Postoperative pain scores and analgesic requirements after thyroid surgery: Comparison of three intraoperative opioid regimens

AbstractObjectivesIn this sub-study of the ‘Paracetamol and Ibuprofen in Combination’ (PANSAID) trial, in which participants were randomised to one of four different non-opioids analgesic regimen consisting of paracetamol, ibuprofen, or a combination of the two after planned primary total hip arthroplasty, our aims were to investigate the distribution of participants’ pain (mild, moderate or severe), integrate opioid use and pain to a single score (Silverman Integrated Approach (SIA)-score), and identify preoperative risk factors for severe pain.MethodsWe calculated the proportions of participants with mild (VAS 0–30 mm), moderate (VAS 31–60 mm) or severe (VAS 61–100 mm) pain and the SIA-scores (a sum of rank-based percentage differences from the mean rank in pain scores and opioid use, ranging from −200 to 200%). Using logistic regression with backwards elimination, we investigated the association between severe pain and easily obtainable preoperative patient characteristics.ResultsAmong 556 participants from the modified intention-to-treat population, 33% (95% CI: 26–42) (Group Paracetamol + Ibuprofen (PCM + IBU)), 28% (95% CI: 21–37) (Group Paracetamol (PCM)), 23% (95% CI: 17–31) (Group Ibuprofen (IBU)), and 19% (95% CI: 13–27) (Group Half Strength-Paracetamol + Ibuprofen (HS-PCM + IBU)) experienced mild pain 6 h postoperatively during mobilisation. Median SIA-scores during mobilisation were: Group PCM + IBU: −48% (IQR: −112 to 31), Group PCM: 40% (IQR: −31 to 97), Group IBU: −5% (IQR: −57 to 67), and Group HS-PCM + IBU: 6% (IQR: −70 to 74) (overall difference: p=0.0001). Use of analgesics before surgery was the only covariate associated with severe pain (non-opioid: OR 0.50, 95% CI: 0.29–0.82, weak opioid 0.56, 95% CI: 0.28–1.16, reference no analgesics before surgery, p=0.02).ConclusionsOnly one third of participants using paracetamol and ibuprofen experienced mild pain after total hip arthroplasty and even fewer experienced mild pain using each drug alone as basic non-opioid analgesic treatment. We were not able, in any clinically relevant way, to predict severe postoperative pain. A more extensive postoperative pain regimen than paracetamol, ibuprofen and opioids may be needed for a large proportion of patients having total hip arthroplasty. SIA-scores integrate pain scores and opioid use for the individual patient and may add valuable information in acute pain research.

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Transversus abdominis Plane Block for Improved Early Postoperative Pain Management after Periacetabular Osteotomy: A Randomized Clinical Trial

Journal of Clinical Medicine ◽

10.3390/jcm10030394 ◽

2021 ◽

Vol 10 (3) ◽

pp. 394

Author(s):

Jannis Löchel ◽

Viktor Janz ◽

Vincent Justus Leopold ◽

Michael Krämer ◽

Georgi I. Wassilew

Keyword(s):

Postoperative Pain ◽

Periacetabular Osteotomy ◽

Opioid Consumption ◽

Transversus Abdominis ◽

Control Group ◽

Block Group ◽

Tap Block ◽

Transversus Abdominis Plane ◽

Ultrasound Guided ◽

Pain Scores

Background: Patients undergoing periacetabular osteotomy (PAO) may experience significant postoperative pain due to the extensive approach and multiple osteotomies. The aim of this study was to assess the efficacy of the transversus abdominis plane (TAP) block on reducing opioid consumption and improving clinical outcome in PAO patients. Patients and Methods: We conducted a two-group randomized-controlled trial in 42 consecutive patients undergoing a PAO for symptomatic developmental dysplasia of the hip (DDH). The study group received an ultrasound-guided TAP block with 20 mL of 0.75% ropivacaine prior to surgery. The control group did not receive a TAP block. All patients received a multimodal analgesia with nonsteroidal anti-inflammatory drugs (NSAID) (etoricoxib and metamizole) and an intravenous patient-controlled analgesia (PCA) with piritramide (1.5 mg bolus, 10 min lockout-time). The primary endpoint was opioid consumption within 48 h after surgery. Secondary endpoints were pain scores, assessment of postoperative nausea and vomiting (PONV), measurement of the quality of recovery using patient-reported outcome measure and length of hospital stay. Forty-one patients (n = 21 TAP block group, n = 20 control group) completed the study, per protocol. One patient was lost to follow-up. Thirty-three were women (88.5%) and eight men (19.5%). The mean age at the time of surgery was 28 years (18–43, SD ± 7.4). All TAP blocks were performed by an experienced senior anaesthesiologist and all operations were performed by a single, high volume surgeon. Results: The opioid consumption in the TAP block group was significantly lower compared to the control group at 6 (3 mg ± 2.8 vs. 10.8 mg ± 5.6, p < 0.0001), 24 (18.4 ± 16.2 vs. 30.8 ± 16.4, p = 0.01) and 48 h (29.1 mg ± 30.7 vs. 54.7 ± 29.6, p = 0.04) after surgery. Pain scores were significantly reduced in the TAP block group at 24 h after surgery. There were no other differences in secondary outcome parameters. No perioperative complication occurred in either group. Conclusion: Ultrasound-guided TAP block significantly reduces the perioperative opioid consumption in patients undergoing PAO.

