Postoperative pain management with tramadol after craniotomy: evaluation and cost analysis

2010 ◽  
Vol 112 (2) ◽  
pp. 268-272 ◽  
Author(s):  
Scott Y. Rahimi ◽  
Cargill H. Alleyne ◽  
Eric Vernier ◽  
Mark R. Witcher ◽  
John R. Vender
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Management Strategies ◽  
Length Of Hospital Stay ◽  
Postoperative Pain Management ◽  
Control Group ◽  
Pain Scores ◽  
Pain Medications ◽  
Hospitalization Costs ◽  
Hospital Stays

Object Patients undergoing craniotomies have traditionally received opiates with acetaminophen for the management of their postoperative pain. The use of narcotic pain medications can be costly, decrease rates of early postoperative ambulation, lengthen hospital stays, and alter a patient's neurological examination. The use of alternative pain medications such as tramadol may benefit patients by resolving many of these issues. Methods The authors conducted a randomized, blinded prospective study to evaluate the efficacy of alternative pain management strategies for patients following craniotomies. Fifty patients were randomly assigned either to a control group who received narcotics and acetaminophen alone or an experimental group who received tramadol in addition to narcotic pain medications (25 patients assigned to each group). Results The control group was noted to have statistically significant higher visual analog scale pain scores, an increased length of hospital stay, and increased narcotic use compared with the tramadol group. The narcotics and acetaminophen group also had increased hospitalization costs when compared with the tramadol group. Conclusions The use of scheduled atypical analgesics such as tramadol in addition to narcotics with acetaminophen for the management of postoperative pain after craniotomy may provide better pain control, decrease the side effects associated with narcotic pain medications, encourage earlier postoperative ambulation, and reduce total hospitalization costs.

scholarly journals SHOULD THE ERECTOR SPINAE PLANE BLOCK BE APPLIED IN THE PAIN MANAGEMENT OF PERCUTANEOUS NEPHROLITHOTOMY?

2021 ◽  
Author(s):  
Şeyma Ünal ◽  
Semih Başkan ◽  
Betül GÜVEN AYTAÇ ◽  
İsmail Aytaç
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Percutaneous Nephrolithotomy ◽  
Length Of Hospital Stay ◽  
Postoperative Pain Management ◽  
Erector Spinae ◽  
Controlled Study ◽  
Control Group ◽  
Rescue Analgesia ◽  
Erector Spinae Plane Block

The Aim: This prospective, randomised controlled study aimed to investigate the efficacy and respiratory effects of postoperative pain management with erector spinae plane block (ESPB) in patients undergoing percutaneous nephrolithotomy surgery. Methods: A total of 60 ASA I-II patients aged 18–65 years, scheduled to undergo percutaneous nephrolithotomy (PCNL) were included. Patients were randomized either to the ESPB or control group. Ultrasound-guided ESPB with 15mL 0.5% bupivacaine at the T11 level was performed preoperatively using the in-plane technique in the ESP group. In both groups, 1gr of intravenous paracetamol was administered intraoperatively. Postoperative pain and agitation was evaluated using VAS, Dynamic VAS at 0, 6 and 24 hours and the Riker sedation-agitation scale at 0th Hours after surgery. Peak expiratory flow rate(PEFR) and SPO2 were measured in preoperative examination and at the 0th, 6th, 24th hours postoperatively. In the postoperative period, intravenous tramadol (100mg) was administered as a rescue analgesic when VAS ≥ 4. Time and number of the rescue analgesias, mobilization time and length of hospital stay were also recorded and analyzed. Results: A significantly lower VAS and DVAS were observed at 0th, 6th, 24th hours in the ESPB group (p < 0.05 for each timepoint). Also number of and time to rescue analgesia decreased in the ESPB group (p< 0.05 and 0.01 respectively). Postoperative/preoperative PEFR ratio was lower and there were more agitated patients in control group (p<0.05). Conclusion: ESPB may have additional clinical advantages while providing effective analgesia in patients who underwent PCNL comparing to intravenous analgesia.

Postoperative Pain Management after Craniotomy: Evaluation and Cost Analysis

Neurosurgery ◽  
2006 ◽  
Vol 59 (4) ◽  
pp. 852-857 ◽  
Author(s):  
Scott Y. Rahimi ◽  
John R. Vender ◽  
Samuel D. Macomson ◽  
Adam French ◽  
Joseph R. Smith ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Control Group ◽  
Pain Medications ◽  
Neurosurgical Patients ◽  
Hospitalization Costs ◽  
Inflammatory Drugs ◽  
Cox 2 ◽  
Anti Inflammatory ◽  
Cox 2 Inhibitors

