Postoperative Pain Control Following Cardiac Implantable Electronic Device Implantation

Postoperative pain following cardiac implantable electronic device (CIED) surgery may not always be adequately treated. The postoperative pain trajectory occurs over several days following the procedure with tenderness and limited arm range of motion lasting for weeks after surgery. Pain control typically commences in the perioperative period while the patient is in the hospital and may continue after discharge; outpatients may be given a prescription and advice for their analgesic regimen. It is not unusual for CIED patients to be discharged a few hours after implantation. While opioids are known as an effective analgesic to manage acute postoperative pain, growing scrutiny on opioid use as well as their side effects and potential risks have limited their use. Opioids may be considered for appropriate patients for a short course of treatment of acute postoperative pain, but other analgesics may likewise be considered.

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Continuous local bupivacaine wound infusion reduces oral opioid use for acute postoperative pain control following myelomeningocele repair

American Journal of Obstetrics & Gynecology MFM ◽

10.1016/j.ajogmf.2020.100296 ◽

2020 ◽

pp. 100296

Author(s):

Anne C. Porter ◽

Nicholas J. Behrendt ◽

Michael V. Zaretsky ◽

Kenneth W. Liechty ◽

Cristina Wood ◽

...

Keyword(s):

Postoperative Pain ◽

Pain Control ◽

Opioid Use ◽

Postoperative Pain Control ◽

Acute Postoperative Pain ◽

Myelomeningocele Repair

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Faculty Opinions recommendation of Preoperative predictors of poor acute postoperative pain control: a systematic review and meta-analysis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.735456301.793560934 ◽

2019 ◽

Author(s):

Winfried Meissner

Keyword(s):

Systematic Review ◽

Postoperative Pain ◽

Pain Control ◽

Meta Analysis ◽

Postoperative Pain Control ◽

Acute Postoperative Pain ◽

Preoperative Predictors

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Preemptive analgesia for endoscopic sinus surgery: a retrospective study

Rhinology Journal ◽

10.4193/rhin20.624 ◽

2021 ◽

Vol 0 (0) ◽

pp. 0-0

Author(s):

D. Nakashima ◽

E. Mori ◽

T. Takeda ◽

Y. Hosokawa ◽

S. Takaishi ◽

...

Keyword(s):

Retrospective Study ◽

Postoperative Pain ◽

Endoscopic Sinus Surgery ◽

Pain Control ◽

Postoperative Bleeding ◽

Perioperative Period ◽

Preemptive Analgesia ◽

Sinus Surgery ◽

Common Disease ◽

Postoperative Pain Control

Background: Chronic rhinosinusitis (CRS) is a common disease, and endoscopic sinus surgery (ESS) is widely performed. However, there is no consensus regarding postoperative pain control after ESS, and postoperative opioid abuse is a problem in many countries. Acetaminophen is reportedly effective for postoperative pain control. Preemptive analgesia has received more attention lately, wherein pain is prevented before it occurs. In this study, we assessed the use of acetaminophen for preemptive analgesia during the perioperative period in ESS. Methodology: This is a retrospective study of 175 patients who underwent ESS, septoplasty, and bilateral inferior turbinate mucosal resection at our hospital from April 2016 to February 2018. In total, 82 patients received 1,000 mg of acetaminophen during surgery and 4 hours after the first dose, while 93 patients did not receive it routinely. We compared these two groups. The primary outcome was the need to use additional analgesics prescribed by the ward physician and the secondary outcomes included postoperative pain, postoperative bleeding, reoperation, blood pressure, and body temperature. Results: The use of additional oral and intravenous analgesics was significantly reduced in the patients who received acetaminophen perioperatively. Conclusion: Preemptive analgesia during the perioperative period of ESS could lead to satisfactory postoperative pain control.

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Current strategies to minimize postoperative hematoma formation in patients undergoing cardiac implantable electronic device implantation: A review

Heart Rhythm ◽

10.1016/j.hrthm.2020.11.017 ◽

2020 ◽

Author(s):

Nishaki Mehta ◽

Kimberly Doerr ◽

Andrew Skipper ◽

Edward Rojas-Pena ◽

Simon Dixon ◽

...

Keyword(s):

Electronic Device ◽

Cardiac Implantable Electronic Device ◽

Hematoma Formation ◽

Device Implantation ◽

Postoperative Hematoma

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The Associations Between OPRM1 and COMT Genotypes and Postoperative Pain, Opioid Use, and Opioid-Induced Sedation

Biological Research For Nursing ◽

10.1177/1099800411436171 ◽

2012 ◽

Vol 15 (3) ◽

pp. 309-317 ◽

Cited By ~ 31

Author(s):

Richard A. Henker ◽

Allison Lewis ◽

Feng Dai ◽

William R. Lariviere ◽

Li Meng ◽

...

Keyword(s):

Postoperative Pain ◽

Postanesthesia Care Unit ◽

Trauma Patients ◽

Orthopedic Trauma ◽

Nucleotide Polymorphisms ◽

Opioid Use ◽

Acute Postoperative Pain ◽

Comt Genotype ◽

Sedation Scores ◽

Physiologic Responses

Previous studies have associated mu-opioid receptor ( OPRM1) genotype with pain and analgesia responses in postoperative and patient populations. This study investigates the role of catechol-O-methyltransferase ( COMT) and OPRM1 genotypes in acute postoperative pain scores, opioid use, and opioid-induced sedation after surgical procedures for orthopedic trauma in an otherwise healthy patient population. Verbal pain/sedation scores, opioid use, and physiologic responses in the immediate postoperative period were examined for association with genetic variants in Caucasians genotyped for OPRM1 single nucleotide polymorphisms (SNPs) A118G and C17T and COMT SNPs. The OPRM1 A118G genotype was associated with patients’ postoperative Numerical Pain scale (NPS) ratings at 15 min in the postanesthesia care unit (PACU) ( p = .01) and patients' sedation scores at 15 min in the PACU ( p = .02). COMT genotype (rs4818) was associated with opioid consumption in the first 45 min in the PACU ( p = .04). NPS ratings at 45 min were also higher in the group of patients with A/A genotype of rs4680 than in patients with the other two genotypes at this SNP ( p = .03). Our haplotype trend analysis identified a COMT haplotype “GCGG” significantly associated with NPS at 15 min ( p = .0013), amount of opioids consumed in the first 45 min ( p = .0024), and heart rate at 45 min in the PACU ( p = .017). The results indicate that genetic variations in COMT contribute to the acute postoperative pain and analgesia responses and physiologic responses in this group of otherwise healthy postoperative orthopedic trauma patients.

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