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The analgesic efficacy of liposomal bupivacaine compared with bupivacaine hydrochloride for the prevention of postoperative pain: a systematic review and meta-analysis with trial sequential analysis

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2020-102427 ◽

2021 ◽

pp. rapm-2020-102427

Author(s):

Hanns-Christian Dinges ◽

Thomas Wiesmann ◽

Berit Otremba ◽

Hinnerk Wulf ◽

Leopold H Eberhart ◽

...

Keyword(s):

Systematic Review ◽

Postoperative Pain ◽

Pain Score ◽

Meta Analysis ◽

End Points ◽

Liposomal Bupivacaine ◽

Bupivacaine Hydrochloride ◽

Pain Scores ◽

Score Difference ◽

The Mean

Background/ImportanceLiposomal bupivacaine (LB) is a prolonged release formulation of conventional bupivacaine designed for prolonging local or peripheral regional single injection anesthesia. To this day, the benefit of the new substance on relevant end points is discussed controversial.ObjectiveThe objective was to determine whether there is a difference in postoperative pain scores and morphine consumption between patients treated with LB and bupivacaine hydrochloride in a systematic review and meta-analysis.Evidence reviewRandomized controlled trials (RCT) were identified in Embase, CENTRAL, MEDLINE and Web of Science up to May 2020. Risk of bias was assessed using Cochrane methodology. Primary end points were the mean pain score difference and the relative morphine equivalent (MEQ) consumption expressed as the ratio of means (ROM) 24 and 72 hours postoperatively.Findings23 RCTs including 1867 patients were eligible for meta-analysis. The mean pain score difference at 24 hours postoperatively was significantly lower in the LB group, at −0.37 (95% CI −0.56 to −0.19). The relative MEQ consumption after 24 hours was also significantly lower in the LB group, at 0.85 (0.82 to 0.89). At 72 hours, the pain score difference was not significant at −0.25 (−0.71 to 0.20) and the MEQ ratio was 0.85 (0.77 to 0.95).ConclusionThe beneficial effect on pain scores and opioid consumption was small but not clinically relevant, despite statistical significance. The effect was stable among all studies, indicating that it is independent of the application modality.

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Incorporation of an intercostal catheter into a multimodal analgesic strategy for uniportal video-assisted thoracoscopic surgery: a feasibility study

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01590-z ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Jian Wei Tan ◽

Jameelah Sheik Mohamed ◽

John Kit Chung Tam

Keyword(s):

