Acute Pain Management In Patients Research Articles

Erector Spinae Plane Blocks with Dexmedetomidine and Dexamethasone for the Treatment of Pain Associated with Rib Fractures: Case Report

BACKGROUND: The erector spinae plane block (ESPB) is an ultrasound-guided approach for acute pain management in patients with single or multiple rib fractures. The addition of a dexmedetomidine and dexamethasone (Dex-Dex) solution to an ESPB injection has been shown to provide longer-lasting pain control in rib-fracture patients. Adding a Dex-Dex adjunct to an ESPB injection diminishes the need for more invasive techniques used in longer-lasting pain management, such as ESPB catheter placements. CASE REPORT: We present 2 cases of rib fractures, one in a 79-year-old woman and the other in an 82-year-old-man. Both patients received a single ESPB injection with Dex-Dex to provide longer-lasting pain control. After the procedure, both patients reported a significant reduction in pain and no complications to the intervention. CONCLUSION: The successful analgesic management of both patients’ conditions suggests that a single ESPB injection with Dex-Dex can be used as an alternative to traditional management techniques such as catheter placements. KEY WORDS: Erector spinae plane block, dexmedetomidine and dexamethasone, rib fractures, respiratory distress

Shared Decision Making in Acute Pain Management in Patients with Opioid Use Disorder: A Scoping Review.

The treatment of acute pain over the years has changed with increasing alternative therapies and increased scrutiny of opioid prescriptions. Shared Decision Making (SDM) has become a vital tool in increasing patient engagement and satisfaction in treatment decisions. SDM has been successfully implemented in the management of pain in a variety of settings; however, information regarding the use of SDM for treating acute pain in patients with a history of opioid use disorder (OUD) remains scarce. Following the Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Reviews (PRISMA-ScR), we conducted a review to understand how SDM is used in acute pain management in patients with OUD. We searched Medline, Embase, CINAHL, and PsychInfo databases for relevant articles. Articles were screened and SDM outcomes of eligible articles were charted. The results were grouped by sub-theme based on a 1997 SDM model. There were three original research studies and one quality improvement study. The remaining articles were split evenly between reviews and reviews of clinical guidelines. Four themes emerged from the review: prior judgment and stigma related to OUD, trust and sharing of information, clinical tools, and interprofessional teams. This scoping review consolidated and expounded the current literature on SDM in the management of acute pain in patients with OUD. More work is needed to address prior judgments by both providers and patients and to build greater dialogue. Clinical tools may aid this process as well as the involvement of a multidisciplinary team.

An Appraisal of Using Opioids in Patients with Opioid Use Disorder.

Podiatric physicians have come to realize that opioid use disorder (OUD) is a public health crisis causing morbidity, mortality, lost productivity, and legal cost in the United States. Opioid analgesics are efficient first-line pain relievers for acute and chronic lower-extremity pain syndrome. Perioperative pain management strategies have been proposed using opioid stewardship, but there are few standardized protocols to guide podiatric medical providers treating patients with OUD. First, we describe the pharmacology of therapeutic agents used as medications for addiction treatment for OUD and substance use disorder (SUD). Second, we offer criteria for selecting acute pain and perioperative management in patients with OUD and SUD per current medical literature. Finally, we review the literature applying opioid stewardship in the context of prescribing opioid analgesics in the presence of OUD and SUD. Three hypothetical clinical scenarios grounded in clinical-based literature are described with congruent data and founded guidelines. The first and second scenarios describe acute pain and perioperative management in patients with OUD receiving methadone and buprenorphine-naloxone, respectively. The third scenario describes acute pain and perioperative management in a patient with SUD receiving intravenous naltrexone. We hope that the lower-extremity specialist will appreciate that thoughtful management of acute perioperative pain among patients who receive medications for addiction treatment for OUD is critically important given the risks of destabilization during the perioperative period. The literature reveals the lack of rigorous evidence on acute pain management in patients who receive medication for OUD; however, some clinical evidence supports the practice of continuing methadone or buprenorphine for most patients during acute pain episodes.

