A Comprehensive Review of Postoperative Analgesics Used in Orthopedic Practice

Goel, Sachin; Deshpande, Sanjay V; Jadawala, Vivek H; Suneja, Anmol; Singh, Rahul

doi:10.7759/cureus.48750

Cited by 3 publications

References 56 publications

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Assessing Post-Operative Pain in Total Knee Arthroplasty Patients Using an Automated Self-Logging Patient Reported Outcome Measure Collection Device: A Retrospective Cohort Study (Preprint)

Ajrawat,

Price,

Gooch

et al. 2024

Preprint

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BACKGROUND Patient-reported outcome measures (PROMs) are standardized tools for assessing symptoms and the quality of care. Despite their growing use, conventional data collection methods limit widespread PROM implementation. In orthopaedics, pain is a frequent patient complaint and a common PROM, especially following total knee arthroplasty (TKA). Although TKA is generally successful, some patients still report post-operative pain, potentially due to tourniquet use. Using an improved PROM data-gathering technique may help to address tourniquet use during a TKA procedure and its impact on post-operative pain. The PainPad, an automated self-logging device, was developed to capture patient pain levels accurately. OBJECTIVE To assess the feasibility and effectiveness of the PainPad device in quantifying in-hospital post-operative pain following TKA with or without tourniquet use. METHODS A retrospective study with 234 patients who underwent TKA from 2018 to 2021 at Milton Keynes University Hospital was conducted. Patients were categorized as receiving TKA with an intra-operative tourniquet (tourniquet group) or TKA without a tourniquet (non-tourniquet group). Twenty-four-hour post-operative pain was collected bi-hourly and was self-reported using the PainPad device. From both groups, data on hospital length of stay (LOS), total tourniquet time, and the presence of post-operative deep vein thrombosis were also collected. RESULTS There were 115 TKAs with tourniquets (63% females, mean age 69.2 years) and 119 TKAs without tourniquets (76% females, mean age: 71 years). When assessing 24-hour mean post-operative pain scores, the PainPad device data indicated no significant difference (P = .53, 95% CI: -0.76 to 0.39) between the tourniquet (mean pain score: 3.31 ± 2.34) and non-tourniquet groups (mean pain score: 3.12 ± 2.15). There was no correlation between tourniquet times and the pain scores retrieved from the PainPad device. A subgroup analysis comparing longer (>90 minutes) vs. shorter (<90 min) tourniquet times showed no significant difference in terms of pain and LOS. CONCLUSIONS The PainPad device is a feasible and effective method for collecting and evaluating in-hospital postoperative pain following total knee arthroplasty (TKA), allowing for the quantification of individual pain levels. This study aligns with the current healthcare trend towards leveraging innovative technologies and personalized data to enhance patient-centered care. CLINICALTRIAL N/A

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Assessing Post-Operative Pain in Total Knee Arthroplasty Patients Using an Automated Self-Logging Patient Reported Outcome Measure Collection Device: A Retrospective Cohort Study (Preprint)

Ajrawat,

Price,

Gooch

et al. 2024

Preprint

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Optimizing Pain Management in Emergency Departments: A Comprehensive Review of Current Analgesic Practices

Nagpal,

Gadkari,

Singh

et al. 2024

Cureus

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Effective pain management in Emergency Departments (EDs) is vital for improving patient comfort and clinical outcomes. This review provides a comprehensive analysis of current pain management practices in ED settings, focusing on the challenges and opportunities for optimization. The review examines pharmacologic and non-pharmacologic pain management strategies, evaluating their effectiveness and identifying inconsistencies and gaps in current practices. Key challenges in the ED environment include time constraints, variability in clinical protocols, and the need to address diverse patient needs, including those of paediatric, geriatric, and chronic pain patients. The review highlights the importance of standardized pain assessment tools and protocols to improve consistency in pain management. Innovations, such as technological advances and multimodal approaches, are explored for their potential to enhance pain management practices. Recommendations address identified challenges, including improved training for ED staff, the development of evidence-based protocols, and the integration of multimodal pain management strategies. By addressing these areas, the review aims to contribute to the development of more effective and uniform pain management practices in emergency care, ultimately leading to better patient outcomes and experiences. This review emphasizes the need for ongoing research and adaptation of best practices to meet the evolving needs of patients in emergency settings.

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Effect of Dexamethasone on Postoperative Analgesia Following the Transversus Abdominis Plane Block in Gynecological Laparotomies

Küçüksaraç,

Arslan,

Sahin

2024

Cureus

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Purpose: Postoperative pain is an acute pain that begins with surgical trauma and decreases as the tissue heals. The transversus abdominis plane (TAP) block is one of the abdominal field blocks used in the treatment of acute postoperative pain after lower abdominal surgery. This study aims to investigate the effects of dexamethasone added to a local anesthetic solution on postoperative analgesia in ultrasonography-guided TAP block.Materials and methods: Our study included female patients aged 18-80 with American Society of Anesthesiology (ASA) I-II status who had undergone gynecological laparotomy (total abdominal hysterectomy (TAH), total abdominal hysterectomy + bilateral salpingoophorectomy (TAH+BSO), myomectomy). The patients were examined in two groups, each consisting of 30 people. Patients in whom dexamethasone was added to the analgesic solution while applying the TAP block were classified as Group D and patients without dexamethasone were classified as Group B. The patients' Visual Analog Scale (VAS) scores at the 2nd, 4th, 8th, 12th, and 24th hours postoperatively; their painkiller needs in the first 24 hours postoperatively; their first mobilization time; and their total analgesic requirements in the first 24 hours postoperatively were examined.Results: When postoperative 2, 4, 8, and 12 hours VAS scores were compared, no significant difference was found between the groups (p>0.05). Postoperative 24th-hour VAS scores were significantly lower in Group D (p<0.001). No statistically significant difference was found when additional analgesic demands were compared between the groups at 2, 4, 8, and 12 hours postoperatively (p>0.05). Additional analgesic demand at the 24th postoperative hour was significantly lower in Group D (p=0.020). When the 24-hour additional IV analgesic demands of the patients were compared, the additional analgesic demand in Group B was found to be significantly higher than in Group D (p=0.038). When postoperative mobilization hours were compared between the groups, no statistically significant difference was found between the two groups (p=0.617). When the patient's first analgesic request times were compared, no significant difference was found between the groups (p=0.617).Conclusion: It was determined that dexamethasone added to bupivacaine in USG-guided TAP block reduced the amount of additional analgesic consumed in the first 24 hours postoperatively and reduced VAS scores. We think that adding dexamethasone to local anesthetics in the TAP block will benefit multimodal analgesia.

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A Comprehensive Review of Postoperative Analgesics Used in Orthopedic Practice

Cited by 3 publications

References 56 publications

Assessing Post-Operative Pain in Total Knee Arthroplasty Patients Using an Automated Self-Logging Patient Reported Outcome Measure Collection Device: A Retrospective Cohort Study (Preprint)

Assessing Post-Operative Pain in Total Knee Arthroplasty Patients Using an Automated Self-Logging Patient Reported Outcome Measure Collection Device: A Retrospective Cohort Study (Preprint)

Optimizing Pain Management in Emergency Departments: A Comprehensive Review of Current Analgesic Practices

Effect of Dexamethasone on Postoperative Analgesia Following the Transversus Abdominis Plane Block in Gynecological Laparotomies

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