Postoperative Pain ◽

Length Of Stay ◽

Urinary Retention ◽

Feasibility Study ◽

Thoracoscopic Surgery ◽

Early Recovery ◽

Rescue Analgesia ◽

Video Assisted ◽

Pain Scores ◽

Video Assisted Thoracoscopic Surgery

Abstract Background Well-controlled postoperative pain is essential for early recovery after uniportal video-assisted thoracoscopic surgery (UVATS). Conventional analgesia like opioids and thoracic epidural anaesthesia have been associated with hypotension and urinary retention. Intercostal catheters are a regional analgesic alternative that can be inserted during UVATS to avoid these adverse effects. This feasibility study aims to evaluate the postoperative pain scores and analgesic requirements with incorporation of an intercostal catheter into a multimodal analgesic strategy for UVATS. Methods In this observational study, 26 consecutive patients who underwent UVATS were administered a multilevel intercostal block and oral paracetamol. All of these patients received 0.2% ropivacaine continuously at 4 ml/h via an intercostal catheter at the level of the incision. Rescue analgesia including etoricoxib, gabapentin and opioids were prescribed using a pain ladder approach. Postoperative pain scores and analgesic usage were assessed. The secondary outcomes were postoperative complications, days to ambulation and length of stay. Results No technical difficulties were encountered during placement of the intercostal catheter. There was only one case of peri-catheter leakage. Mean pain score was 0.31 (range 0–2) on post-operative day 1 and was 0.00 by post-operative day 5. 16 patients (61.6%) required only oral rescue analgesia. The number of patients who required rescue non-opioids only increased from 1 in the first 7 months to 8 in the next 7 months. There were no cases of hypotension or urinary retention. Median time to ambulation was 1 day (range 1–2). Mean post-operative length of stay was 4.17 ± 2.50 days. Conclusions Incorporation of an intercostal catheter into a multimodal analgesia strategy for UVATS is feasible and may provide adequate pain control with decreased opioid usage.

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Analgesic effects of intravenous ketamine after spinal anaesthesia for non-elective caesarean delivery: a randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2020-044168 ◽

2021 ◽

Vol 11 (6) ◽

pp. e044168

Author(s):

Prahlad Adhikari ◽

Asish Subedi ◽

Birendra Prasad Sah ◽

Krishna Pokharel

Keyword(s):

Postoperative Pain ◽

Adverse Effects ◽

Outcome Measures ◽

Caesarean Delivery ◽

Low Dose ◽

Saline Group ◽

Secondary Outcome ◽

Pain Scores ◽

Intravenous Ketamine ◽

Elective Caesarean Delivery

ObjectivesThis study aimed to determine if low dose intravenous ketamine is effective in reducing opioid use and pain after non-elective caesarean delivery.DesignProspective, randomised, double-blind.SettingTertiary hospital, Bisheshwar Prasad Koirala Institute of Health Sciences, Dharan, NepalParticipants80 patients undergoing non-elective caesarean section with spinal anaesthesia.InterventionsPatients were allocated in 1:1 ratio to receive either intravenous ketamine 0.25 mg/kg or normal saline before the skin incision.Primary and secondary outcome measuresThe primary outcome was the total amount of morphine equivalents needed up to postoperative 24 hours. Secondary outcome measures were postoperative pain scores, time to the first perception of pain, maternal adverse effects (nausea, vomiting, hypotension, shivering, diplopia, nystagmus, hallucination) and neonatal Apgar score at 1 and 5 min, neonatal respiratory depression and neonatal intensive-care referral.ResultsThe median (range) cumulative morphine consumption during the first 24 hours of surgery was 0 (0–4.67) mg in ketamine group and 1 (0–6) mg in saline group (p=0.003). The median (range) time to the first perception of pain was 6 (1–12) hours and 2 (0.5–6) hours in ketamine and saline group, respectively (p<0.001). A significant reduction in postoperative pain scores was observed only at 2 hours and 6 hours in the ketamine group compared with placebo group (p<0.05). Maternal adverse effects and neonatal outcomes were comparable between the two groups.ConclusionsIntravenous administration of low dose ketamine before surgical incision significantly reduced the opioid requirement in the first 24 hours in patients undergoing non-elective caesarean delivery.Trial registration numberNCT03450499.

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Predicted Versus Non-Predicted Opioid Administration Using Preoperative Pain Sensitivity in Patients Undergoing Gynecological Surgery: A Randomized-Controlled Trial

Journal of Clinical Medicine ◽

10.3390/jcm10040585 ◽

2021 ◽

Vol 10 (4) ◽

pp. 585

Author(s):

Sun-Kyung Park ◽

Hansol Kim ◽

Seokha Yoo ◽

Won Ho Kim ◽

Young-Jin Lim ◽

...

