Patient education and engagement in postoperative pain management decreases opioid use following knee replacement surgery

2019 ◽  
Vol 102 (2) ◽  
pp. 383-387 ◽  
Author(s):  
Meghana Yajnik ◽  
Jonay N. Hill ◽  
Oluwatobi O. Hunter ◽  
Steven K. Howard ◽  
T. Edward Kim ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Patient Education ◽  
Knee Replacement ◽  
Postoperative Pain Management ◽  
Opioid Use ◽  
Knee Replacement Surgery ◽  
Replacement Surgery

Ketamine Improves the Management of Exaggerated Postoperative Pain Observed in Perioperative Fentanyl-treated Rats

2005 ◽  
Vol 102 (2) ◽  
pp. 421-428 ◽  
Author(s):  
Philippe Richebé ◽  
Cyril Rivat ◽  
Jean-Paul Laulin ◽  
Pierre Maurette ◽  
Guy Simonnet
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Weight Bearing ◽  
Experimental Studies ◽  
Postoperative Pain Management ◽  
Opioid Use ◽  
Short Term ◽  
Postoperative Rehabilitation ◽  
Pain Hypersensitivity ◽  
Plantar Incision

Background Although opioids are unsurpassed analgesics, experimental and clinical studies suggest that opioids activate N-methyl-d-aspartate pronociceptive systems leading to pain hypersensitivity and short-term tolerance. Because it is difficult in humans to differentiate pain from hyperalgesia during the postoperative period, the authors performed experimental studies with fentanyl using the rat incisional pain model for evaluating relations between hyperalgesia and short-term tolerance. Because N-methyl-d-aspartate receptor antagonists oppose both pain hypersensitivity and tolerance induced by opioids, the authors examined the capability of ketamine for improving exaggerated postoperative pain management. Methods During halothane anesthesia, a hind paw plantar incision was performed in rats receiving four fentanyl subcutaneous injections (100 microg/kg per injection, every 15 min). In some groups, three subcutaneous ketamine injections (10 mg/kg per injection, every 5 h) were performed in saline- or fentanyl-treated rats. One day after surgery, the analgesic effect of morphine (2 mg/kg subcutaneous) was tested. Analgesia, mechanical hyperalgesia, tactile allodynia, and pain score were assessed for several days using the paw pressure vocalization test, the von Frey application test, and the postural disequilibrium test. Results Fentanyl induced analgesia but also produced exaggerated postoperative pain as indicated by the enhancement of hyperalgesia, allodynia, and weight-bearing decrease after hind paw plantar incision. Ketamine pretreatment prevented such a fentanyl-induced enhancement of postoperative pain and improved its management by morphine. Conclusions By opposing postoperative pain hypersensitivity and subsequent short-term tolerance induced by perioperative opioid use, ketamine not only improves exaggerated postoperative pain management but also provides better postoperative rehabilitation.

Implications of uninterrupted preoperative transdermal buprenorphine use on postoperative pain management

2019 ◽  
Vol 44 (3) ◽  
pp. 342-347 ◽  
Author(s):  
Yvette N Martin ◽  
Amy C S Pearson ◽  
John R Tranchida ◽  
Toby N Weingarten ◽  
Phillip J Schulte ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Pain Score ◽  
Recovery Room ◽  
Severe Pain ◽  
Receptor Agonist ◽  
Postoperative Pain Management ◽  
Opioid Use ◽  
Intravenous Morphine ◽  
Matched Study

