Postoperative Pain Control

Lovich-Sapola, Jessica A.; Smith, Charles E.; Brandt, Christopher P.

doi:10.1016/j.suc.2014.10.002

Cited by 231 publications

(218 citation statements)

References 25 publications

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“…Finally, there is the pain that occurs entirely independently of the neoplastic disease process and/or its treatment 3 . Acute pain is considered to be an immediate sensorial consequence of nociceptive system activation, an alarm signal triggered by the body's protecting systems.…”

Section: Acute Painmentioning

confidence: 99%

“…With recent advances in anesthetic and surgical techniques, this degree of surgical stimulation has decreased. Anesthetic depth, multimodal approaches, and surgical invasion reduction have been shown to result in postoperative pain decrease 3 .…”

Section: Transoperative Managementmentioning

confidence: 99%

“…The use of intravenous lidocaine in up to 100 mg boluses and subsequent continuous administration at 2-3 mg/hour has been shown to have analgesic effects and anti-inflammatory properties, as well as to reduce opioid requirements 3 . Beta-blockers have been used to minimize sympathetic responses both at the moment of endotracheal intubation and induced by the surgical stimulus, which decreases inhaled analgesics and opioid requirements 3 .…”

Section: Intravenous Drugsmentioning

confidence: 99%

“…Beta-blockers have been used to minimize sympathetic responses both at the moment of endotracheal intubation and induced by the surgical stimulus, which decreases inhaled analgesics and opioid requirements 3 . Alpha-2 agonists such as clonidine and dexmedetomidine have analgesic properties and have been shown to reduce postoperative pain and opioid consumption, with this effect being superior with dexmedetomidine; however, it cannot be used in all patients, especially in those with heart blocks or ventricular dysfunction, owing to the cardiovascular changes it produces 3 .…”

Section: Intravenous Drugsmentioning

confidence: 99%

“…The initial dose is that which is required to reduce pain to 4/10 in the numeric rating scale (NRS), or to a respiratory rate of 12 breaths/minute or less, after which, the PCA pump is programmed establishing the bolus doses, maximum number of boluses in one hour and the closure interval, which limits how close consecutive doses can be. PCA is usually used with morphine or hydromorphone; fentanyl is not recommended unless the patient is under continuous monitoring as, for example, in the ICU 3 . There are different routes of administration, including transdermal, epidural, in peripheral nerves, and the most widely studied is the intravenous route.…”

Section: Postoperative Managementmentioning

confidence: 99%

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Perioperative Pain Management in Gynecologic Oncology Surgery

Garza¹,

Pérez-González²

2022

GAMO

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Postoperative pain is a normal reaction to surgical intervention; however, it has been shown to increase morbidity, thus compromising the quality of recovery, which entails a delay in hospital discharge, increased risk of wound infection, and respiratory or cardiovascular complications, with an increase in mortality. Pain syndromes observed in patients with gynecologic oncology pathology result from three primary etiologies: those directly occurring due to the tumor, those deriving from treatments focused on reducing the tumor and those syndromes that are entirely independent of cancer or its treatment. Postoperative pain optimal management requires understanding the pathophysiology of pain and knowing the methods to be able to assess it in each patient, as well as knowledge on the different options available to control it. The key points that have to be considered are: the type of patient, type of surgical procedure, skills of the surgeon and anesthesiologist, and support of the working team. Improving the treatment of postoperative pain requires a broader perspective, since most healthcare providers have been shown to focus only on the postoperative period; however, ideal management is that where interventions are carried out before, during, and after surgery. (creativecommons.org/licenses/by-nc-nd/4.0/).Pain management in gynecologic oncology surgery 125

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Section: Acute Painmentioning

confidence: 99%

Section: Transoperative Managementmentioning

confidence: 99%

Section: Intravenous Drugsmentioning

confidence: 99%

Section: Intravenous Drugsmentioning

confidence: 99%

Section: Postoperative Managementmentioning

confidence: 99%

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Perioperative Pain Management in Gynecologic Oncology Surgery