Keyword(s):

Postoperative Pain ◽

Pain Sensitivity ◽

Control Group ◽

Gynecological Surgery ◽

Control Groups ◽

Preoperative Pain ◽

Pain Scores ◽

Pressure Pain Thresholds ◽

Opioid Administration ◽

And Control

Individualized administration of opioids based on preoperative pain sensitivity may improve postoperative pain profiles. This study aimed to examine whether a predicted administration of opioids could reduce opioid-related adverse effects after gynecological surgery. Patients were randomized to the predicted group or control group. Participants received a preoperative sensory test to measure pressure pain thresholds. Patients were treated with a higher or lower (15 or 10 μg/mL) dose of fentanyl via intravenous patient-controlled analgesia. The opioid dose was determined according to pain sensitivity in the predicted group, while it was determined regardless of pain sensitivity in the control group. The primary outcome was the incidence of nausea over the first 48 h postoperative period. Secondary outcomes included postoperative pain scores and opioid requirements. There was no difference in the incidence of nausea (40.0% vs. 52.5% in predicted and control groups, respectively; p = 0.191) and postoperative pain scores (3.3 vs. 3.5 in predicted and control groups, respectively; p = 0.691). However, opioid consumptions were lower in the predicted group compared to the control group (median 406.0 vs. 526.5 μg; p = 0.042). This study showed that offering a predicted dose of opioids according to pain sensitivity did not affect the incidence of nausea and pain scores.

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Ultrasound-Guided Funicular Block: Ropivacaine Injection into the Tissue around the Spermatic Cord to Improve Analgesia during Orchiectomy in Dogs

Animals ◽

10.3390/ani11051275 ◽

2021 ◽

Vol 11 (5) ◽

pp. 1275

Author(s):

Vincenzo Cicirelli ◽

Pasquale Debidda ◽

Nicola Maggio ◽

Michele Caira ◽

Giovanni M. Lacalandra ◽

...

Keyword(s):

Postoperative Pain ◽

General Anaesthesia ◽

Spermatic Cord ◽

Postoperative Pain Management ◽

Control Group ◽

Ultrasound Guided ◽

Hemodynamic Stability ◽

Pain Scores ◽

Lower Pain ◽

Ropivacaine Hydrochloride

Orchiectomy is a common surgical procedure performed on small animals, and it requires postoperative pain management despite its relative simplicity. This study aimed to evaluate the hemodynamic stability, intraoperative administration of additional hypnotic and/or analgesic drugs, and postoperative pain scores following the combination of ultrasound-guided injection of ropivacaine hydrochloride into the spermatic cord and infiltration by the same anaesthetic of the incisional prescrotal line (ROP) or general anaesthesia. Dogs in the ROP group showed greater intraoperative hemodynamic stability and lower pain scores than the control group. The locoregional approach used in this study proved effective in minimising the responses to the surgical stimulus and ensured adequate analgesia intra- and postoperatively. This method, called ultrasound-guided funicular block, allows orchiectomy to be performed under deep sedation without general anaesthesia.

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The comparison of single-dose preemptive intravenous ibuprofen and paracetamol on postoperative pain scores and opioid consumption after open septorhinoplasty: a randomized controlled study

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-018-5065-6 ◽

2018 ◽

Vol 275 (9) ◽

pp. 2259-2263 ◽

Cited By ~ 5

Author(s):

Erkan Cem Çelik ◽

Duygu Kara ◽

Ersen Koc ◽

Ahmet Murat Yayik

Keyword(s):

Single Dose ◽

Postoperative Pain ◽

Opioid Consumption ◽

Randomized Controlled Study ◽

Controlled Study ◽

Randomized Controlled ◽

Pain Scores ◽

Intravenous Ibuprofen

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Lumbosacral paraspinal interfascial plane blocks for pain control after feminizing genital gender affirmation surgery

Pain Management ◽

10.2217/pmt-2020-0062 ◽

2021 ◽

Author(s):

Sudipta Sen ◽

Johanna B de Haan ◽

Grace Guvernator ◽

Andrzej P Kwater ◽

Xuan T Langridge ◽

...

Keyword(s):

Postoperative Pain ◽

Pain Control ◽

Case Series ◽

Erector Spinae ◽

Anesthetic Techniques ◽

Pain Scores ◽

Gender Affirmation ◽

The Usa ◽

Gender Affirmation Surgery ◽

Regional Anesthetic

Aim: Feminizing genital gender affirmation surgery (fgGAS) is increasing in prevalence in the USA. Management of postoperative pain following fgGAS is challenging. We report a series of patients where post-fgGAS pain was adequately controlled with paraspinal blocks. Materials & methods: This is a case series of three patients who received bilateral lumbar and sacral erector spinae plane blocks after fgGAS. Block techniques, medications administered, opioid requirements and pain scores were reviewed. Results: Erector spinae plane blocks provided adequate analgesia for 24–48 h following the block. Conclusion: Currently, there are two regional anesthetic techniques described for the treatment of postoperative pain after fgGAS. We describe two additional approaches as options for improved pain management in this patient population.

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