Postoperative Pain Management

Nett, Michael P.

doi:10.3928/01477447-20100722-60

Cited by 28 publications

(11 citation statements)

References 31 publications

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“…With no well-defined dosing schemes, PCA often leads to inconsistent pain relief and requires frequent adjustments to optimize relief or minimize the opioid-associated side effects. 6,21 Even when the PCA demand dose is optimized, patients often wake up in pain, having not pushed the button while asleep. Programming and medication errors have also been widely reported.…”

Section: Patient-controlled Analgesiamentioning

confidence: 99%

Multimodal Analgesia for Total Joint Arthroplasty

Halawi¹,

Grant²,

Bolognesi³

2015

Orthopedics

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Optimal perioperative pain control for total joint arthroplasty remains a challenge. Whereas traditional regimens have relied heavily on opioids, newer multimodal pathways are increasingly gaining popularity as safer and more effective alternatives. The main premise of multimodal analgesia is decreased consumption of opioids, and hence lesser opioid-related adverse events. Other reported advantages include lower pain scores, faster functional recovery, higher patient satisfaction, and shorter length of hospital stay. Unfortunately, despite the advent of numerous analgesic techniques, the multimodal approach has remained widely variable, making direct comparison between studies difficult to interpret. This article provides an extensive review of traditional and modern perioperative interventions in pain management for total joint arthroplasty, including intravenous patient-controlled analgesia, epidural infusion, oral opioids, nonsteroidal anti-inflammatory drugs, acetaminophen, peripheral nerve blocks, periarticular infiltration, steroids, anticonvulsants, and long-acting local anesthetics. Emphasis is placed on pathophysiology, clinical evidence, and timing. A standardized multimodal analgesia protocol is also proposed based on best available evidence. In addition to pharmacologic interventions, patient education and interdisciplinary collaboration among the care teams play an important role in the success of any treatment pathway. With a growing demand for total joint arthroplasty in an era of bundled payments and accountable care, there has never been a greater need for a standardized multimodal analgesia pathway.

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Section: Patient-controlled Analgesiamentioning

confidence: 99%

Multimodal Analgesia for Total Joint Arthroplasty

Halawi¹,

Grant²,

Bolognesi³

2015

Orthopedics

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“…Pain is one of the major factors limiting early mobilization after hip surgery, resulting increased risks of thromboembolism and infection, or delayed postoperative rehabilitation, especially for the elderly patient [9,10]. Appropriate pain management is crucial, and there are several choices of techniques for postoperative analgesia including epidural block, peripheral nerve block, transdermal administration, and intravenous analgesics infusion.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Oxycodone and Sufentanil for intravenous patient-controlled analgesia after hip surgery: a prospective, randomized controlled trial

Zhu

Liao

2019

Preprint

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Background Intravenous patient-controlled analgesia (PCA) after hip surgery should be focused on the balance of sufficient analgesia and the risk of associated adverse reactions. Sufentanil has high analgesic efficacy as a common used drug for PCA while with obvious side effects. Oxycodone is a semi-synthetic opioid which has been reported to have good analgesic effect and lower incidence of adverse reactions related to long-acting opioid. We hypothesize that in hip surgery, compared with sufentanil PCA, the equipotency dose of oxycodone PCA could achieve the same postoperative analgesic efficacy and may also reduce the incidence of adverse reactions associated with long-acting opioids. Methods/Design This trial is a prospective, randomized, controlled clinical trial comparing the safety and efficacy of oxycodone and sufentanil for postoperative patient-controlled analgesia in patients undergoing hip surgery. A total of 570 subjects undergoing hip surgery will be randomly allocated to either sufentanil PCA group or oxycodone PCA group. The primary outcome is the resting numerical rating scales (NRS) pain scores at 30 min, 2 h, 6 h, 24 h, 48 h, and 72h after surgery. The secondary outcomes include postoperative NRS pain scores on movement, in-hospital complications, range of motion of hip joints, mobilization time, length of hospital stay, total in-hospital cost, and readmission rate by 30 days after discharge from the hospital. Discussion This trial is designed to compare the safety and efficacy of oxycodone and sufentanil PCA in patients undergoing hip surgery, in order to find an optimal postoperative analgesic regime with fewer adverse reactions and promoting patients’ rehabilitation. The results will provide evidence for anesthetic choice in clinical practice.

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“…ere are continuing advancements in multimodal analgesia techniques to prevent and control pain after surgical interventions [1][2][3][4][5][6]. ough solutions are available, patients undergoing surgery still suffer from postoperative pain of varying degrees in low-and high-income countries across the globe [6][7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Pain Management and Its Possible Implementation Research in North Ethiopia: A before and after Study

Tequare

Huntzicker

Mhretu

et al. 2020

Advances in Medicine

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Background. Though there is an effective intervention, pain after surgical intervention is undermanaged worldwide. A systematic implementation is required to increase the utilization of available evidence-based intervention to manage the inevitable pain after surgery. The aim of this research project is to develop a scalable model for managing pain after cesarean section by implementing the World Health Organization’s (WHO) pain management guidelines through a combination of implementation research and quality improvement methods. Methods. We implemented the World Health Organization (WHO) pain management guidelines using effective implementation strategies. First, we conducted a formative qualitative exploration to identify enablers and obstacles. In addition, we took base-line assessment on pain management implementation process and outcome using a checklist prepared from the guideline and an adapted American Pain Outcome assessment tool version 2010, respectively. Then, we integrated the guidelines into the existing practice by using collaborative iterative learning strategy. We analyzed the data by Statistical Packages for Social Sciences (SPSS) version 21. We compared the before and after data using chi-squared and Fischer’s exact test. A change in any measurement was considered as significant at p value 0.05. Result. We collected data from 106 mothers before and 110 mothers after intervention implementation. We successfully integrated pain as a fifth vital sign in more than 87% (p value <0.001) of patient, and fidelity was approximately 59% (p value <0.001). In addition, we significantly improved pain outcome measures after the implementation of the intervention. Conclusion and Recommendations. A systematic approach to implement pain management guidelines was successful. We recommend the ward sustain these gains and that hospital, the region, and the nation to replicate the success.

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Postoperative Pain Management

Cited by 28 publications

References 31 publications

Multimodal Analgesia for Total Joint Arthroplasty

Multimodal Analgesia for Total Joint Arthroplasty

Comparison of Oxycodone and Sufentanil for intravenous patient-controlled analgesia after hip surgery: a prospective, randomized controlled trial

Pain Management and Its Possible Implementation Research in North Ethiopia: A before and after Study

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