Early postoperative patient-controlled analgesia ratio predicts 24-hour morphine consumption and pain in children undergoing scoliosis surgery

2014 ◽  
Vol 10 (1) ◽  
pp. 39 ◽  
Author(s):  
Clyde T. Matava, MBCHB ◽  
Mark W. Crawford, MBBS ◽  
Carolyne Pehora, RN ◽  
Basem Naser, MD ◽  
Conor McDonnell, MBCHB
Keyword(s):  
Side Effects ◽  
Postoperative Pain ◽  
Hospital Stay ◽  
Univariate Analysis ◽  
Morphine Consumption ◽  
Scoliosis Surgery ◽  
Patient Controlled Analgesia ◽  
Duration Of Hospital Stay ◽  
Pain Scores ◽  
Severe Postoperative Pain

Background: The identification of patients at risk for developing severe postoperative pain and/or opioid-related side effects is difficult due to a lack of sensitive indicators. The patient-controlled analgesia (PCA) ratio of demands to deliveries is a potential tool for early identification of patients who experience severe postoperative pain. The authors hypothesized that the PCA ratio is able to predict morphine requirement in the first 24 hours after scoliosis surgery.Methods: The authors performed a retrospective study of adolescents who had surgery for idiopathic scoliosis. They collected data describing PCA demands and deliveries, morphine consumption, numerical rating scale (NRS) pain scores, opioidrelated side effects, and duration of hospital stay. Spearman rank analysis assessed association among 4-hour PCA ratios, NRS pain score, and 24-hour morphine consumption. Patients were divided into groups on the basis of PCA ratios <1.5 and ≥1.5. Univariate analysis and multiple regression were used to identify independent factors predictive for increased 24-hour morphine. Mann-Whitney rank-sum and Fisher exact tests were used to compare data. p < 0.05 was considered statistically significant.Results: One hundred forty-seven patients were included in the analysis, mean (SD) age and weight were 15 (1.8) years and 55 (27) kg, respectively. There was a significant positive correlation between the 4-hour PCA ratio and initial 24-hour cumulative morphine consumption (r = 0.33, p = 0.0002). Patients with a 4-hour PCA ratio ≥1.5 demonstrated a significantly greater initial 24-hour morphine consumption (p = 0.0002), greater pain scores at 24 hours after surgery (p = 0.02), a greater incidence of at least one opioid-related side effect within the initial 24 hours after surgery, and a longer duration of hospital stay (p = 0.04) compared with those patients with a 4-hour PCA ratio <1.5. PCA ratio ≥1.5, age, and patient sex were predictive for 24-hour morphine consumption.Conclusions: The authors have demonstrated that a PCA ratio of demands/deliveries ≥1.5 is predictive of increased opioid requirements and is associated with greater pain scores in the initial 24 hours after surgery, an increased incidence of opioid-related side effects, and duration of hospital stay.

scholarly journals Can Combination of Peripheral Nerve Block and Non-opioidal Patient Controlled Analgesia Be an Effective Postoperative Pain Control Method?

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0023
Author(s):  
Chan Kang ◽  
Gi Soo Lee ◽  
Dong Yeol Kim ◽  
Jeong-kil Lee ◽  
Ki Jun Ahn ◽  
...  
Keyword(s):  
Side Effects ◽  
Postoperative Pain ◽  
Pain Control ◽  
Control Method ◽  
Patient Controlled Analgesia ◽  
Ultrasound Guided ◽  
Bone Surgery ◽  
Pain Scores ◽  
Group A ◽  
Group B