Abstract OBJECTIVE: Patients undergoing craniotomies have traditionally received opiates for the management of their postoperative pain. The use of narcotic pain medications can be costly, can decrease early walking, can lengthen hospital stay, and can alter a patient's neurological examination results. The use of alternative pain medications such as cyclooxygenase-2 (COX-2) inhibitors may benefit patients by resolving many of these issues. Compared with traditional nonsteroidal anti-inflammatory drugs, these anti-inflammatory medications may be used safely in neurosurgical patients because of their selective inhibition of the COX-2 enzyme, which avoids the platelet dysfunction caused by other nonsteroidal anti-inflammatory drugs. METHODS: A randomized, single-blinded prospective study was used to evaluate the efficacy of alternative pain management strategies for patients who have undergone craniotomy. Twenty-seven patients were randomly assigned to a control group (n = 13) receiving narcotics alone or an experimental group (n = 14) receiving a COX-2 inhibitor in addition to narcotic pain medications. RESULTS: The narcotics group was noted to have statistically significantly higher visual analog scale scores, increased length of stay, and increased narcotic use compared with the COX-2 group. The narcotics group also had increased hospitalization costs when compared with the COX-2 group. CONCLUSION: The use of scheduled atypical analgesics, such as COX-2 inhibitors, in addition to narcotics for the management of postoperative pain after craniotomy may provide better pain control, may decrease side effects associated with narcotic pain medications, may encourage earlier walking, and may reduce total hospitalization costs.

scholarly journals Ultrasound-Guided Funicular Block: Ropivacaine Injection into the Tissue around the Spermatic Cord to Improve Analgesia during Orchiectomy in Dogs

Animals ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 1275
Author(s):  
Vincenzo Cicirelli ◽  
Pasquale Debidda ◽  
Nicola Maggio ◽  
Michele Caira ◽  
Giovanni M. Lacalandra ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
General Anaesthesia ◽  
Spermatic Cord ◽  
Postoperative Pain Management ◽  
Control Group ◽  
Ultrasound Guided ◽  
Hemodynamic Stability ◽  
Pain Scores ◽  
Lower Pain ◽  
Ropivacaine Hydrochloride

Orchiectomy is a common surgical procedure performed on small animals, and it requires postoperative pain management despite its relative simplicity. This study aimed to evaluate the hemodynamic stability, intraoperative administration of additional hypnotic and/or analgesic drugs, and postoperative pain scores following the combination of ultrasound-guided injection of ropivacaine hydrochloride into the spermatic cord and infiltration by the same anaesthetic of the incisional prescrotal line (ROP) or general anaesthesia. Dogs in the ROP group showed greater intraoperative hemodynamic stability and lower pain scores than the control group. The locoregional approach used in this study proved effective in minimising the responses to the surgical stimulus and ensured adequate analgesia intra- and postoperatively. This method, called ultrasound-guided funicular block, allows orchiectomy to be performed under deep sedation without general anaesthesia.

scholarly journals Postoperative Pain Management Strategies in Hip Arthroscopy

2019 ◽  
Vol 12 (4) ◽  
pp. 479-485 ◽  
Author(s):  
Collin LaPorte ◽  
Michael D. Rahl ◽  
Olufemi R. Ayeni ◽  
Travis J. Menge
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Hip Arthroscopy ◽  
Management Strategies ◽  
Postoperative Pain Management

scholarly journals Postoperative Analgesic Effects of Laserpuncture and Meloxicam in Bitches Submitted to Ovariohysterectomy

2020 ◽  
Vol 7 (3) ◽  
pp. 94
Author(s):  
Rubia M. Tomacheuski ◽  
Marilda O. Taffarel ◽  
Guilherme S. Cardoso ◽  
Ana A. P. Derussi ◽  
Marcos Ferrante ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Area Under The Curve ◽  
Postoperative Pain Management ◽  
Pain Scale ◽  
Rescue Analgesia ◽  
Analgesic Effects ◽  
Pain Scores ◽  
Chi Squared ◽  
Perioperative Pain Management

Background: This prospective, randomised and blind study investigated the efficacy of laserpuncture for postoperative pain management in dogs. Method: Sixteen bitches were sedated with acepromazine and randomly treated before ovariohysterectomy with meloxicam 0.2 mg·kg−1 intramuscular or laserpuncture (wavelength 904 mm, frequency 124 Hz, potency 10 Joules, 100 s in each acupoint). Anaesthesia was performed with propofol, isoflurane/O2, and fentanyl. The Glasgow Composite Measure Pain Scale (GCMPS) and Dynamic Interactive Visual Analog Scale (DIVAS) were used to evaluate postoperative pain before and for 24 h after surgery. Morphine was administrated as rescue analgesia when pain scores were ≥3.33 (GCMPS). Differences between treatments, time points, and amount of rescue analgesia between groups were investigated by the Mann–Whitney test and the area under the curve (AUC) for GCMPS, Friedman, and Chi-squared tests, respectively (p < 0.05). Results: Dogs treated with laserpuncture presented lower GCMPS AUC for 24 h and lower GCMPS scores at 2 and 4 h postoperatively (p = 0.04). Three dogs treated with meloxicam required postoperatively rescue analgesia against none treated with laserpuncture. Conclusions: In this preliminary study, laserpuncture mitigated postoperative pain in dogs following ovariohysterectomy, and the technique is a promising adjunct to perioperative pain management in dogs undergoing soft tissue surgery.

scholarly journals Efficacy of ketamine for postoperative pain following robotic thyroidectomy: A prospective randomised study