Background and objectivesBuprenorphine is a partial µ-receptor agonist resistant to displacement from receptors by conventional opioids, which can block the effect of conventional opioids and may interfere with postoperative pain management. We aimed to quantify perioperative opioid use in patients receiving transdermal buprenorphine (TdBUP).MethodsWe identified patients receiving TdBUP who underwent surgery between 2004 and 2016. To compare opioid requirements (intravenous morphine equivalents (IV-MEq)), we constructed a matched study, matching each TdBUP patient with two opioid-naive patients by sex, age, and type of anesthesia and procedure.ResultsNineteen unique patients underwent 22 procedures while receiving TdBUP. Total (IQR) amounts of IV-MEq (intraoperative, recovery room, and 24 hours after recovery-room discharge) were 98 (63, 145) and 46 (30, 65) mg IV-MEq for TdBUP and opioid-naive patients, respectively (p<0.001). Postoperative IV-MEq requirements were 54 (38, 90) and 15 (3, 35) mg for TdBUP and opioid-naive patients, respectively (p<0.001). Among TdBUP patients, higher preoperative doses of TdBUP were associated with greater postoperative opioid requirements (p=0.02). Specifically, patients with a 20 µg/hour TdBUP patch required 133.8 mg IV-MEq more postoperatively than patients with a 5 µg/hour patch (p=0.002). Following discharge from the recovery room, 17 (77%) TdBUP patients and 15 (34%) opioid-naive patients reported severe pain (OR 6.6 (95% CI 2.0 to 21.3); p<0.001; adjusting for baseline pain score, 5.0 (95% CI, 1.4 to 17.8); p=0.01).ConclusionsAnalgesic management for patients receiving TdBUP therapy must account for increased opioid needs, and greater preoperative doses of TdBUP were associated with greater postoperative opioid requirements.

A prospective study of opioid use for postoperative pain management after breast operation

2020 ◽  
Vol 219 (1) ◽  
pp. 8-14
Author(s):  
Kristen E. Limbach ◽  
SuEllen J. Pommier ◽  
Kristen P. Massimino ◽  
Rodney F. Pommier ◽  
Arpana M. Naik
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Prospective Study ◽  
Postoperative Pain Management ◽  
Opioid Use ◽  
A Prospective Study

scholarly journals Extended Perineural Analgesia After Hip and Knee Replacement When Buprenorphine-Clonidine-Dexamethasone Is Added to Bupivacaine: Preliminary Report from a Randomized Clinical Trial

Pain Medicine ◽  
2020 ◽  
Vol 21 (11) ◽  
pp. 2893-2902
Author(s):  
Brian A Williams ◽  
James W Ibinson ◽  
Marsha E Ritter ◽  
Catalin S Ezaru ◽  
Hulimangala R Rakesh ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Knee Replacement ◽  
Mean Difference ◽  
Nerve Blocks ◽  
Double Blind ◽  
Knee Replacement Surgery ◽  
Joint Replacement Surgery ◽  
Replacement Surgery ◽  
Time Parameters ◽  
To Receive

Abstract Objective We tested the hypothesis that buprenorphine-clonidine-dexamethasone (BCD) extends perineural analgesia compared with plain bupivacaine (BPV) nerve blocks used for hip and knee replacement surgery. Design Prospective, parallel-arms, randomized, double-blind trial. Setting A single veterans’ hospital. Subjects Seventy-eight veterans scheduled for total hip or knee replacement with plans for spinal as the primary anesthetic. Methods Participants underwent nerve/plexus blocks at L2–L4 and L4–S3 in advance of hip or knee joint replacement surgery. Patients were randomized to receive BPV-BCD or plain BPV in a 4:1 allocation ratio. Patients answered four block duration questions (listed below). Time differences between treatments were analyzed using the t test. Results Significant (P &lt; 0.001) prolongation of the time parameters was reported by patients after the BPV-BCD blocks (N = 62) vs plain BPV (N = 16). The time until start of postoperative pain was 26 vs 11 hours (mean difference = 15 hours, 95% CI = 8 to 21). The time until no pain relief from the blocks was 32 vs 15 hours (mean difference = 17 hours, 95% CI = 10 to 24). The time until the numbness wore off was 37 vs 21 hours (mean difference = 16 hours, 95% CI = 8 to 23). The time until the worst postoperative pain was 39 vs 20 hours (mean difference = 19 hours, 95% CI = 11 to 27). Conclusions BPV-BCD provided 26–39 hours of perineural analgesia in the L2–L4 and L4–S3 nerve distributions after hip/knee replacement surgery, compared with 11–21 hours for plain BPV.

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