Category: Ankle, Pain medicine Introduction/Purpose: Even though bone surgery is very painful after operation, there is no established method to control postoperative pain due to efficacy and side effects. Ultrasound-guided peripheral nerve block (PNB) and nonsteroidal anti- inflammatory drugs (NSAIDs) patient controlled analgesia (PCA) can effectively control pain and reduce side effects. Methods: We conducted a prospective study of 150 patients over 18 years of age who underwent bone surgery from June 2018 to December 2018. All operations were performed under anesthetic ultrasound-guided PNB and additional PNB was performed to control postoperative pain. Among the 120 patients who participated in the final study, NSAIDs PCA was used in group A (65 patients) and NSAIDs PCA was not used in group B (55 patients) for pain control. Postoperative management except PCA was same in both groups. Pain scores are measured at 6, 12, 18, 24, 36, 48, and 72 hours after the operation and they were compared using visual analogue scale (VAS) pain scores. Survey was done on satisfaction of patients, and their willingness to reconsider same method of pain control when they undergo same surgery next time. Also, we evaluated possible side effects that might happen during process of controlling pain. Results: VAS pain score were significantly different only at 24 h postoperatively (p=0.004). In Group A, three patients were prescribed 3 amples of pethidine intramuscular injection as rescue analgesic. In group B, 35 patients were prescribed 50 amples of pethidine and 12 patients of them were received additional 18 amples of ketorolac intramuscular injection as rescue analgesic(p=0.000). In group A, all patients were satisfied with the pain control method, but 5 of the group B patients were dissatisfied (p=0.001). 3 patients responded to severe pain after operation and 2 of them due to postoperative nausea and vomiting (PONV). In group A, there were no patients complaining of PONV, but in group B, 5 patients complained of symptoms (p=0.018), and 3 of them were prescribed additional antiemetics (p=0.093). Conclusion: Combined use of ultrasound-guided PNB and NSAIDs PCA seems to be an effective postoperative pain control method in foot and ankle surgery. Because, pain can be effectively controlled and PONV can be reduced.

Comparison of the effect of adding remifentanil to patient-controlled tramadol or morphine for postoperative analgesia after major abdominal surgery

2018 ◽  
Vol 5 (5) ◽  
pp. 247 ◽  
Author(s):  
Hakki Unlugenc, MD ◽  
Sibel Tetiker, MD ◽  
Selim Büyükkurt, MD ◽  
Tayfun Guler, MD ◽  
Geylan Isik, MD
Keyword(s):  
Side Effects ◽  
Abdominal Surgery ◽  
Outcome Measure ◽  
Major Abdominal Surgery ◽  
Morphine Consumption ◽  
Patient Controlled Analgesia ◽  
Double Blind ◽  
Rescue Analgesia ◽  
Pain Scores ◽  
To Receive

Objective: In this study, the authors investigated the effect of the addition of remifentanil to tramadol or morphine for patient-controlled analgesia (PCA).Design: Prospective, randomized, double-blind, controlled study.Setting: University Hospital.Patients, participants: The authors randomly allocated 133 patients undergoing major abdominal surgery to receive IV PCA with tramadol alone, tramadol plus remifentanil, morphine alone or morphine plus remifentanil.Interventions: Bolus doses of tramadol (0.2 mg/kg), tramadol (0.2 mg/kg) plus remifentanil (0.2 μg/kg), morphine (0.02 mg/kg), or morphine (0.02 mg/kg) plus remifentanil (0.2 μg/kg) were available every 10 minutes without time limit or background infusion.Main outcome measure(s): Discomfort, sedation, pain scores, side effects, and total and bolus tramadol and morphine consumption were recorded for up to 24 hours after the start of PCA.Results: Pain scores at rest and movement were greater with tramadol alone than in the other groups at 1, 2, and 6 hours (p < 0.0125). The addition of remifentanil reduced cumulative tramadol consumption at 6, 12, and 24 hours, but not morphine consumption. More patients required supplementary rescue analgesia with meperidine, and with greater dosage, with tramadol alone (p < 0.001), and the incidence of nausea was greater with tramadol alone. The addition of remifentanil not only significantly improved discomfort scores in remifentanil groups, but also increased the degree of sedation in morphine-remifentanil group.Conclusions: After major abdominal surgery, adding remifentanil to PCA tramadol resulted in better pain scores, lower analgesic consumption, and fewer side effects when compared with tramadol alone. However, analgesic outcome with remifentanil was not prominent in MR group as much as in TR group.

Intercostal nerve block in pediatric minimally invasive thoracic surgery

2012 ◽  
Vol 19 (3) ◽  
pp. 150-153 ◽  
Author(s):  
Laura Lukošienė ◽  
Lina Kalibatienė ◽  
Vidmantas Barauskas
Keyword(s):  
Side Effects ◽  
Nerve Block ◽  
Intercostal Nerve ◽  
Early Postoperative Period ◽  
Morphine Consumption ◽  
Single Shot ◽  
Intercostal Nerve Block ◽  
Pain Scores ◽  
Severe Postoperative Pain ◽  
Minimally Invasive Thoracic Surgery

