Patientenkontrollierte Analgesie: Methoden, Handhabung und Ausbaufähigkeit

Abrolat, Marie; Eberhart, Leopold; Kalmus, G.; Koch, T.; Nardi-Hiebl, Stefan

doi:10.1055/s-0043-104665

Cited by 12 publications

(5 citation statements)

References 34 publications

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“…Because opioids are likely to be administered more than necessary due to basal infusion of IV-PCA, they can occasionally cause serious adverse events. 18 Effective regional analgesia is important to discontinue IV-PCA, so we adopted regional procedures such as preincisional infiltration, intraoperative intercostal nerve block, and surgeon-guided continuous serratus anterior plane block. In previous studies, preemptive local anesthesia was related to a significant reduction in postoperative wound pain after VATS, 15 and single-injection intercostal nerve block was associated with a reduction in postoperative pain and clinically noninferior to thoracic epidural analgesia or paravertebral block.…”

Section: Discussionmentioning

confidence: 99%

Enhanced Recovery After Surgery Program and Opioid Consumption in Pulmonary Resection Surgery: A Retrospective Observational Study

Son¹,

Jeong

Yun³

et al. 2023

Anesthesia &Amp; Analgesia

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BACKGROUND: Pulmonary resection surgery causes severe postoperative pain and usually requires opioid-based analgesia, particularly in the early postoperative period. However, the administration of large amounts of opioids is associated with various adverse events. We hypothesized that patients who underwent pulmonary resection under an enhanced recovery after surgery (ERAS) program consumed fewer opioids than patients who received conventional treatment. METHODS: A total of 2147 patients underwent pulmonary resection surgery between August 2019 and December 2020. Two surgeons (25%) at our institution implemented the ERAS program for their patients. After screening, the patients were divided into the ERAS and conventional groups based on the treatment they received. The 2 groups were then compared after the stabilized inverse probability of treatment weighting. The primary end point was the total amount of opioid consumption from surgery to discharge. The secondary end points included daily average and highest pain intensity scores during exertion, opioid-related adverse events, and clinical outcomes, such as length of intensive care unit (ICU) stay, hospital stay, and postoperative complication grade defined by the Clavien-Dindo classification. Additionally, the number of patients discharged without opioids prescription was assessed. RESULTS: Finally, 2120 patients were included in the analysis. The total amount of opioid consumption (median [interquartile range]) after surgery until discharge was lower in the ERAS group (n = 260) than that in the conventional group (n = 1860; morphine milligram equivalents, 44 [16–122] mg vs 208 [146–294] mg; median difference, −143 mg; 95% CI, −154 to −132; P < .001). The number of patients discharged without opioids prescription was higher in the ERAS group (156/260 [60%] vs 329/1860 [18%]; odds ratio, 7.0; 95% CI, 5.3–9.3; P < .001). On operation day, both average pain intensity score during exertion (3.0 ± 1.7 vs 3.5 ± 1.8; mean difference, −0.5; 95% CI, −0.8 to −0.3; P < .001) and the highest pain intensity score during exertion (5.5 ± 2.1 vs 6.4 ± 1.7; mean difference, −0.8; 95% CI, −1.0 to −0.5; P < .001) were lower in the ERAS group than in the conventional group. There were no significant differences in the length of ICU stay, hospital stay, or Clavien-Dindo classification grade. CONCLUSIONS: Patients who underwent pulmonary resection under the ERAS program consumed fewer opioids than those who received conventional management while maintaining no significant differences in clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Enhanced Recovery After Surgery Program and Opioid Consumption in Pulmonary Resection Surgery: A Retrospective Observational Study

Son¹,

Jeong

Yun³

et al. 2023

Anesthesia &Amp; Analgesia

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“…PCA is one of the accepted methods for the management of postoperative pain. A cochrane review concluded that PCA was associated with better postoperative pain scores and increased patient satisfaction compared with traditional modes of analgesic drug administration (Abrolat et al, 2018). Intravenous PCA has been widely used for postoperative analgesia over the past few decades (Hadi et al, 2006;Kim et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety evaluation of dexmedetomidine for postoperative patient controlled intravenous analgesia: A systematic review and meta-analysis

Chen

Sun

et al. 2022

Front. Pharmacol.

