‘Scheduled’ dosing of lornoxicam provides analgesia superior to that provided by ‘on request’ dosing following craniotomy

Dolmatova, Elena; Imaev, A.; Lubnin, А. Yu.

doi:10.1097/eja.0b013e328329b0c6

Cited by 20 publications

(12 citation statements)

References 20 publications

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“…[ 92 ] Studies provide inconclusive evidence for the safety of drugs such as ketorolac,[ 76 ] demonstrating a higher risk for intracranial hematoma associated with intraoperative use but not in the postoperative setting. [ 59 ] Further, trial studies do not show an increase in complication rates for hematomas, renal failure, or peptic ulcers[ 28 ] following neurosurgery. Though their use remains controversial, emerging studies are now focusing on selective COX-2 inhibitors that appear to be safer with regard to coagulation effects.…”

Section: Introductionmentioning

confidence: 99%

Designing a pain management protocol for craniotomy: A narrative review and consideration of promising practices

Vacas¹,

Wiele²

2017

Surg Neurol Int

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Background:Craniotomy is a relatively common surgical procedure with a high incidence of postoperative pain. Development of standardized pain management and enhanced recovery after surgery (ERAS) protocols are necessary and crucial to optimize outcomes and patient satisfaction and reduce health care costs.Methods:This work is based upon a literature search of published manuscripts (between 1996 and 2017) from Pubmed, Cochrane Central Register, and Google Scholar. It seeks to both synthesize and review our current scientific understanding of postcraniotomy pain and its part in neurosurgical ERAS protocols.Results:Strategies to ameliorate craniotomy pain demand interventions during all phases of patient care: preoperative, intraoperative, and postoperative interventions. Pain management should begin in the perioperative period with risk assessment, patient education, and premedication. In the intraoperative period, modifications in anesthesia technique, choice of opioids, acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), regional techniques, dexmedetomidine, ketamine, lidocaine, corticosteroids, and interdisciplinary communication are all strategies to consider and possibly deploy. Opioids remain the mainstay for pain relief, but patient-controlled analgesia, NSAIDs, standardization of pain management, bio/behavioral interventions, modification of head dressings as well as patient-centric management are useful opportunities that potentially improve patient care.Conclusions:Future research on mechanisms, predictors, treatments, and pain management pathways will help define the combinations of interventions that optimize pain outcomes.

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Section: Introductionmentioning

confidence: 99%

Designing a pain management protocol for craniotomy: A narrative review and consideration of promising practices

Vacas¹,

Wiele²

2017

Surg Neurol Int

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“…A structured review on time-scheduled opioid dosing for post-operative pain management [12] concluded that there is “sparse empirical work warranting endorsement of this dosing regimen.” Subsequently, several trials of time-scheduled opioid dosing reported benefits relative to pain-contingent dosing in postoperative pain management [6,7,11,19]. Whether findings for time-scheduled opioid dosing in post-operative pain management translate to COT in ambulatory care settings has not been examined.…”