Acute Care Physical Therapy and Sickle Cell Disease

Background and Purpose: Vaso-occlusive crises (VOC) are the most common cause for hospitalization in children and adolescents with sickle cell disease (SCD) in the United States. Physical therapy interventions provide nonpharmacological pain management and help hospitalized patients maintain mobility and function, but little is known about their application to the unique pathophysiology of those with SCD. The purpose of this review is to summarize evidence relevant to the physical therapy management of children and adolescents hospitalized with VOC. Methods: A literature search of PubMed, Cochrane, CINAHL, and EMBASE databases was performed using key words relevant to physical therapy interventions for children and adolescents with SCD and acute pain. Results: Sixteen articles were included in this review. Interventions identified included heat, mobilization, transcutaneous electrical nerve stimulation, massage, yoga, mindfulness, breathing exercises, virtual reality, incentive spirometry, and patient/family education. Conclusions: Physical therapists may be able to aid in the acute pain management of patients with SCD. Current literature relies on small observational studies making generalization difficult. Future studies are critical to improve evidence-based physical therapy practice in this population.

A Potential Role for Steroids in Acute Pain Management in Patients with Trigeminal Neuralgia

Effective therapies for acute pain management in trigeminal neuralgia (TN) are limited. We aimed to investigate the role of steroids in TN patients experiencing acute pain flares. We retrospectively reviewed patients presenting to the emergency department of a tertiary care institution between 2014 and 2020 for acute TN pain flares. Patients were divided into those who received steroids versus those who did not. Presenting characteristics, admission and surgical intervention rates, Barrow Neurological Institute pain scores, pain recurrence rates, and surgical intervention within 6 months of discharge were obtained for each patient. Our cohort comprised 151 patients, of whom 40 (26.5%) received steroids before admission and/or discharge. These patients were less likely to undergo surgical intervention to treat acute pain (P= 0.023). Specifically, patients receiving steroids were less likely to undergo combined glycerin and radiofrequency rhizotomy compared with patients not receiving steroids (P= 0.012). Frequency and dosage of opioid administration did not differ between groups. The steroids group demonstrated a lower average Barrow Neurological Institute pain score on discharge compared with the no steroids group (P= 0.013). Patients receiving steroids for acute pain management were less likely to undergo surgical intervention within 6 months of discharge than patients who did not receive steroids (P= 0.033). Steroid administration in patients with acute TN pain flares may reduce the likelihood of surgical intervention both during admission and within 6 months of discharge. Future prospective studies should examine the efficacy of steroids as an adjunctive medication in acute TN pain management.

Management of opioid use disorder and associated conditions among hospitalized adults: A Consensus Statement from the Society of Hospital Medicine.

Hospital-based clinicians frequently care for patients with opioid withdrawal or opioid use disorder (OUD) and are well-positioned to identify and initiate treatment for these patients. With rising numbers of hospitalizations related to opioid use and opioid-related overdose, the Society of Hospital Medicine convened a working group to develop a Consensus Statement on the management of OUD and associated conditions among hospitalized adults. The guidance statement is intended for clinicians practicing medicine in the inpatient setting (e.g., hospitalists, primary care physicians, family physicians, advanced practice nurses, and physician assistants) and is intended to apply to hospitalized adults at risk for, or diagnosed with, OUD. To develop the Consensus Statement, the working group conducted a systematic review of relevant guidelines and composed a draft statement based on extracted recommendations. Next, the working group obtained feedback on the draft statement from external experts in addiction medicine, SHM members, professional societies, harm reduction organizations and advocacy groups, and peer reviewers. The iterative development process resulted in a final Consensus Statement consisting of 18 recommendations covering the following topics: (1) identification and treatment of OUD and opioid withdrawal, (2) perioperative and acute pain management in patients with OUD, and (3) methods to optimize care transitions at hospital discharge for patients with OUD. Most recommendations in the Consensus Statement were derived from guidelines based on observational studies and expert consensus. Due to the lack of rigorous evidence supporting key aspects of OUD-related care, the working group identified important issues necessitating future research and exploration.

