Benefit Of Analgesia Score Research Articles

The Impact of Preoperative Combined Pectoserratus and/or Interpectoral Plane (Pectoralis Type II) Blocks on Opioid Consumption, Pain, and Overall Benefit of Analgesia in Patients Undergoing Minimally Invasive Cardiac Surgery: A Prospective, Randomized, Controlled, and Triple-blinded Trial

ObjectiveAcute postoperative pain remains a major obstacle in minimally invasive cardiac surgery (MICS). Evidence of the analgesic benefit of chest wall blocks is limited. This study aimed to assess the influence of combined pectoserratus-plane-block plus interpectoral-plane-block (PSPB+IPPB) on postoperative pain and overall benefit of analgesia compared to placebo. DesignProspective, randomized, triple-blinded. SettingThe operating room, intensive care unit of a university hospital Participants60 patients undergoing elective right-lateral MICS. InterventionsPatients were randomly assigned to preoperative PSPB+IPPB with 30 ml ropivacaine 0.5% or saline. Measurements and Main resultsThe primary endpoint was total intravenous morphine milligram equivalents administered in the first 24 hours after extubation (24 h - ivMME). Secondary endpoints included the Overall Benefit of Analgesia Score (OBAS) at 24h after extubation and repeated visual analogue scale (VAS). 24 hours - ivMMEs were significantly lower (median (IQR): 4.2 mg (2.1 – 7.9) versus 8.3 mg (4.2 - 15.7); p = 0.025; mean difference: 6.7 mg (0.94-12 mg), p = 0.024; Cohen's d: 0.64 (0.09-1.2)). Moreover, OBAS at 24 hours and VAS after extubation were significantly lower (4.0 (3.0 – 6.0) versus 7.0 (3.0 – 9.0), p = 0.043; 0.0 cm (0.0 - 2.0) versus 1.5 cm (0.3 - 3.0); p = 0.030). VAS did not differ between groups at later points. ConclusionsPre-operative PSPB+IPPB reduced 24 hours post-extubation opioid consumption, pain at extubation and OBAS. Given its low risk and expedient placement, it could be a helpful addition to MICS protocols. Future studies should evaluate these findings in multicenter settings, and further elucidate the optimal timing of block placement.

The effectiveness of ambulatory continuous popliteal sciatic nerve blockade on patient-reported overall benefit of analgesia in patients undergoing foot or ankle surgery (CAREFREE trial); a randomized, open label, non-inferiority trial

Study objectiveManagement of pain after foot and ankle surgery remains a concern for patients and healthcare professionals. This study determined the effectiveness of ambulatory continuous popliteal sciatic nerve blockade, compared to standard of care, on overall benefit of analgesia score (OBAS) in patients undergoing foot or ankle surgery. We hypothesized that usage of ambulatory continuous popliteal sciatic nerve blockade is non-inferior to standard of care. DesignSingle center, randomized, non-inferiority trial. SettingTertiary hospital in the Netherlands. PatientsPatients were enrolled if ≥18 years and scheduled for elective inpatient foot or ankle surgery. InterventionPatients were randomized to ambulatory continuous popliteal sciatic nerve blockade or standard of care. MeasurementsThe primary outcome was the difference in OBAS, which includes pain, side effects of analgesics, and patient satisfaction, measured daily from the first to the third day after surgery. A non-inferiority margin of 2 was set as the upper limit for the 90% confidence interval of the difference in OBAS score. Mixed-effects modeling was employed to analyze differences in OBAS scores over time. Secondary outcome was the difference in opioid consumption. Main resultsPatients were randomized to standard of care (n = 22), or ambulatory continuous popliteal sciatic nerve blockade (n = 22). Analyzing the first three postoperative days, the OBAS was significantly lower over time in the ambulatory continuous popliteal sciatic nerve blockade group compared to standard of care, demonstrating non-inferiority (−1.9 points, 90% CI -3.1 to −0.7). During the first five postoperative days, patients with ambulatory continuous popliteal sciatic nerve blockade consumed significantly fewer opioids over time compared to standard of care (−8.7 oral morphine milligram equivalents; 95% CI -16.1 to −1.4). ConclusionsAmbulatory continuous popliteal sciatic nerve blockade is non-inferior to standard of care with single shot popliteal sciatic nerve blockade on patient-reported overall benefit of analgesia.

The impact of PECS II blockade in patients undergoing minimally invasive cardiac surgery—a prospective, randomized, controlled, and triple-blinded trial

BackgroundClassic neuraxial techniques, such as thoracic epidural anesthesia, or alternative approaches like the paravertebral block, are not indicated in cardiac surgery due to increased bleeding risk. To provide satisfactory analgesia without the need for excessive opioid use, novel ultrasound techniques gained popularity and are of growing interest. The pectoralis nerve block II (PECS II) has been shown to provide good postoperative analgesia in modified radical mastectomy and might also be suitable for minimally invasive cardiac surgery.MethodsIn a single center, prospective, triple-blinded, two-group randomized trial, 60 patients undergoing elective, unilateral minimal invasive cardiac surgery will be randomized to receive a PECS II with 30 ml of ropivacaine 0.5% (intervention group) or sodium chloride 0.9% (placebo group). The primary outcome parameter is the overall opioid demand given as intravenous morphine milligram equivalents (MME) during the first 24 h after extubation. Secondary endpoints are the visual analog scale (VAS) 2, 4, 6, 8, 12, and 24 h after extubation, the Overall Benefit of Analgesia Score (OBAS) after 24 h, the interval until extubation, and intensive care unit (ICU) discharge within 24 h, as well as the length of hospital stay (LOS).DiscussionThis prospective randomized, controlled, and triple-blinded trial aims to assess if a PECS II with ropivacaine 0.5% helps to decrease the opioid demand in the first 24 h and increases postoperative pain control after minimally invasive cardiac surgery.Trial registrationwww.clinicaltrialsregister.eu; EudraCT Nr: 2021–005452-11; Lukas Gasteiger MD, November 18, 2021.