2017 ◽  
Vol 46 (3) ◽  
pp. 1109-1120 ◽  
Author(s):  
Jiwon Lee ◽  
Hee-Pyoung Park ◽  
Mu-Hui Jeong ◽  
Je-Do Son ◽  
Hyun-Chang Kim
Keyword(s):  
Postoperative Pain ◽  
Severe Pain ◽  
Analogue Scale ◽  
Postoperative Pain Management ◽  
Robotic Thyroidectomy ◽  
Control Group ◽  
Randomised Study ◽  
Pain Scores ◽  
Vas Scores ◽  
Induction Of Anaesthesia

Objective Although robotic thyroidectomy (RoT) is a minimally invasive surgery, percutaneous tunneling causes moderate to severe pain immediately postoperatively. We evaluated the efficacy of ketamine for postoperative pain management in patients following RoT. Methods Sixty-four patients scheduled for RoT were randomly divided into two groups. In the ketamine group (n = 32), ketamine was infused from induction of anaesthesia until the end of the procedure (0.15-mg/kg bolus with continuous infusion at 2 µg/kg/min). In the control group (n = 32), the same volume of saline was infused. Visual analogue scale (VAS) scores for acute and chronic pain, the incidence of hypoesthesia, postoperative analgesic requirements, and complications related to opioids or ketamine were compared between the two groups. Results The VAS pain scores were significantly lower in the ketamine group up to 24 h postoperatively. The VAS pain score when coughing was significantly higher in the control group than in the ketamine group at 24 h postoperatively. A significantly greater proportion of patients in the control group required rescue analgesics. Complications were comparable in both groups. Conclusions Ketamine infusion decreased pain scores for 24 h postoperatively and reduced analgesic requirements without serious complications in patients following RoT. Trial Registration: Clinicaltrials.gov Identifier: NCT01997801

Regional anaesthesia for postoperative pain management after liver resection

2012 ◽  
Vol 19 (3) ◽  
pp. 126-129
Author(s):  
Darius Trepenaitis ◽  
Tadas Česnaitis ◽  
Andrius Macas
Keyword(s):  
Pain Management ◽  
Liver Resection ◽  
Postoperative Pain ◽  
Adverse Effects ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Postoperative Pain Management ◽  
Control Group ◽  
Wound Infiltration ◽  
Adequate Treatment

Background. Pain is the most common complication in the postoperative period. If adequate treatment is not taken, it can transform to chronic pain. Postoperative pain brings a lot of social, psychological and financial problems for patients and their families. Materials and methods. This prospective study included 30 patients after laparatomic liver resection operation. Patients were randomly assign­ ed to Infiltrated or Control groups. An infiltration of 40 ml levobupivacaine 0.25% solution to the operation cut edges was performed to the Infiltrated group. The pain was evaluated using the numerical rating scale after 2, 5, 12, 24, 48 hours and 1 month after the operation. Our aim was to determine the effect of local anesthesia in the operation wound. The total usage of morphine and any side effects were registered. Results. A statistically significant reduction in pain was observed in the Infiltrated group in all evaluation periods. Opioids usage was higher in the Control group almost by 4 times and adverse effects were 9 to 1 compared to the Infiltrated group. Conclusions. Surgical wound infiltration with local anesthetic for postoperative pain management after liver resection operations has a positive effect on postoperative pain reduction and leads to lesser usage of opioid analgetics. As a result, there is a less chance of opioids induced adverse effects.

The Effect of Preoperative Education on Postoperative Pain After Joint Surgery: An Integrative Literature Review

2017 ◽  
Vol 23 (1) ◽  
pp. 42-46 ◽  
Author(s):  
Mary Ashley Barry
Keyword(s):  
Total Knee Arthroplasty ◽  
Pain Management ◽  
Postoperative Pain ◽  
Literature Review ◽  
Knee Arthroplasty ◽  
Length Of Hospital Stay ◽  
Postoperative Pain Management ◽  
Postoperative Phase ◽  
Preoperative Education ◽  
Total Knee

As the number of total knee arthroplasty surgeries continues to increase and the length of hospital stay is trending down, preoperative education continues to be an important factor to support positive postoperative outcomes. The purpose of this literature review is to examine whether preoperative education for patients undergoing total knee arthroplasty affects postoperative pain management compared to those who do not receive this education. Findings from the literature review indicate that receiving preoperative education before a total knee arthroplasty does not impact pain management in the postoperative phase.

Postoperative Pain Management Surgery

2018 ◽  
Author(s):  
Abhishek Parmar
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Perioperative Period ◽  
Postoperative Pain Management ◽  
Multimodal Analgesia ◽  
Anesthetic Techniques ◽  
Clinical Approach ◽  
Acute Setting ◽  
Pain Medications

Optimal pain management in the perioperative period is essential to improving patient quality of life, preventing postoperative complications, and ensuring improved surgical outcomes.1 This review discusses the optimal clinical approach to pain management in the acute setting, centering on the concept of multimodal analgesia. Various opioid and nonopioid medications available for treating acute pain are discussed, with a focus on the “pain ladder,” adverse effects of pain medications, epidural and regional anesthetic techniques, and common pitfalls to avoid when managing postoperative pain. This review does not discuss chronic pain management.

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