Fascia Iliaca Block in Hip and Femur Fractures to Reduce Opioid Use

BackgroundFascia iliaca compartment block (FICB) has become a keystone technique for acute pain management in patients with hip and proximal femur fractures. ObjectivesTo demonstrate that administering FICB preoperatively to patients with hip or proximal femur fractures in the emergency department (ED) is likely to reduce opioid use and related complications, and to decrease hospital length of stay (LOS). MethodsAn unblinded study of adult patients with hip and proximal femur fractures who consented to receive an FICB with 30 cc of bupivacaine with epinephrine administered in the ED. We compared this group with a contemporaneous group of controls who only received systemic opioids. Over the course of approximately 6 months, main outcome measured between the two groups was amount of morphine equivalents given from block administration until 8 h after. We also compared complications such as delirium, constipation, and bleeding rates (oozing from injection site or hematoma formation). ResultsA total of 166 patients with hip and proximal femur fractures from August 12, 2018 to April 25, 2021; 81 received FICB plus systemic opioids, and 85 received only systemic opioids. Among the FICB group, morphine equivalents were reduced by 0.6 mg/h with no significant difference in LOS. A statistically significant difference in opioid-related adverse outcomes was found between the anticoagulated group vs. the no anticoagulation group. ConclusionsFICB is a safe and effective preoperative technique for initial pain management in patients with hip and proximal femur fractures, as it can also be used with additional systemic opioids. FICB administration may reduce systemic opioid use preoperatively, thus reducing opioid-related adverse effects with no significant impact on hospital LOS.

COMPARISION OF LANDMARK GUIDED FEMORAL NERVE BLOCK AND SYSTEMIC INTRAVENOUS ANALGESIA FOR PAIN RELIEF IN TRAUMATIC SHAFT FEMUR FRACTURE.

Background: Femoral nerve block is useful technique for acute pain relief in case of fracture shaft femur in comparison to systemic analgesia. a) To study and compare whether femoral nerve block is more efficaciousAims and Objective: in pain management of femoral shaft fractures than systemic intravenous analgesia. b) To study the duration of action of femoral nerve block for pain relief in femoral shaft fractures. c) To notify any complication. 60Materials and Methods: patients of ASA I and II, aged 20-60 years, having fracture traumatic shaft femur at either level (mid, upper, lower) were studied after admission of patient in emergency ward. They were randomly allocated to group A (n-30, femoral nerve block using 15 ml 2% Lignocaine) and group B (n-30, systemic analgesia using Inj. Paracetamol 1 gm). Each case was subsequently followed up for onset and total duration of analgesia till 6 hrs. Efficacy in both groups was assessed by visual analogue scale. There is no significant difference in onset of action between both theResults and Summary: groups. The duration of action in group A was more (4.08±1.06 hours) than group B (2.18±1.24hours). Visual analogue score showed significant pain reduction in group A after 15 minutes and also at 180 minutes (p=0.000) in comparison with group B. femoral nerve block is safe, simple and more efficacious procedure in comparison toConclusion: systemic IV analgesia for acute pain management in patients with fracture shaft femur.

Pre-pperative low intensity vestibular shockwave therapy (LiSWT) decreases opioid use post-vestibulectomy: A pilot study