Garza¹,

Pérez-González²

2022

GAMO

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A Phase 3, Randomized, Placebo‐Controlled Evaluation of the Safety of Intravenous Meloxicam Following Major Surgery

Bergese

Melson

Candiotti

et al. 2019

Clinical Pharm in Drug Dev

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An intravenous (IV) formulation of meloxicam is being studied for moderate to severe pain management. This phase 3, randomized, multicenter, double‐blind, placebo‐controlled trial evaluated the safety of once‐daily meloxicam IV 30 mg in subjects following major elective surgery. Eligible subjects were randomized (3:1) to receive meloxicam IV 30 mg or placebo administered once daily. Safety was evaluated via adverse events, clinical laboratory tests, vital signs, wound healing, and opioid consumption. The incidence of adverse events was similar between meloxicam IV– and placebo‐treated subjects (63.0% versus 65.0%). Investigators assessed most adverse events as mild or moderate in intensity and unrelated to treatment. Adverse events of interest (injection‐site reactions, bleeding, cardiovascular, hepatic, renal, thrombotic, and wound‐healing events) were similar between groups. Over the treatment period, meloxicam IV was associated with a 23.6% (P = .0531) reduction in total opioid use (9.2 mg morphine equivalent) compared to placebo‐treated subjects. The results suggest that meloxicam IV had a safety profile similar to that of placebo with respect to numbers and frequencies of adverse events and reduced opioid consumption in subjects with moderate to severe postoperative pain following major elective surgery.

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The 14‐day repeated‐dose toxicity study of a fixed‐dose combination, QXOH/levobupivacaine, via subcutaneous injection in beagle dogs

Zhang

Yin

et al. 2020

J of Applied Toxicology

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QXOH‐Levobupivacaine (LB) is a fixed‐dose combination of 35‐mM QXOH and 10‐mM LB. It was developed for perioperative analgesia because of its long‐acting analgesic effect. The purpose of this study was to evaluate the potential toxicity of QXOH‐LB in beagle dogs in accordance with the Guidance on the repeated‐dose toxicity published by the China Food and Drug Administration. Groups of five male and five female beagle dogs received normal saline, QXOH‐LB (2, 4, and 8 mg/kg, calculated as QXOH), QXOH (2, 4, and 8 mg/kg), or LB (2 mg/kg, equals the concentration of LB in 8‐mg/kg QXOH‐LB group) at the volume of 1 mL/kg once per day for 14 days through subcutaneous injection. No mortality was observed. Dogs in the control group as well as animals treated with 2‐mg/kg QXOH or QXOH‐LB exhibited normal behaviors. Clinical signs of toxicity in dogs treated with 4 and 8 mg/kg of QXOH or QXOH‐LB included decreased activity, unsteady gait, jerks, tremors, vocalization, emesis, ataxia, lateral/sternal recumbency, deep/rapid respiration, and gasping. Additionally, neurological function was found to be affected by QXOH and QXOH‐LB at the doses of 4 and 8 mg/kg. All clinical signs were recovered within 24 h. The no‐observed‐adverse‐effect level of QXOH and QXOH‐LB was considered to be 2 mg/kg. Toxicokinetic data showed that exposure to QXOH and LB increased as QXOH‐LB doses were increased from 4 to 8 mg/kg. There was no evidence of drug accumulation or any effect of gender.

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Postoperative Pain Control

Cited by 231 publications

References 25 publications

Perioperative Pain Management in Gynecologic Oncology Surgery

Perioperative Pain Management in Gynecologic Oncology Surgery

A Phase 3, Randomized, Placebo‐Controlled Evaluation of the Safety of Intravenous Meloxicam Following Major Surgery

The 14‐day repeated‐dose toxicity study of a fixed‐dose combination, QXOH/levobupivacaine, via subcutaneous injection in beagle dogs

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