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confidence: 99%

Time-scheduled vs. pain-contingent opioid dosing in chronic opioid therapy

Korff

Merrill

Rutter

et al. 2011

Pain

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Some expert guidelines recommend time-scheduled opioid dosing over pain-contingent dosing for patients receiving chronic opioid therapy (COT). The premise is that time-scheduled dosing results in more stable opioid blood levels and better pain relief, fewer side effects, less reinforcement of pain behaviors, and lower addiction risk. We report results of a survey of 1781 patients receiving COT for chronic non-cancer pain, in which 967 reported time-scheduled opioid dosing only and 325 reported pain-contingent opioid dosing only. Opioid-related problems and concerns were assessed with the Prescribed Opioids Difficulties Scale. We hypothesized that respondents using time-scheduled opioid dosing would report significantly fewer problems and concerns than those using pain-contingent dosing. Patients receiving time-scheduled dosing received substantially higher average daily opioid doses than those using pain-contingent dosing (97.2 vs. 37.2 milligrams average daily dose morphine equivalents, p<.0001). Contrary to expectation, timescheduled opioid dosing was associated with higher levels of patient opioid control concerns than pain-contingent dosing (6.2 vs. 4.8, p=.008), after adjusting for patient and drug regimen differences. Opioid-related psychosocial problems were somewhat greater among patients using time-scheduled dosing, but this difference was non-significant after controlling for patient and drug regimen differences (5.9 versus 5.0, p=.14). Time-scheduled dosing typically involved higher dosage levels and was associated with higher levels of patient concerns about opioid use. Controlled comparative effectiveness research is needed to assess benefits and risks of timescheduled opioid dosing relative to pain-contingent opioid dosing among COT patients in ambulatory care.Address correspondence to Dr. Michael Von Korff: 206-287-2874 (Phone) 206-287-2871 Vonkorff.m@ghc.org. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Empirical research on time-scheduled opioid dosing has largely concerned postoperative pain management. A structured review on time-scheduled opioid dosing for post-operative pain management [12] concluded that there is "sparse empirical work warranting endorsement of this dosing regimen." Subsequently, several trials of time-scheduled opioid dosing reported benefits relative to pain-contingent dosing in postoperative pain management [6,7,11,19]. Whether findings for time-scheduled opioid dosing in postoperative pain management translate to COT in ambulatory care settings has not been examined.Lack of evidence regarding the effectiveness of time...

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“…Numerous studies showed that a time-scheduled pattern was better than a pain-contingent pattern (PRN) in postoperative pain management. The former with adequate dosing could provide stable therapeutic blood levels and a continuous relieving effect for acute pain [12, 45, 47, 55, 59]. Our time-scheduled analgesic was consistent with this principle and its efficacy was observed by better functional end points.…”

Section: Discussionmentioning

confidence: 61%

Scheduled Analgesic Regimen Improves Rehabilitation After Hip Fracture Surgery

Chin

Cheung

2013

Clinical Orthopaedics &Amp; Related Research

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BackgroundPostoperative pain often is the limiting factor in the rehabilitation of patients after hip fracture surgery.Questions/purposesWe compared an approach using scheduled analgesic dosing with as-needed analgesic dosing in patients after hip fracture surgery, to compare these approaches in terms of (1) resting and dynamic pain intensity, (2) postoperative patient mobility, and (3) functional end points.MethodsWe conducted a prospective cohort study of 400 patients who underwent surgical treatment of hip fractures at our hospital. The groups were formed sequentially, such that the first 200 patients formed the intervention group (treated with scheduled analgesic intake for the first 3 weeks after surgery), and the next 200 patients were the control group (treated using a protocol of analgesic administration on request). Resting and dynamic pain intensity, mobility, and functional performance were compared between the two analgesic protocols.ResultsAs expected, analgesic consumption was lower in the control group (tramadol doses, 27 versus 63; paracetamol doses, 29 versus 63). Despite the large difference in the amounts of analgesics consumed, resting and dynamic pain intensity showed improvement in each group and there was no difference between groups in terms of postoperative pain. However, there was a positive correlation between functional outcomes and analgesic consumption in the control group. The intervention group achieved higher functional performance on discharge (elderly mobility scale, 11 versus 8; functional independence measure, 88 versus 79). On discharge, fewer patients in the intervention group were wheelchair ambulators (3 versus 32), meaning more patients in the intervention group were able to walk.ConclusionsThe study showed that a scheduled analgesic intake can improve the functional outcomes of patients with geriatric hip fractures after surgery.Level of EvidenceLevel II, therapeutic study. See the guidelines for authors for a complete description of levels of evidence.

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‘Scheduled’ dosing of lornoxicam provides analgesia superior to that provided by ‘on request’ dosing following craniotomy

Abstract: 'Scheduled' analgesia with lornoxicam was more effective for treating post-craniotomy pain than 'on request' analgesia with lornoxicam.

Cited by 20 publications

References 20 publications

Designing a pain management protocol for craniotomy: A narrative review and consideration of promising practices

Designing a pain management protocol for craniotomy: A narrative review and consideration of promising practices

Time-scheduled vs. pain-contingent opioid dosing in chronic opioid therapy

Scheduled Analgesic Regimen Improves Rehabilitation After Hip Fracture Surgery

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