care unit stay was same in each group and there was no difference in PONV Similarly, median postoperative LOS was 31 h in both groups. Conclusion Patients undergoing RALP and receiving multimodal analgesia do not need significant amount of opioids postoperatively and can be discharged soon after the procedure. Pre-emptive administration of oral pregabalin does not reduce postoperative opioid consumption, PONV or LOS in these patients.

Download Full-text

Postoperative opioids and risk of respiratory depression – A cross-sectional evaluation of routines for administration and monitoring in a tertiary hospital

Scandinavian Journal of Pain ◽

10.1515/sjpain-2020-0060 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Karoline Kolås Andersen ◽

Gunnvald Kvarstein

Keyword(s):

Respiratory Depression ◽

Patient Monitoring ◽

Current Practice ◽

Tertiary Hospital ◽

University Hospital ◽

Post Anesthesia Care Unit ◽

Cross Sectional ◽

Routes Of Administration ◽

Surgical Ward ◽

Cross Sectional Design

AbstractObjectivesOpioids are the most potent analgesics in the treatment of postoperative pain. Respiratory depression is, however, a serious side effect. The aims of this study were to evaluate current practice and routines for post-operative administration of opioids in a Norwegian university hospital and to evaluate whether the clinical safeguards adequately protected patients’ safety regarding risk of respiratory depression.MethodsThe study had a retrospective cross-sectional design and included 200 patients, treated with opioids postoperatively. The patients were treated in a post-anesthesia care unit (PACU) before transferal to a surgical ward. Relevant data such as opioid dosages, routes of administration, sedation and respiratory function, routines for patient monitoring, and numbers of patients with opioid induced respiratory depression was collected.ResultsTwo patients (1%) developed respiratory depression that needed naloxone to reverse the effect, and 32 patients (16%) had a respiratory rate (RR) <10/min, which may have been caused by opioids. In the PACU, the patient’s RR was evaluated on a routine base, but after transferal to a surgical ward RR documented in only 7% of the patients.ConclusionsThe lack of routines for patient monitoring, especially RR, represented a risk of not detecting opioid induced respiratory depression.

Download Full-text