ABSTRACT Introduction Surgeons performing complete vestibulectomy with vaginal advancement flap reconstruction for suspected neuroproliferative vestibulodynia (NPV) take into consideration the need for acute pain relief in the early postoperative period as well as risks for persistent post-operative opioid use. Post-operative acute pain has traditionally been managed with narcotics which are effective but are highly addictive and can cause unwanted side effects including nausea/vomiting, impaired mental function, and severe constipation/obstipation. We serendipitously observed that one patient who tried to avoid surgery by undergoing numerous vestibular low intensity shockwave therapy (LiWST) treatments used very few narcotics post vestibulectomy. LiWST is FDA-cleared for pain amelioration. It has been hypothesized that LiSWT downregulates inflammatory cytokines, promotes enhancement of blood flow and angiogenesis through expression of vascular endothelial growth factor and nitric oxide synthesis. Objective We performed a pilot study using pre-operative LiSWT to determine whether or not it might decrease post-operative opioid use (oxycodone/acetaminophen tablets; 5mg/325mg) for acute pain management in patients undergoing complete vestibulectomy with vaginal advancement flap for suspected NPV. Method We studied the post-op opioid use of women who underwent complete vestibulectomy at our facility during the period January 1, 2019 through June 30, 2021. We assessed opioid use based on the patient's recall of the total oxycodone/acetaminophen tablets required in the first 30 days post-vestibulectomy. When possible, patients confirmed the use by counting tablets left in the pill container. Women scheduled to undergo vestibulectomy for suspected NPV were placed in the LiSWT study group if they agreed to undergo vestibular LiSWT treatment daily for the three business days immediately pre-operatively. Using the Urogold 100™MTS, LiSWT involved delivery of 1800 shocks to the vestibule per session, energy flux density 0.05-0.1 mJ/mm2, 3 Hz, membrane pressure 3. We compared the post-op opioid use by women in the LiSWT study group to the use by women who did not undergo pre-op LiSWT. Results Forty-five women (mean age 28 years; range 17 - 57) underwent complete vestibulectomy for suspected NPV during the 30 month period. Twenty women (mean age 27 +/- 9 years) agreed to undergo pre-op LiSWT and post-op opioid use was obtained in all. Twenty-five women (mean age 29 +/- 11 years) did not undergo pre-op LiSWT and opioid use was obtained in 19/25 (76%). Mean post-operative opioid use was 47 +/- 13 (range 25 - 90) tablets in those vestibulectomy patients who did not undergo pre-op vestibular LiSWT; opioid side effects included constipation, nausea, fainting, drowsiness, fatigue, and blurred vision. Mean post-op opioid use was 22 +/- 10 (range 1 - 26) tablets in the 20 vestibulectomy patients who did undergo pre-op vestibular LISWT sessions; opioid side effects were restricted to constipation, sleepiness, and nausea. Conclusion In this pilot study, pre-operative low intensity shockwave therapy decreased post-operative opioid use after complete vestibulectomy with vaginal advancement flap. While encouraging, more research is needed. Disclosure Work supported by industry: no.

A Pilot Study of Pre-Operative Vestibular Low Intensity Shockwave Therapy to Decrease Opioid Use Post-Vestibulectomy

ABSTRACT Introduction Surgeons performing complete vestibulectomy with vaginal advancement flap reconstruction for suspected neuroproliferative vestibulodynia (NPV) take into consideration the need for acute pain relief in the early postoperative period as well as risks for persistent post-operative opioid use. Post-operative acute pain has traditionally been managed with narcotics which are effective but are highly addictive and can cause unwanted side effects including nausea/vomiting, impaired mental function, and severe constipation/obstipation. We serendipitously observed that one patient who tried to avoid surgery by undergoing numerous vestibular low intensity shockwave therapy (LiWST) treatments used very few narcotics post vestibulectomy. LiWST is FDA-cleared for pain amelioration. It has been hypothesized that LiSWT downregulates inflammatory cytokines, promotes enhancement of blood flow and angiogenesis through expression of vascular endothelial growth factor and nitric oxide synthesis. Objective We performed a pilot study using pre-operative LiSWT to determine whether or not it might decrease post-operative opioid use (oxycodone/acetaminophen tablets; 5mg/325mg) for acute pain management in patients undergoing complete vestibulectomy with vaginal advancement flap for suspected NPV. Methods We studied the post-op opioid use of women who underwent complete vestibulectomy at our facility during the period January 1, 2019 through June 30, 2021. We assessed opioid use based on the patient's recall of the total oxycodone/acetaminophen tablets required in the first 30 days post-vestibulectomy. When possible, patients confirmed the use by counting tablets left in the pill container. Women scheduled to undergo vestibulectomy for suspected NPV were placed in the LiSWT study group if they agreed to undergo vestibular LiSWT treatment daily for the three business days immediately pre-operatively. Using the Urogold 100™MTS, LiSWT involved delivery of 1800 shocks to the vestibule per session, energy flux density 0.05-0.1 mJ/mm2, 3 Hz, membrane pressure 3. We compared the post-op opioid use by women in the LiSWT study group to the use by women who did not undergo pre-op LiSWT. Results Forty-five women (mean age 28 years; range 17 - 57) underwent complete vestibulectomy for suspected NPV during the 30 month period. Twenty women (mean age 27 +/- 9 years) agreed to undergo pre-op LiSWT and post-op opioid use was obtained in all. Twenty-five women (mean age 29 +/- 11 years) did not undergo pre-op LiSWT and opioid use was obtained in 19/25 (76%). Mean post-operative opioid use was 47 +/- 13 (range 25 - 90) tablets in those vestibulectomy patients who did not undergo pre-op vestibular LiSWT; opioid side effects included constipation, nausea, fainting, drowsiness, fatigue, and blurred vision. Mean post-op opioid use was 22 +/- 10 (range 1 - 26) tablets in the 20 vestibulectomy patients who did undergo pre-op vestibular LISWT sessions; opioid side effects were restricted to constipation, sleepiness, and nausea. Conclusions In this pilot study, pre-operative low intensity shockwave therapy decreased post-operative opioid use after complete vestibulectomy with vaginal advancement flap. While encouraging, more research is needed. Disclosure No