Background. Very severe postoperative pain is observed after minimal­ ly invasive repair of pectus excavatum (MIRPE), extremely in the early postoperative period. Pain is usually managed by either thoracic epidu­ ral block (TEB) or intravenous patient-controlled analgesia (PCA) with opioids. But the issue of optimal pain management is still controversial. The purpose of our study was to investigate efficiency and side effects of intercostal nerve block (ICNB) in children after MIRPE in comparison with only PCA. Materials and methods. Records of 20 patients, given PCA with mor­ phine (PCA group), were examined retrospectively. 27 patients, given in­ traoperative ICNB (single shot) and PCA with morphine (ICNB group), were examined prospectively. Postoperatively, we recorded morphine consumption, pain scores and side effects every 3 hours. Results. There was no need of the initial dose of morphine in the ICNB group. Pain scores during the first 3 hours, morphine consumption dur­ ing the first 3 hours and during 12 hours after surgery were significantly higher in the PCA group (p 

scholarly journals Reduced Postoperative Pain and Complications after a Modified Multidisciplinary Approach for Bariatric Surgery

2013 ◽  
Vol 5 (1) ◽  
pp. 60-64 ◽  
Author(s):  
Rachel A. Karlnoski ◽  
Collin Sprenker B.S ◽  
Suvikram Puri ◽  
Ren Chen ◽  
Devanand Mangar ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Pain Management ◽  
Postoperative Pain ◽  
Hospital Stay ◽  
Medical Center ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Pain Scores ◽  
Operative Care ◽  
Analgesic Regimen

Background: There are considerable implications for pain management in morbidly obese patients undergoing weight loss operations. The purpose of this study was to determine if a modified postoperative analgesic regimen and a dedicated postoperative bariatric team reduced pain scores, length of stay and postoperative complications. Materials and Methods: We performed a retrospective analysis of morbidly obese patients admitted to our medical center for laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic adjustable gastric banding (LAGB). Our previous postoperative pain regimen was ketorolac (30 mg IV plus 15 mg q6h) and patient controlled analgesia (PCA) morphine and was converted to ketorolac (30 mg IV and 30 mg i.m, plus 15 mg q6h), and IV PCA hydromorphone. Visual analog scale (VAS) pain scores from the post-operative care unit were collected retrospectively. The bariatric team was led by a nurse practitioner consisted of a psychologist, exercise physiologist, and nutritionist. Results: Eighty-five patients underwent bariatric operations in the year prior to implementation of the revised postoperative pain management regimen and 372 patients underwent bariatric surgery in the 2 years following implementation. Patient age, gender and BMI were evenly distributed for both groups. Mean VAS scores on postoperative days 1 through 5 were significantly lower after implanting our modified pain regimen (p<0.0001). Pain scores were significantly higher for patients that underwent LRYGB compared to LAGB (p<0.0001). Overall, length of hospital stay was unaffected by the new pain regimen, however a significant reduction was found in patients that underwent LAGB (0.8 days less; p=0.0001). Conclusion: Use of our modified pain regimen resulted in a more effective analgesic protocol and a reduction of hospital stay, without added complications or side effects.

scholarly journals Long-term outcomes and prognostic factor analysis of resected Siewert type II adenocarcinoma of esophagogastric junction in China: a seven-year study

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Yiding Feng ◽  
Youhua Jiang ◽  
Qiang Zhao ◽  
Jinshi Liu ◽  
Hangyu Zhang ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Adjuvant Chemotherapy ◽  
Blood Transfusion ◽  
Hospital Stay ◽  
Tumor Size ◽  
Esophagogastric Junction ◽  
Perineural Invasion ◽  
Univariate Analysis ◽  
Rank Test ◽  
Duration Of Hospital Stay

Abstract Background The incidence rate of adenocarcinoma of the esophagogastric junction (AEG) has significantly increased over the past two decades. Surgery remains the only curative treatment. However, there are currently few studies on Chinese AEG patients. The purpose of this study was to retrospectively analyze the survival and prognostic factors of AEG patients in our center. Methods Between January 2008 and September 2014, 249 AEG patients who underwent radical resection were enrolled in this retrospective study, including 196 males and 53 females, with a median age of 64 (range 31–82). Prognostic factors were assessed with the log-rank test and Cox univariate and multivariate analyses. Results The 5-year survival rate of all patients was 49%. The median survival time of all enrolled patients was 70.1 months. Pathological type, intraoperative blood transfusion, tumor size, adjuvant chemotherapy, duration of hospital stay, serum CA199, CA125, CA242 and CEA, pTNM stage, lymphovascular or perineural invasion, and the ratio of positive to negative lymph nodes (PNLNR) were significantly associated with overall survival when analyzed in univariate analysis. Conclusions Our study found that adjuvant chemotherapy, PNLNR, intraoperative blood transfusion, tumor size, perineural invasion, serum CEA, and duration of hospital stay after surgery had significance in multivariate analysis and were independent risk factors for survival.

