Multimodal analgesia as an essential part of enhanced recovery protocols in the ambulatory settings

Kaye, Alan D.; Urman, Richard D.; Rappaport, Yury; Siddaiah, Harish; Cornett, Elyse M.; Belani, Kumar G.; Salinas, Orlando J.; Fox, Charles J.

doi:10.4103/joacp.joacp_51_18

Cited by 82 publications

(49 citation statements)

References 28 publications

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“…These findings suggest that duloxetine might play a role in the multimodal pain management options following LC. Multimodal approaches yield not only improved pain scores but also faster discharge and lower cost ( Kaye et al, 2019 ). So far, this study is the first randomized, placebo-controlled trial that has examined the effect of preoperative duloxetine on postoperative pain in patients undergoing LC.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of preoperative duloxetine use for postoperative analgesia following laparoscopic cholecystectomy: A randomized controlled trial

et al. 2022

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Background: The pain pattern after laparoscopic cholecystectomy (LC) is complex and distinct from postoperative pain after other laparoscopic procedures, suggesting that procedure-specific optimal analgesic management plans should be proposed. Duloxetine, a non-opioid neuromodulator, has been widely used to manage pain with dual central and peripheral analgesic properties.Aims: To assess the effect of preoperative administration of duloxetine compared to placebo on postoperative pain control in patients undergoing LC.Patients and Methods: This study was a randomized, parallel-group, placebo-controlled, double-blinded study performed on patients undergoing LC. Patients were randomly divided into two groups of 30 each on the day of surgery in the preoperative holding area, using a computer-generated random number to receive 60 mg duloxetine as a single oral dose 2 h before the procedure or placebo. The primary outcome was the difference in the mean of visual analogue scale (VAS) scores between the two studied groups, as measured by the area under the curve (AUC) of the VAS scores.Results: The derived AUC of VAS scores in the duloxetine group (757.89 ± 326.01 mm × h) was significantly lower than that calculated for the control group (1005.1 ± 432.5 mm × h). The mean postoperative VAS scores recorded at 4 and 24 h were statistically different between the study groups (p = 0.041 and 0.003, respectively). As observed in the survival curve analysis, there was no significant difference (p = 0.665) for the time until the patient’s first request for rescue medications in the two groups. The frequency of postoperative nausea and vomiting (PONV) was lower in patients of the duloxetine group than that recorded in those allocated to the control group at 8 and 24-h time intervals (p = 0.734 and 0.572, respectively).Conclusion: Preoperative use of duloxetine reduces postoperative pain significantly compared with placebo. In addition, its use is associated with a reduction in PONV. These preliminary findings suggest that duloxetine could play a role in the acute preoperative period for patients undergoing LC.Clinical Trial Registration: [https://clinicaltrials.gov/ct2/show/NCT05115123, identifier NCT05115123],

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Section: Discussionmentioning

confidence: 99%

Evaluation of preoperative duloxetine use for postoperative analgesia following laparoscopic cholecystectomy: A randomized controlled trial

et al. 2022

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“…3 In the intraoperative phase, in addition to minimally invasive procedures and goal directed fluid therapy, patients have an evidence-based and procedure-specific analgesic regimens, which included regional analgesia. 4,5 In the postoperative scenario, the key protocol elements are early feeding, early mobilization and opioid-sparing analgesia.…”

Section: Introductionmentioning

confidence: 99%

The Impact of the Enhanced Recovery After Surgery (ERAS) Protocol on Colorectal Surgery in a Portuguese Tertiary Hospital

et al. 2022

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Introduction: The benefits of the multimodal Enhanced Recovery After Surgery® (ERAS) program have been described all over the world. The adoption of several perioperative strategies translates into an improvement in the quality of the healthcare provided. The aim of this study was to report the results of the implementation of the ERAS® program for colorectal surgery in a tertiary hospital.Material and Methods: In this single-center observational study, 534 patients who underwent colorectal surgery between December 2018 and May 2021 were included. Two groups were considered: before and after the implementation of the ERAS® program. The primary outcome measure was 30-day morbidity. The length of hospital stay, readmission rate, reintervention and mortality among the two groups were also evaluated.Results: The pre-ERAS group included 102 patients and the ERAS group included 432 patients. There was a statistically significant reduction in morbidity at 30 days (37.3% vs 26.5%, p < 0.05), length of stay (7 days vs 5 days, p < 0.001) and readmission rate (12.9% vs 6%, p < 0.05) after the implementation of the ERAS program.Conclusion: The ERAS® protocol for colorectal surgery was successfully and safely implemented in our hospital, contributing to an improvement in perioperative care provided to patients.

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“…Enhanced recovery after surgery care pathways are aimed at improving postsurgical patient recovery through implementation of perioperative multimodal analgesia, which serves as a cornerstone for postoperative pain management. 1 Multimodal analgesia involves the use of 2 or more drugs that act by different pharmacological mechanisms to target multiple neuronal pathways, resulting in additive and/or synergistic pain control. These analgesic regimens may use opioids, acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), gabapentinoids, serotonin norepinephrine reuptake inhibitors, tricyclic antidepressants, and N -methyl- d -aspartate receptor antagonists.…”

Section: Introductionmentioning

confidence: 99%

Liposomal Bupivacaine Versus Immediate-Release Bupivacaine for Postoperative Pain Control

2021

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Background Liposomal bupivacaine (LB) is increasingly being used for postoperative pain control, but there are conflicting efficacy data when compared with immediate-release bupivacaine (IRB). Objective To evaluate the comparative efficacies of LB and IRB for postoperative pain control in order to assess the formulary status of LB at our institution. Methods A single-center, retrospective, institutional review board–approved, noninferiority matched cohort study at a tertiary care academic medical center. Adult surgical patients admitted for >24 hours who received LB or IRB were included. The primary outcome was total opioid consumption within 24 hours postoperatively. Secondary outcomes included total opioid consumption within 72 hours postoperatively, nonopioid analgesic use within 24 and 72 hours postoperatively, time to rescue analgesic use, and postoperative length of stay (LOS). Results A total of 326 patients were included in the matched cohort. Median 24-hour opioid consumption was significantly lower in the IRB group compared with the LB group (81 mg [30, 153] vs 103 mg [46, 241]; P = 0.01). Patients receiving IRB compared with LB also had a decrease in total opioid consumption 72 hours postoperatively (110 mg [45, 258] vs 165 mg [68, 402]; P = 0.005) and shorter postoperative LOS (2.8 days [1.7, 4] vs 3.3 days [2, 5.1]; P < 0.001). There was no difference in time to rescue analgesic use. Conclusion and Relevance Across a variety of surgical procedures, administration of IRB compared with LB was associated with a reduction in total opioid consumption within 24 and 72 hours postoperatively and shorter LOS in adult surgical patients.

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Multimodal analgesia as an essential part of enhanced recovery protocols in the ambulatory settings

Cited by 82 publications

References 28 publications

Evaluation of preoperative duloxetine use for postoperative analgesia following laparoscopic cholecystectomy: A randomized controlled trial

Evaluation of preoperative duloxetine use for postoperative analgesia following laparoscopic cholecystectomy: A randomized controlled trial

The Impact of the Enhanced Recovery After Surgery (ERAS) Protocol on Colorectal Surgery in a Portuguese Tertiary Hospital

Liposomal Bupivacaine Versus Immediate-Release Bupivacaine for Postoperative Pain Control

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