Effect of Multimodal Analgesia on Opioid Use After Open Ventral Hernia Repair

Warren, Jeremy A.; Stoddard, Caroline; Hunter, Ahan L.; Horton, Anthony J.; Atwood, C. A.; Ewing, Joseph A.; S, Pusker; Cancellaro, Vito; Walker, Kevin B.; Cobb, William S.; Carbonell, Alfredo M.; Morgan, Robert R.

doi:10.1007/s11605-017-3529-4

Cited by 48 publications

(30 citation statements)

References 23 publications

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“…All dogs undergoing cystotomies via celiotomy that were treated with either OBA or EPID between January 2015 and December 2017 at our institution were included in this study. Exclusion criteria were (1) an American Society of Anesthesia (ASA) status classification >III (https://www.asahq.org/standards-andguidelines/asa-physical-status-classification-system), (2) postoperative intubation, (3) history of preoperative chronic opioid or nonsteroidal anti-inflammatory drug (NSAID) administration, (4) administration of transversus abdominis plane block, (5) use of an opioid-containing lumbosacral epidural, (6) pregnancy or obesity, (7) administration of more than one procedure, and (8) use of sevoflurane as the volatile anesthetic.…”

Section: Case Selection Criteriamentioning

confidence: 99%

“…Epidural anesthesia, on the other hand, causes fewer negative physiological effects compared with systemic opioids. Epidural anesthesia attenuates surgically induced stress and reduces intraoperative sympathetic activation, incidence of arrhythmias, time to extubation, and duration of intensive care unit stay and thus improves postoperative outcome …”

Section: Introductionmentioning

confidence: 99%

“…Epidural anesthesia attenuates surgically induced stress and reduces intraoperative sympathetic activation, incidence of arrhythmias, time to extubation, and duration of intensive care unit stay and thus improves postoperative outcome. [6][7][8][9][10] Epidural anesthesia is considered a simple, safe, and effective technique. Adverse effects are rare in dogs but include phrenic nerve paralysis secondary to cervical spread of the local anesthetic, hypotension, Horner's syndrome caused by sympathetic blockade, and, infrequently, signs of cardiotoxicity and neurotoxicity in the event of accidental intravascular injection of the local anesthetic.…”

Section: Introductionmentioning

confidence: 99%

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Impact of epidural bupivacaine on perioperative opioid requirements, recovery characteristics, and duration of hospitalization in dogs undergoing cystotomy: A retrospective study of 56 cases

2019

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Objective To compare perioperative opioid consumption and duration of hospitalization (DOH) in anesthetized dogs receiving opioid‐based analgesia (OBA) vs those receiving bupivacaine epidural‐based analgesia (EPID) during cystotomy. Study design Retrospective cross‐sectional study. Animals Fifty‐six client‐owned dogs undergoing cystotomy. Methods Clinical records of dogs undergoing cystotomy between January 2015 and December 2017 were reviewed. Demographic data, duration of anesthesia and surgery, anesthetic management, perioperative opioid consumption expressed in morphine equivalents (ME), perioperative use of adjuvant analgesics, time to first micturition, time to eat, time to ambulate, and DOH were recorded. Opioid consumption and DOH were compared with a Wilcoxon rank‐sum test, followed by linear regression analysis as appropriate. Time to first micturition, time to eat, and time to walk unassisted were modeled with Cox‐proportional hazard models. Results Dogs treated with EPID during surgery required 1.5 mg/kg ME less compared with those treated with OBA (P = .04) during surgery. Three of 19 dogs treated with EPID vs 15 of 37 dogs receiving OBA required intraoperative adjuvant analgesics (P = .06). Dogs treated with EPID regained motor function slower than dogs treated with OBA (P = .01); however, there was no difference in time to urinate, time to eat, or DOH between treatments. Conclusion Perioperative lumbosacral epidural with bupivacaine reduced intraoperative opioid consumption in dogs anesthetized for cystotomy. Clinical significance The use of epidural bupivacaine in dogs undergoing cystotomy may reduce intraoperative opioid requirements without affecting return of bladder function or DOH.

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Section: Case Selection Criteriamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of epidural bupivacaine on perioperative opioid requirements, recovery characteristics, and duration of hospitalization in dogs undergoing cystotomy: A retrospective study of 56 cases

2019

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“…Postoperatif opioid koruyucu etki sağlaması ve ağrının azaltılması amacıyla tek başına veya kombinasyon halinde birkaç ajanın kullanımı gündemdedir. Yeni ERAS protokolunun bir parçası olan ağrı tedavisinde, hastalarda IV opioid ilaçların kullanımı sınırlanır ve ağrı yönetiminde çok yönlü bir analjezi (multimodal) planlanır[46][47][48][49] . Multimodal analjezi kavramı, farmakolojik ve klinik sinerjizm oluşturan ve bireysel yan etkileri en aza indiren ilacın veya müdahalenin faydalı etkilerini en üst düzeye çıkarmak için preoperatif, intraoperatif ve postoperatif dönemlerde farklı etki mekanizmalarına sahip çeşitli tedavilerin kullanımını gerektirir50 .…”

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Nörocerrahi ve Eras (Enhanced Recovery After Surgery)

Biricik

Güneş

2020

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ERAS protocols provide improved patient outcomes, reduced complication rates, shorter hospital stays, and significant cost-savings. ERAS protocols were first studied in major abdominal surgeries; nowadays, this protocols also applied to patients undergoing neurosurgery. This is a protocol, which covered preoperative evaluation of the patients, concerning perioperative management and postoperative period. Both surgical preparation, patient information and anesthesia management are part of ERAS protocol. Optimization of elective spinal or cranial surgery patients and use of the ERAS protocols will help to minimize post-operative morbidity and mortality. This review discusses the role of ERAS protocols in both spinal surgery and craniotomy operations.

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“…We are now seeing wider applications of nonopioid-based analgesia in other subspecialties such as trauma [7] , [8] , [9] , spine [10] , [11] , [12] , and upper extremity [13] . We are also seeing an increased number of publications in journals outside of orthopaedic surgery [14] , [15] , [16] . Ironically, most of the pharmacologics used in multimodal analgesia (eg, acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and local anesthetics) have been available for decades, but now there is an increased awareness of the detrimental side effects associated with opioids.…”

mentioning

confidence: 99%