The role of regional analgesia in personalized postoperative pain management

Chitnis, Shruti; Tang, Raymond; Mariano, Edward R.

doi:10.4097/kja.20323

Cited by 49 publications

(35 citation statements)

References 57 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The increased postoperative day 1 opioid use may be reflective of poorly controlled acute postoperative pain, a known risk factor for developing persistent pain after various surgical procedures 19–22. For this reason, literature strongly supports the use of multimodal analgesia, early counseling, peripheral nerve blocks as well as neuraxial anesthesia as strategies to minimize the transition from acute to prolonged opioid requirement after surgery 23–25…”

Section: Discussionmentioning

confidence: 99%

Machine learning approach to predicting persistent opioid use following lower extremity joint arthroplasty

Gabriel

Harjai

Prasad

et al. 2022

Reg Anesth Pain Med

View full text Add to dashboard Cite

BackgroundThe objective of this study is to develop predictive models for persistent opioid use following lower extremity joint arthroplasty and determine if ensemble learning and an oversampling technique may improve model performance.MethodsWe compared various predictive models to identify at-risk patients for persistent postoperative opioid use using various preoperative, intraoperative, and postoperative data, including surgical procedure, patient demographics/characteristics, past surgical history, opioid use history, comorbidities, lifestyle habits, anesthesia details, and postoperative hospital course. Six classification models were evaluated: logistic regression, random forest classifier, simple-feedforward neural network, balanced random forest classifier, balanced bagging classifier, and support vector classifier. Performance with Synthetic Minority Oversampling Technique (SMOTE) was also evaluated. Repeated stratified k-fold cross-validation was implemented to calculate F1-scores and area under the receiver operating characteristics curve (AUC).ResultsThere were 1042 patients undergoing elective knee or hip arthroplasty in which 242 (23.2%) reported persistent opioid use. Without SMOTE, the logistic regression model has an F1 score of 0.47 and an AUC of 0.79. All ensemble methods performed better, with the balanced bagging classifier having an F1 score of 0.80 and an AUC of 0.94. SMOTE improved performance of all models based on F1 score. Specifically, performance of the balanced bagging classifier improved to an F1 score of 0.84 and an AUC of 0.96. The features with the highest importance in the balanced bagging model were postoperative day 1 opioid use, body mass index, age, preoperative opioid use, prescribed opioids at discharge, and hospital length of stay.ConclusionsEnsemble learning can dramatically improve predictive models for persistent opioid use. Accurate and early identification of high-risk patients can play a role in clinical decision making and early optimization with personalized interventions.

show abstract

Section: Discussionmentioning

confidence: 99%

Machine learning approach to predicting persistent opioid use following lower extremity joint arthroplasty

Gabriel

Harjai

Prasad

et al. 2022

Reg Anesth Pain Med

View full text Add to dashboard Cite

show abstract

“…The key strategy to enhance perioperative pain management includes the use of a multimodal analgesia approach to reduce opioid consumption, decrease time in the hospital and improve patient satisfaction [ 2 ]. Ultrasound-guided nerve block has become a crucial component of the multimodal analgesia approach [ 3 ]. A large number of studies have shown that the perioperative analgesic effect of nerve block is superior to that of other drugs [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Dexmedetomidine combined with ropivacaine for erector spinae plane block after posterior lumbar spine surgery: a randomized controlled trial