scholarly journals Comparison of Postoperative Renal Function between Non-Steroidal Anti-Inflammatory Drug and Opioids for Patient-Controlled Analgesia after Laparoscopic Nephrectomy: A Retrospective Cohort Study

2020 ◽  
Vol 9 (9) ◽  
pp. 2959
Author(s):  
Jiwon Han ◽  
Young-Tae Jeon ◽  
Ah-Young Oh ◽  
Chang-Hoon Koo ◽  
Yu Kyung Bae ◽  
...  
Keyword(s):  
Renal Function ◽  
Serum Creatinine ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Laparoscopic Nephrectomy ◽  
Complication Rates ◽  
Patient Controlled Analgesia ◽  
Pain Scores ◽  
Postoperative Renal Function ◽  
Anti Inflammatory

Non-steroidal anti-inflammatory drugs (NSAIDs) can be used as opioid alternatives for patient-controlled analgesia (PCA). However, their use after nephrectomy has raised concerns regarding possible nephrotoxicity. This study compared postoperative renal function and postoperative outcomes between patients using NSAID and patients using opioids for PCA in nephrectomy. In this retrospective observational study, records were reviewed for 913 patients who underwent laparoscopic or robot-assisted laparoscopic nephrectomy from 2015 to 2017. After propensity score matching, 247 patients per group were analyzed. Glomerular filtration rate (GFR) percentages (postoperative value divided by preoperative value), blood urea nitrogen (BUN)/creatinine ratios, and serum creatinine percentages were compared at 2 weeks, 6 months, and 1 year after surgery between users of NSAID and users of opioids for PCA. Additionally, postoperative complication rates, postoperative acute kidney injury (AKI) incidences, postoperative pain scores, and lengths of hospital stay were compared between groups. Postoperative GFR percentages, BUN/creatinine ratios, and serum creatinine percentages were similar between the two groups. There were no significant differences in the rates of postoperative complications, incidences of AKI, and pain scores at 30 min, 6 h, 48 h, or 7 days postoperatively. The length of hospital stay was significantly shorter in the NSAID group than in the opioid group. This study showed no association between the use of NSAID for PCA after laparoscopic nephrectomy and the incidence of postoperative renal dysfunction.

Combinations of Morphine with Ketamine for Patient-controlled Analgesia

2003 ◽  
Vol 98 (5) ◽  
pp. 1195-1205 ◽  
Author(s):  
Gorazd Sveticic ◽  
Andrea Gentilini ◽  
Urs Eichenberger ◽  
Martin Luginbühl ◽  
Michele Curatolo
Keyword(s):  
Lumbar Spine ◽  
Side Effects ◽  
Drug Concentration ◽  
Optimization Procedure ◽  
Hip Surgery ◽  
Patient Controlled Analgesia ◽  
Pain Scores ◽  
Lockout Interval ◽  
Novel Method ◽  
Low Incidence

Background According to previous studies, the addition of ketamine to morphine for intravenous patient-controlled analgesia (PCA) may be beneficial. The authors developed and applied a new model to optimize the combination of morphine, ketamine, and a lockout interval for PCA after lumbar spine and hip surgery. Methods One-hundred two patients undergoing lumbar spine or hip surgery participated in the study. The analgesic effect of PCA during 48 h after surgery was optimized under restrictions dictated by side effects. Initially, eight combinations of morphine, ketamine (expressed as drug concentration in the solution administered), and a lockout interval (i.e., minimal allowed time between two consecutive PCA boluses) were empirically chosen and investigated. To determine subsequent combinations, an optimization model was applied until three consecutive steps showed no decrease in pain score. Results The authors analyzed 12 combinations with an allowed morphine and ketamine range in a PCA solution of 0-2 mg/ml and a lockout interval range of 5-12 min. During the optimization procedure, a reduction in mean pain scores with a low incidence of side effects was observed. The procedure converged to a morphine-to-ketamine ratio of 1:1 and a lockout interval of 8 min. Conclusions Using a novel method to analyze drug combinations, the study supports combinations of morphine with ketamine in a ratio of 1:1 and a lockout interval of 8 min for postoperative PCA following spine and hip surgery.

