scholarly journals A Pain Control Optimization Pathway to Reduce Acute Postoperative Pain and Opioid Consumption Postoperatively: An Approach to Battling the Opioid Epidemic

2020 ◽  
Author(s):  
◽  
Holly Franson
Keyword(s):  
Pain Management ◽  
Acute Pain ◽  
Pain Control ◽  
Opioid Consumption ◽  
Care Process ◽  
Management Technique ◽  
Evidence Based ◽  
Post Intervention ◽  
Acute Pain Management ◽  
Control Optimization

Practice Problem: Healthcare providers worldwide are working to battle the opioid epidemic and reduce opioid-related harm to patients. Utilizing evidence-based acute pain management methods to reduce opioid consumption is critical to combat the problem. PICOT: The PICOT question that guided this project was: In opioid-naïve adult patients undergoing general anesthesia for out-patient, minimally invasive abdominal wall hernia surgery, how does the implementation of an evidence-based, preventative Pain Control Optimization Pathway (POP) using a multimodal, opioid-sparing acute pain management technique and standardized procedure-specific opioid prescribing, compared to standard treatment, affect postoperative pain scores and opioid consumption, upon discharge from the recovery room and 72 hours postoperative? Evidence: Evidence supported utilizing a multimodal, opioid-sparing acute pain management technique, patient counseling, and opioid prescribing guidelines to improve outcomes among opioid-naïve patients undergoing abdominal surgeries. Intervention: In this pre- and post-intervention evaluation, N = 28 patients received the POP care process during the perioperative period. Outcome: Results showed the mean pain score at discharge from the recovery room decreased from 4.8 to 2.82 on the 10-point Numeric Rating Scale post-intervention (p< 0.001). Also, provider compliance with prescribing a procedure-specific opioid prescription increased from 73% to 100%, thus reducing opioid exposure and access. Conclusion: This project provided evidence that utilization of the innovative POP care process provided optimal pain control and decreased opioid consumption, consequently reducing the risk of new persistent opioid use.

Acute pain management in morbid obesity – an evidence based clinical update

2017 ◽  
Vol 13 (3) ◽  
pp. 523-532 ◽  
Author(s):  
Adele Sandra Budiansky ◽  
Michael P Margarson ◽  
Naveen Eipe
Keyword(s):  
Morbid Obesity ◽  
Pain Management ◽  
Acute Pain ◽  
Evidence Based ◽  
Acute Pain Management

Acute pain management in patients with prior opioid consumption: a case-controlled retrospective review

Pain ◽  
1995 ◽  
Vol 61 (2) ◽  
pp. 195-201 ◽  
Author(s):  
Suzanne E. Rapp ◽  
Brian L. Ready ◽  
Michael L. Nessly
Keyword(s):  
Pain Management ◽  
Acute Pain ◽  
Retrospective Review ◽  
Opioid Consumption ◽  
Acute Pain Management

scholarly journals Efficacy of Dronabinol for Acute Pain Management in Adults with Traumatic Injury: Study Protocol of A Randomized Controlled Trial

2020 ◽  
Vol 10 (3) ◽  
pp. 161 ◽  
Author(s):  
Claire Swartwood ◽  
Kristin Salottolo ◽  
Robert Madayag ◽  
David Bar-Or
Keyword(s):  
Randomized Controlled Trial ◽  
Pain Management ◽  
Acute Pain ◽  
Controlled Trial ◽  
Dose Range ◽  
Traumatic Injury ◽  
Primary Objective ◽  
Opioid Consumption ◽  
Acute Pain Management ◽  
Randomized Controlled

Delta-9-tetrahydrocannabinol (Δ9-THC) and other cannabinoids present in cannabis (marijuana) have been shown to affect the normal inhibitory pathways that influence nociception in humans. The potential benefits of cannabinoids as an analgesic are likely greatest in hyperalgesic and inflammatory states, suggesting a role as a therapeutic agent for treating acute pain following injury. Dronabinol is a licensed form of Δ9-THC. The primary objective of this single center randomized controlled trial is to evaluate the efficacy of adjunctive dronabinol versus control (systemic analgesics only, no dronabinol) for reducing opioid consumption in adults with traumatic injury. Study inclusion is based on high baseline utilization of opioids ≥50 morphine equivalents (mg) within 24 h of admission for adults aged 18–65 years with traumatic injury. There is a 48-hour screening period followed by a 48-hour treatment period after randomization. A total of 122 patients will be randomized 1:1 across 2 study arms: adjunctive dronabinol versus control (standard of care using systemic analgesics, no adjunctive dronabinol). Patients randomized to the dronabinol arm should receive their first dose within 12 h of randomization, with a dose range of 5 mg up to 30 mg daily in divided doses, in addition to systemic analgesics as needed for pain. The primary efficacy endpoint is a change in opioid consumption (morphine equivalents), assessed post-randomization (48 h after randomization) minus pre-randomization (24 h prior to randomization). This is the first randomized trial to investigate whether adjunctive dronabinol is effective in reducing opioid consumption in acute pain management of traumatic injury. Trial Registration: ClinicalTrials.gov Identifier: NCT03928015.

Barriers to Optimal Pain Management in the General Surgery Population

2018 ◽  
Author(s):  
Anand C. Thakur
Keyword(s):  
Pain Management ◽  
Pain Control ◽  
Pain Perception ◽  
Evidence Based ◽  
Multimodal Approach ◽  
Short List ◽  
Acute Pain Management ◽  
Physiological Factors ◽  
Physician Knowledge ◽  
Perception Management

Barriers to the implementation of adequate pain control are multifactorial and encompass all caregivers. A complete list of barriers to adequate pain control would involve biopsychosocial factors, physiological factors, pharmacological concerns, and medical legal concerns. A short list of barriers to adequate pain control can be separated into physician knowledge, expectations and perceptions, nurses’ and other ancillary providers’ knowledge, expectations and perceptions, patient expectations and perception, management of acute pain, management of chronic pain, discrepancies of pain perception and different population groups, and both regulatory and formulary issues. To have an understanding of up-to-date recommendations and standards regarding evidence-based pain management requires a multimodal approach with a team of physicians.

scholarly journals Sustainability of Evidence-Based Acute Pain Management Practices for Hospitalized Older Adults

2017 ◽  
Vol 40 (12) ◽  
pp. 1749-1764 ◽  
Author(s):  
Clayton J. Shuman ◽  
Xian-Jin Xie ◽  
Keela A. Herr ◽  
Marita G. Titler
Keyword(s):  
Older Adults ◽  
Pain Management ◽  
Pain Intensity ◽  
Acute Pain ◽  
Management Practices ◽  
Cluster Randomized Trial ◽  
Evidence Based ◽  
Acute Pain Management ◽  
Factors Affecting ◽  
Hospitalized Older Adults

Little is known regarding sustainability of evidence-based practices (EBPs) following implementation. This article reports sustainability of evidence-based acute pain management practices in hospitalized older adults following testing of a multifaceted Translating Research Into Practice (TRIP) implementation intervention. A cluster randomized trial with follow-up period was conducted in 12 Midwest U.S. hospitals (six experimental, six comparison). Use of evidence-based acute pain management practices and mean pain intensity were analyzed using generalized estimating equations across two time points (following implementation and 18 months later) to determine sustainability of TRIP intervention effects. Summative Index scores and six of seven practices were sustained. Experimental and comparison group differences for mean pain intensity over 72 hours following admission were sustained. Results revealed most evidence-based acute pain management practices were sustained for 18 months following implementation. Further work is needed to identify factors affecting sustainability of EBPs to guide development and testing of sustainability strategies.

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