Wang

Tang

et al. 2022

BMC Musculoskelet Disord

View full text Add to dashboard Cite

Purpose Due to lumbar spinal surgery is frequently accompanied with moderate-to-severe postoperative pain, it is necessary to find an effective postoperative analgesia for patients with this surgery. This study aimed to observe the analgesic effect of dexmedetomidine combined with ropivacaine erector spinae plane block (ESPB) used in posterior lumbar spine surgery. Methods In this clinical trial, patients undergoing posterior lumbar spine surgery were recruited and randomly divided into two groups: intervention and control. The intervention group (Group E) received 0.375% ropivacaine with 1 µg/kg dexmedetomidine in a total of 20 ml for ESPB; the control group (Group C) received 20 ml ropivacaine 0.375% for ESPB. US-guided ESPB was performed preoperatively in all patients. Demographics, anesthesia time, surgery time, and ASA grade from the participants were recorded at baseline. The primary clinical outcome measures were 2-, 4-, 8-, 12-, 24-and 48-h visual analog scale (VAS) pain scores after surgery at rest and movement state. Other end points included opioid consumption, number of PCIA presses, flurbiprofen-axetil consumption, quality of recovery and pain management after surgery. Results One hundred twenty patients were enrolled in the study (mean [SD] ages: Group E, 54.77 [8.61] years old; Group C,56.40 [7.87] years old; P = 0.280). The mean anesthesia time was 152.55 (15.37) min in Group E and 152.60 (16.47) min in Group C (P = 0.986). Additionally, the surgery time was 141.70 (15.71) min in Group E compared to 141.48 (17.13) min in Group C (P = 0.943). In addition, we found that the VAS pain scores in the resting state during the postoperative period at 8–48 h were lower in Group E than in Group C. However, the VAS pain scores in the active state were lower in Group E at 12–48 h (P < 0.05). More importantly, the consumption of opioids and flurbiprofen-axetil after surgery was also lower in Group E (P < 0.05). Subsequently, we administered questionnaires on the quality of recovery and pain management after surgery that were positively correlated with the postoperative analgesic effect. It was worth affirming that the QoR-15 scores and APS-POQ-R questionnaire results were different between the two groups, further confirming that the combination of drugs not only could obtain an ideal analgesic effect but also had no obvious adverse reactions (P < 0.05). Conclusions All the findings suggested that dexmedetomidine could significantly relieve postoperative pain and reduce the consumption of opioids in patients undergoing posterior lumbar spine surgery without obvious adverse reactions as a local anesthetic adjuvant. Further studies with larger sample sizes and different drug dosages may be useful in understanding the potential clinical benefits of dexmedetomidine.

show abstract

“…Regional analgesia uses different nerve block techniques as part of the multimodal analgesia arsenal to favor ERAS. 28 Techniques are presented in two different chronologic groups: 1) Classic Techniques; and 2) Novel Techniques.…”

Section: Regional Analgesia For Tkamentioning

confidence: 99%

A guide to regional analgesia for Total Knee Arthroplasty

Rodriguez-Patarroyo

Cuello²,

Molloy

et al. 2021

EFORT Open Reviews

View full text Add to dashboard Cite

Regional analgesia has been introduced successfully into the postoperative pain management after total knee arthroplasty, reducing pain scores, opioid use and adverse effects. Combination of regional analgesia techniques is associated with better pain management and lower side effects than single regional techniques. Adductor canal block provides good analgesia and considerably lower detrimental effect in muscular strength than femoral nerve block, enhancing surgical recovery. Infiltration techniques may have equivalent analgesic effect than epidural analgesia and peripheral nerve blocks, however there should be awareness of dose dependent toxicity. Novel long-acting local anesthetics role for regional analgesia is still to be determined, and will require larger randomized trials to support its advantage over traditional local anesthetics. Cite this article: EFORT Open Rev 2021;6:1181-1192. DOI: 10.1302/2058-5241.6.210045

show abstract

The role of regional analgesia in personalized postoperative pain management

Cited by 49 publications

References 57 publications

Machine learning approach to predicting persistent opioid use following lower extremity joint arthroplasty

Machine learning approach to predicting persistent opioid use following lower extremity joint arthroplasty

Dexmedetomidine combined with ropivacaine for erector spinae plane block after posterior lumbar spine surgery: a randomized controlled trial

A guide to regional analgesia for Total Knee Arthroplasty

Contact Info

Product

Resources

About