scholarly journals Continuous Fentanyl Background Infusion Regimen Optimised by Patient-Controlled Analgesia for Acute Postoperative Pain Management: A Randomised Controlled Trial

2020 ◽  
Vol 9 (1) ◽  
pp. 211 ◽  
Author(s):  
Jihoon Hwang ◽  
Sang Kee Min ◽  
Yun Jeong Chae ◽  
Gang Mee Lim ◽  
Han Bum Joe
Keyword(s):  
Pain Management ◽  
Side Effects ◽  
Postoperative Pain ◽  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Postoperative Pain Management ◽  
Patient Controlled Analgesia ◽  
Acute Postoperative Pain ◽  
Background Infusion ◽  
Randomised Controlled

Owing to a lack of studies investigating the effect of adjustments in fentanyl background infusion (BI) with patient-controlled analgesia (PCA) on postoperative analgesia, we evaluated three BI regimens with fentanyl PCA for acute postoperative pain management. This randomised controlled trial enrolled 105 patients, who were assigned to three parallel groups: constant rate BI of 2 mL/h (CRBI group); time-scheduled decremental BI of 6, 2 and 1 mL/h (TDBI group); and BI rates optimised to the demand of PCA (POBI group). The incidence of insufficient analgesia, visual analogue scale (VAS) pain score and side effects were evaluated. The incidence of insufficient analgesia in the post-anaesthesia care unit was lower in the TDBI and POBI groups than the CRBI group. Incidence of insufficient analgesia in the ward was lower in the POBI group than the CRBI group. Postoperative VAS scores were significantly lower in the TDBI and POBI groups for up to 4 h and 24 h, respectively, compared with the CRBI group. Side effects and infused fentanyl dose were highest in the CRBI group. Adjusting BI rate based on time or patient demands could improve postoperative analgesia and reduce side effects. Compared to a constant BI rate, PCA-optimised BI achieved higher patient satisfaction.

scholarly journals A multicentre, prospective, observational cohort study of variation in practice in perioperative analgesia strategies in elective laparoscopic colorectal surgery (the LapCoGesic study)

2020 ◽  
Vol 102 (1) ◽  
pp. 28-35
Author(s):  
L Brown ◽  
M Gray ◽  
B Griffiths ◽  
M Jones ◽  
A Madhavan ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Colorectal Surgery ◽  
Outcome Measure ◽  
Enhanced Recovery ◽  
Laparoscopic Colorectal Surgery ◽  
Patient Controlled Analgesia ◽  
Thoracic Epidural ◽  
Pain Scores ◽  
Patient Reported ◽  
Observational Cohort

Introduction Enhanced recovery programmes are established as an essential part of laparoscopic colorectal surgery. Optimal pain management is central to the success of an enhanced recovery programme and is acknowledged to be an important patient reported outcome measure. A variety of analgesia strategies are employed in elective laparoscopic colorectal surgery ranging from patient-controlled analgesia to local anaesthetic wound infiltration catheters. However, there is little evidence regarding the optimal analgesia strategy in this cohort of patients. The LapCoGesic study aimed to explore differences in analgesia strategies employed for patients undergoing elective laparoscopic colorectal surgery and to assess whether this variation in practice has an impact on patient-reported and clinical outcomes. Materials and methods A prospective, multicentre, observational cohort study of consecutive patients undergoing elective laparoscopic colorectal resection was undertaken over a two-month period. The primary outcome measure was postoperative pain scores at 24 hours. Data analysis was conducted using SPSS version 22. Results A total of 103 patients undergoing elective laparoscopic colorectal surgery were included in the study. Thoracic epidural was used in 4 (3.9%) patients, spinal diamorphine in 56 (54.4%) patients and patient-controlled analgesia in 77 (74.8%) patients. The use of thoracic epidural and spinal diamorphine were associated with lower pain scores on day 1 postoperatively (P < 0.05). The use of patient-controlled analgesia was associated with significantly higher postoperative pain scores and pain severity. Discussion Postoperative pain is managed in a variable manner in patients undergoing elective colorectal surgery, which has an impact on patient reported outcomes of pain scores and pain severity.

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