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Objective: To investigate the efficacy and safety of dexmedetomidine (DEX) for postoperative patient controlled intravenous analgesia (PCIA).Measurements: Two investigators independently searched Pubmed, Embase, Scopus, Cochrane Library and CBM for randomized controlled trials of DEX for PCIA.Main results: Thirty-seven studies with a total of 5,409 patients were included in this meta-analysis. Compared with analgesics alone, DEX for PCIA reduced pain score at 24 h [mean difference (MD) = −0.70; 95% confidence interval (CI): −0.85, −0.54; p < 0.00001, I2 = 90%] and 48 h postoperatively (MD = −0.43; 95% CI: −0.52, −0.34; p < 0.00001, I2 = 96%). Moreover, DEX reduced analgesics consumption during the first 24 h [standardized mean difference (SMD) = −0.25; 95% CI: −0.34, −0.16; p < 0.00001, I2 = 91%] and the number of resuscitation analgesics administered [odds ratio (OR) = 0.54; 95% CI: 0.44, 0.66; p < 0.00001, I2 = 72%]. Furthermore, DEX improved patient satisfaction (OR = 3.55; 95% CI: 2.36, 5.35; p < 0.00001, I2 = 60%), and reduced incidence of side effects, such as postoperative nausea and vomiting (PONV) (OR = 0.47; 95% CI: 0.39, 0.57; p < 0.00001, I2 = 59%) and pruritus after surgery (OR = 0.45; 95% CI: 0.30, 0.68; p = 0.0001, I2 = 0%). Besides, DEX attenuates inflammatory cytokine levels, such as IL-6 (MD = −5.73; 95% CI: −8.34, −3.12; p < 0.00001, I2 = 91%) and TNF-α (MD = −0.63; 95% CI: −0.76, −0.50; p < 0.00001, I2 = 89%). Finally, DEX increased the risk of bradycardia (OR = 1.66; 95% CI: 1.12, 2.45; p = 0.01, I2 = 15%), but the complication of hypotension did not differ between the two groups (OR = 1.30; 95% CI: 0.84, 2.04; p = 0.25, I2 = 0%).Conclusion: DEX is used for postoperative PCIA analgesia, which can significantly improve the analgesic effect, effectively control postoperative inflammatory response, reduce the dosage and adverse reactions of analgesics, and improve postoperative patient satisfaction. Of course, the impact of the immunosuppressive effect of DEX on the prognosis of patients needs further study.Systematic review registration: CRD42022340933, https://www.crd.york.ac.uk/prospero/.

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“…[61] Postoperative pain is usually controlled by patient-controlled analgesia. [62] The use of noninvasive transdermal analgesics (such as lidocaine, fentanyl, and morphine) overcomes the problems associated with patient-controlled analgesia. For example, iontophoresis can drive fentanyl molecules through the skin into the systemic circulation.…”

Section: Iontophoresismentioning

confidence: 99%

How physical techniques improve the transdermal permeation of therapeutics: A review

Gao

et al. 2022

Medicine

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Background: Transdermal delivery is very important in pharmaceutics. However, the barrier function of the stratum corneum hinders drugs absorption. How to improve transdermal delivery efficiency is a hot topic. The key advantages of physical technologies are their wide application for the delivery of previously nonappropriate transdermal drugs, such as proteins, peptides, and hydrophilic drugs. Based on the improved permeation of drugs delivered via multiple physical techniques, many more diseases may be treated, and transdermal vaccinations become possible. However, their wider application depends on the related convenient and portable devices. Combined products comprising medicine and devices represent future commercial directions of artificial intelligence and 3D printing. Methods: A comprehensive search about transdermal delivery assisted by physical techniques has been carried out on Web of Science, EMBASE database, PubMed, Wanfang Database, China National Knowledge Infrastructure, and Cochrane Library. The search identified and retrieved the study describing multiple physical technologies to promote transdermal penetration. Results: Physical technologies, including microneedles, lasers, iontophoresis, sonophoresis, electroporation, magnetophoresis, and microwaves, are summarized and compared. The characteristics, mechanism, advantages and disadvantages of physical techniques are clarified. The individual or combined applicable examples of physical techniques to improve transdermal delivery are summarized. Conclusion: This review will provide more useful guidance for efficient transdermal delivery. More therapeutic agents by transdermal routes become possible with the assistance of various physical techniques.

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Patientenkontrollierte Analgesie: Methoden, Handhabung und Ausbaufähigkeit

Cited by 12 publications

References 34 publications

Enhanced Recovery After Surgery Program and Opioid Consumption in Pulmonary Resection Surgery: A Retrospective Observational Study

Enhanced Recovery After Surgery Program and Opioid Consumption in Pulmonary Resection Surgery: A Retrospective Observational Study

Efficacy and safety evaluation of dexmedetomidine for postoperative patient controlled intravenous analgesia: A systematic review and meta-analysis

How physical techniques improve the transdermal permeation of therapeutics: A review

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