Acute Pain Management for a Tibial Plateau Fracture Shortly After a Buprenorphine XR Depot Injection: A Case Report

Acute pain management of patients on buprenorphine for opioid use disorder remains a challenge. The buprenorphine extended-release depot injection which lasts for 1 month and has a higher plasma concentration of buprenorphine compared to the sublingual formulation is increasingly being used in patients. Acute pain management of patients on buprenorphine depot remains a challenge because waiting for the washout of the medication is not feasible and discontinuation is challenging because it requires surgical excision. We describe here the pharmacokinetics of the buprenorphine depot formulation and the clinical implications of its long duration of action. A 39-year-old woman with a history of alcohol and opioid use disorder, on buprenorphine depot, was admitted to the hospital with a left tibial plateau fracture. Acute pain service managed her pain by utilizing a multimodal analgesia plan including femoral and popliteal nerve catheters, intravenous patient-controlled analgesia and oral opioid and nonopioid medications. The patient had a prolonged length of stay of 11 days but was successfully weaned off nerve catheters and intravenous medications and converted to an oral medication regiment such that she could be discharged from the acute care hospital.

Acute Pain Assessment Inadequacy in the Emergency Department: Patients' Perspective.

For many patients, acute pain is a common cause to seek treatment in an Emergency Department (ED). An inadequate assessment could cause inappropriate pain management. The aim of this study was to describe and explain patients’ perceptions of acute pain assessment in the Emergency Department. The data were collected from ED patients (n = 114). Patients reported that nurses were asking about intensity of pain at rest, but only 52% during movement. According to the patients, the most common tools to assess acute pain were the verbal rating scale (VRS; 54% of patients), numerical rating scale (NRS; 28% of patients), and visual analogue scale (VAS; 9.7% of patients). Over twenty per cent of patients stated that ED nurses did not ask about the intensity of pain after analgesic administration. Twenty-four per cent of the patients were not pleased with nursing pain assessment in the ED. The assessment of acute pain is still inadequate in the ED. Therefore, ED nurses need to be more attentive to systematic acute pain management of patients in the ED.

The Use of Virtual Reality for Managing Chronic Tinnitus

The Use of Virtual Reality for Managing Chronic Tinnitus

Managing Acute Pain in Patients Taking Medication for Opioid Use Disorder: a Rapid Review.

Managing acute pain in patients with opioid use disorder (OUD) on medication (methadone, buprenorphine, or naltrexone) can be complicated by patients' higher baseline pain sensitivity and need for higher opioid doses to achieve pain relief. This review aims to evaluate the benefits and harms of acute pain management strategies for patients taking OUD medications and whether strategies vary by OUD medication type or cause of acute pain. We systematically searched multiple bibliographic sources until April 2020. One reviewer used prespecified criteria to assess articles for inclusion, extract data, rate study quality, and grade our confidence in the body of evidence, all with second reviewer checking. We identified 12 observational studies-3 with control groups and 9 without. Two of the studies with control groups suggest that continuing buprenorphine and methadone in OUD patients after surgery may reduce the need for additional opioids and that ineffective pain management in patients taking methadone can result in disengagement in care. A third controlled study found that patients taking OUD medications may need higher doses of additional opioids for pain control, but provided insufficient detail to apply results to clinic practice. The only case study examining naltrexone reported that postoperative pain was managed using tramadol. We have low confidence in these findings as no studies directly addressed our question by comparing pain management strategies and few provided adequate descriptions of the dosage, timing, or rationale for clinical decisions. We lack rigorous evidence on acute pain management in patients taking medication for OUD; however, evidence supports the practice of continuing methadone or buprenorphine for most patients during acute pain episodes. Well-described, prospective studies of adjuvant pain management strategies when OUD medications are continued would add to the existing literature base. Studies on nonopioid treatments are also needed for patients taking naltrexone. PROSPERO; CRD42019132924.

