scholarly journals Perioperative Management of a Patient Taking Suboxone® at the Time of Ambulatory Surgery

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Shawn H. Malan ◽  
Christopher H. Bailey ◽  
Narjeet Khurmi
Keyword(s):  
Postoperative Pain ◽  
Minimally Invasive ◽  
Pain Control ◽  
Perioperative Management ◽  
Ambulatory Surgery ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Postoperative Pain Control ◽  
Recovery Unit ◽  
Postanesthesia Recovery

In 2016, more than 11 million people reported misuse of opioids in the previous year. In an effort to combat opioid use disorder (OUD), the use of agonist/antagonist is becoming increasingly common, with more than 2.2 million patients reporting use of a buprenorphine containing medication such as Suboxone®. Buprenorphine is a unique opioid which acts as a partial μ agonist and ĸ antagonist. These properties make it an effective tool in treating OUD and abuse. However, despite its advantages in treating OUD and abuse, buprenorphine can make it difficult to control acute perioperative pain. We present a case in which the Mayo Clinic Arizona protocol for patients undergoing minimally invasive ambulatory surgery while taking Suboxone® is successfully executed, resulting in adequate postoperative pain control and timely discharge from the postanesthesia recovery unit.

Comparison of intravenous ketorolac with or without paracetamol in postoperative pain control following ambulatory surgery

2013 ◽  
Vol 29 (12) ◽  
pp. 1685-1690 ◽  
Author(s):  
Vittorio Iorno ◽  
Laura Landi ◽  
Raffaella Di Pasquale ◽  
Stefano Cicenia ◽  
Vincenzo Moschini
Keyword(s):  
Postoperative Pain ◽  
Pain Control ◽  
Ambulatory Surgery ◽  
Postoperative Pain Control ◽  
Intravenous Ketorolac

scholarly journals Survey Criteria for Fibromyalgia Independently Predict Increased Postoperative Opioid Consumption after Lower-extremity Joint Arthroplasty

2013 ◽  
Vol 119 (6) ◽  
pp. 1434-1443 ◽  
Author(s):  
Chad M. Brummett ◽  
Allison M. Janda ◽  
Christa M. Schueller ◽  
Alex Tsodikov ◽  
Michelle Morris ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Lower Extremity ◽  
Pain Control ◽  
Joint Arthroplasty ◽  
Opioid Consumption ◽  
Self Report ◽  
Pain Severity ◽  
Anesthetic Technique ◽  
Opioid Use ◽  
Postoperative Pain Control

Abstract Background: Variance in pain after total knee and hip arthroplasty may be due to a number of procedural and peripheral factors but also, in some individuals, to aberrant central pain processing as is described in conditions like fibromyalgia. To test this hypothesis, the authors conducted a prospective, observational cohort study of patients undergoing lower-extremity joint arthroplasty. Methods: Five hundred nineteen patients were preoperatively phenotyped using validated self-reported pain questionnaires, psychological measures, and health information. In addition to being assessed for factors previously found to be associated with poor outcomes in arthroplasty, participants also completed the American College of Rheumatology survey criteria for fibromyalgia. Previous studies have suggested that rather than being “present” or “absent,” features of fibromyalgia as measured by this instrument, occur over a wide continuum. Postoperative pain control was assessed by total postoperative opioid consumption. Results: Preoperatively, patients with higher fibromyalgia survey scores were younger, more likely to be female, taking more opioids, reported higher pain severity, and had a more negative psychological profile. In the multivariate analysis, the fibromyalgia survey score, younger age, preoperative opioid use, knee (vs. hip), pain severity at baseline, and the anesthetic technique were all predictive of increased postoperative opioid consumption. Conclusions: The use of the survey criteria for fibromyalgia led to the finding of distinct phenotypic differences, and the measure was independently predictive of opioid consumption. This self-report measure may provide an additional simple means of predicting postoperative pain outcomes and analgesic requirements. Future studies are needed to determine whether tailored therapies can improve postoperative pain control in this population.

scholarly journals The effect of ketorolac on posterior thoracolumbar spinal fusions: a prospective double-blinded randomised placebo-controlled trial protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e025855 ◽  
Author(s):  
Chad F Claus ◽  
Evan Lytle ◽  
Doris Tong ◽  
Diana Sigler ◽  
Dominick Lago ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Length Of Stay ◽  
Pain Control ◽  
Average Length ◽  
Controlled Trial ◽  
Opioid Use ◽  
Postoperative Pain Control ◽  
Minimal Effective Dose ◽  
Spinal Fusions ◽  
Double Blinded

IntroductionKetorolac has been shown to provide quality postoperative pain control and decrease opioid requirement with minimal side effects following spinal surgery. However, the literature addressing its use in spinal fusions is highly variable in both its effectiveness and complications, such as pseudarthrosis. Recent literature postulates that ketorolac may not affect fusion rates and large randomised controlled trials are needed to demonstrate ketorolac as a safe and effective adjuvant treatment to opioids for postoperative pain control.Methods and analysisThis is a multihospital, prospective, double-blinded, randomised placebo-controlled trial. Data concerning fusion rates, postoperative opioid use, pain scores, length of stay will be recorded with the aim of demonstrating that the use of ketorolac does not decrease thoracolumbar spinal fusion rates while identifying possible adverse events related to short-term minimal effective dose compared with placebo. Additionally, this investigation aims to demonstrate a decrease in postoperative opioid use demonstrated by a decrease in morphine equivalence while showing equivalent postoperative pain control and decrease the average length of stay.Ethics and disseminationEthical approval was obtained at all participating hospitals by the institutional review board. The results of this study will be submitted for publication in peer-reviewed journals.Trial registration numberNCT03278691.

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