Intravenous Lidocaine for Acute Pain: A Single-Institution Retrospective Study.

BackgroundIn the perioperative period, intravenous lidocaine has been used as an opioid-sparing systemic analgesic with additional anti-inflammatory and anti-hyperalgesic properties.ObjectiveThe aim of this retrospective study was to review the utilization, efficacy, and safety of intravenous lidocaine on our Acute Pain Service (APS) and identify surgical and patient populations where this intervention was found to be useful.Patients and MethodsThis retrospective study was designed to assess acute pain management in patients who received an intravenous lidocaine infusion between February 2013 and December 2017. Data collected included demographics, surgery type, infusion duration, pain scores, analgesic consumption, and adverse effects. Pain scores included rest and active pain scores and were analyzed by surgical model and subgroups. Clinically important differences (CIDs) in pain were determined by changes in pain score difference of ≥ 2 (11-point scale) or ≥ 30% reduction in pain intensity. A patient was considered to have a true CID if a CID was observed with rest and/or active pain scores at both first to second (4–24 h) and first to final time point (4 h to infusion end) comparisons.ResultsIn total, 544 patients received intravenous lidocaine during this period, and 394 were included in the final analysis. The average (± standard deviation) duration of infusion was 68.60 ± 49.52 h. Surgical specialties included gastrointestinal surgery (41%), orthopedics (28%), neurosurgery (15%), vascular surgery (10%), and others (6%). Overall, 56.1% of the study population experienced a CID, with reduced pain scores at rest and/or with activity. CIDs were also observed in patients with chronic pain (53.5%) and when intravenous lidocaine was used as a rescue technique (69.6%). Within the rescue cohort, opioid-dependent and opioid-naïve patients experienced 23.0% and 45.6% reductions, respectively, in their 8-h intravenous opioid consumption. In total, 37 patients in the study experienced transient signs of mild local anesthetic toxicity, which resolved with infusion titration (conservative) management. One serious adverse event required intervention, and the patient was successfully resuscitated.ConclusionsThis retrospective study at a single institution with an APS policy for intravenous lidocaine in the postoperative period identifies benefits of intravenous lidocaine in certain surgical and patient populations. The findings need to be confirmed with further research.

Continuation of Buprenorphine to Facilitate Postoperative Pain Management for Patients on Buprenorphine Opioid Agonist Therapy

Background: Acute pain management in patients on buprenorphine opioid agonist therapy (BOAT) can be challenging. It is unclear whether BOAT should be continued or interrupted for optimization of postoperative pain control. Objectives: To determine an evidence-based approach for pain management in patients on BOAT in the perioperative setting, particularly whether BOAT should be continued or interrupted with or without bridging to another mu opioid agonist and to identify benefits and harms of either perioperative strategy. Study Design: Systematic literature review with qualitative data synthesis. Setting: Hospital, perioperative. Methods: The study protocol was registered on PROSPERO (Registration number 9030276355). Medline via OVID, EMBASE, CINAHL, and the Cochrane CENTRAL register of trials were searched for prospective or retrospective observational or controlled studies, case series, and case reports that described perioperative or acute pain care for patients on BOAT. References of narrative and systematic reviews addressing acute pain management in patients on BOAT and references of included articles were hand-searched to identify additional original articles for inclusion. The full text of publications were reviewed for final inclusion, and data were extracted using a standardized data extraction form. Results were summarized qualitatively. Primary outcomes were postoperative pain intensity and total opioid use and identification of benefits and harms of perioperative strategies. Results: Eighteen publications presenting data on the perioperative management of patients on BOAT were identified: 10 case reports, 5 case series, and 3 retrospective cohort studies. Eleven articles reported continuation of BOAT, 2 concerned bridging BOAT, and 4 articles described stopping BOAT without planned bridging. In one retrospective cohort study, BOAT was continued in half and interrupted in half of patients. Patients on BOAT may have pain that is more difficult to treat than those who are not on OAT. There is no clear evidence that one particular strategy provides superior postoperative pain control, but interruption of BOAT may result in harm, including failure to return to baseline BOAT doses, continuing non-BOAT opioid use, or relapse of opioid use disorder. Limitations: There were a limited number of articles relevant to the study question consisting of case reports and retrospective observational studies. Some omitted relevant details. No prospective studies were found. Conclusions: There is no clear benefit to bridging or stopping BOAT but failure to restart it may pose concerns for relapse. We recommend continuing BOAT in the perioperative period when possible and incorporating an interdisciplinary approach with multimodal analgesia. Key words: Opioid use disorder, opiate substitution treatment, buprenorphine, buprenorphinenaloxone, buprenorphine opioid agonist therapy, postoperative pain, acute pain, multimodal analgesia

863 Drug Addiction and Opioid Use in the Acute Burn Patient

Abstract Introduction In light of the opioid crisis, there is an increased interest in the acute pain management of patients with history of drug addiction. There is no consensus on pain management among different burn centers and the amount of narcotic prescription reportedly doubled over a seven year period according to Tully in 20191. Our aim was to study the association of previous drug addiction history and the treatment of acute burn patients with special interest on the daily morphine equivalent requirements. Methods A prospectively maintained database was queried to study acute burn patients admitted in a reference burn center from 2013 to 2018. Patients with a previous history of drug addiction (group 1) were compared to patients without it (group 2). Drug abuse was defined as patients with history of opioids abuse, heroin, cocaine, cannabis, inhalants, and alcoholism, specifically those with diagnostic codes on file. The expected mortality was calculated using the Premier® database. A p0.05 was considered significant. Results A total of 3046 patients were studied, 502 (16.5%) had previous history of drug abuse on file. Compared to group 2, group 1 had: more males - 343 (68.3%) vs 1456 (57.2%) p0.001; was younger - 45.7914.65 vs 52.0219.57 p0.001; required intubation at a higher rate - 100 (19.9%) vs 329 (12.9%) p0.001; longer intubation period - 2.4310.05 vs 1.377.71 p0.001; had a prolonged admission - 13.8728.82 vs 8.4816.58 p0.001; more surgeries - 1.213.30 vs 0.71.58 p=0.002, and a higher daily morphine milligram equivalent requirement - 148.34320.56 vs 56.0297.81 p0.001. The groups had similar expected mortality rates: 3.03% vs 3.56%p=0.483; which may be partly explained by the fact that the drug use history is not accounted for on the formula. No significant difference was seen on the burned area between the groups. Conclusions Drug addiction was associated with increased need for intubation and length of intubation, prolonged admission, increased surgery rate and a higher daily morphine equivalent usage. Further studies are necessary guide the treatment of the specific needs of these increasingly common burn patients subgroup and also to define the need of including the history of drug use on the expected mortality rate formula. Applicability of Research to Practice This study adds to the literature differences in the treatment of burn patients with history of drug addiction and highlights the need for specific protocols for improved care.

Oxycodone intravenous for acute pain management in modified radical mastectomy

Oxycodone hydrochloride is a semisynthetic opioid which extracted from the baine plant, with a similar analgesic potency compared with morphine. Although oxycodone was introduced in 1917, the global use of oxycodone in acute postoperative management became popular in the past decades. Oxycodone has a bioavailability up to twice from the bioavailability of morphine in the enteral route and shows more potency in visceral pain. Furthermore, oxycodone has better pharmacokinetics in the central nervous system than morphine and has less adverse effects. In this case series, we report the effects of analgesia, inflammatory markers, and adverse effects of continued intravenous oxycodone as acute pain management in patients who underwent a modified radical mastectomy.

Acute Pain Management in Patients Treated With Buprenorphine

Acute Pain Management in Patients Treated With Buprenorphine

Acute Pain Management in Patients on Opioid Replacement Therapy

Acute Pain Management in Patients on Opioid Replacement Therapy