Sublingual Sufentanil versus Standard-of-Care (Patient-Controlled Analgesia with Epidural Ropivacaine/Sufentanil or Intravenous Morphine) for Postoperative Pain Following Pancreatoduodenectomy: A Randomized Trial.

BackgroundThe optimal treatment strategy for postoperative pain following pancreatoduodenectomy remains unknown. The aim of this study was to investigate whether sublingual sufentanil tablet (SST) is a non-inferior analgesic compared to our standard-of-care (patient-controlled epidural analgesia [PCEA] or PCA morphine) in the treatment of pain following pancreatoduodenectomy.MethodsThis was a pragmatic, strategy, open-label, non-inferiority, parallel group, randomized (1:1) trial. The primary outcome was an overall mean pain score (Numerical Rating Scale: 0–10) on postoperative days 1 to 3 combined. The non-inferiority margin was −1.5 since this difference was considered clinically relevant.ResultsBetween October 2018 and July 2021, 190 patients were assessed for eligibility and 36 patients were included in the final analysis: 17 patients were randomized to SST and 19 patients to standard-of-care. Early treatment failure in the SST group occurred in 2 patients (12%) due to inability to operate the SST system and in 2 patients (12%) due to severe nausea despite antiemetics. Early treatment failure in the standard-of-care group occurred in 2 patients (11%) due to preoperative PCEA placement failure and in 1 patient (5%) due to hemodynamic instability caused by PCEA. The mean difference in pain score on postoperative day 1 to 3 was −0.10 (95% CI −0.72–0.52), and therefore the non-inferiority of SST compared to standard-of-care was demonstrated. The mean pain score, number of patients reporting unacceptable pain (pain score >4), Overall Benefit of Analgesia Score, and patient satisfaction per postoperative day, perioperative hemodynamics and postoperative outcomes did not differ significantly between groups.ConclusionThis first randomized study investigating the use of SST in 36 patients following pancreatoduodenectomy showed that SST is non-inferior compared to our standard-of-care in the treatment of pain on postoperative days 1 to 3. Future research is needed to confirm that these findings are applicable to other settings.

Liposomal Bupivacaine Plus Bupivacaine Versus Ropivacaine Plus Dexamethasone Brachial Plexus Blockade for Arthroscopic Rotator Cuff Repair: An Unblinded Randomized Controlled Trial.

Background:Brachial plexus blockade is utilized for pain control during arthroscopic rotator cuff repair. The purpose of the present study was to evaluate brachial plexus blockade with liposomal bupivacaine plus bupivacaine (LB+B) as compared with ropivacaine plus dexamethasone (R+D) for arthroscopic rotator cuff repair. Our hypothesis was that the use of LB+B would result in lower pain scores and opioid consumption as compared with R+D.Methods:We performed a randomized controlled trial of 45 patients receiving ultrasound-guided brachial plexus blockade with LB+B and 44 patients receiving R+D prior to arthroscopic rotator cuff repair. The “worst pain” score in a 24-hour period, oral morphine equivalent dose (OMED), and overall benefit of analgesia score (OBAS) were recorded for 8 days following surgery.Results:Patient-reported “worst pain” was significantly lower in the LB+B group as compared with the R+D group on postoperative day 0 through day 5. OMED was significantly less for all 8 days studied, with an average cumulative 8-day OMED of 48.5 milligram equivalents in the LB+B group as compared with 190.1 milligram equivalents in the R+D group (p < 0.001). The OBAS score was significantly lower in the LB+B group as compared with R+D group on all postoperative days. The use of LB+B for brachial plexus blockade resulted in a 4% complication rate in a population of patients predominantly with American Society of Anesthesiologists (ASA) scores of 1 and 2.Conclusions:The use of LB+B for brachial plexus blockade during arthroscopic rotator cuff repair was associated with a significant and sustained decrease in the “worst pain” score, opioid consumption, and OBAS compared with R+D. LB+B for brachial plexus blockade also exhibited a strong safety profile.Level of Evidence:Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Liposomal Bupivacaine vs Ropivacaine for Adductor Canal Blocks in Total Knee Arthroplasty: A Prospective Randomized Trial.

The purpose of this study is to determine the benefit of the analgesic liposomal bupivacaine compared to ropivacaine, by assessing pain and joint stiffness, and total oral opioid consumption by milligram morphine equivalent (MME) after total knee arthroplasty. Patients were randomized to receive either the study drug (liposomal bupivacaine admixed with bupivacaine) or the control drug (ropivacaine) in an adductor canal block. Only the anesthesiologist performing the block was aware of which arm of the study the patient was randomized to. MME, pain, Knee injury and Osteoarthritis Outcome Score Joint Replacement, and overall benefit of analgesia scores were recorded 24, 48, and 72hours post-surgery either face-to-face or via telephone depending on patient discharge status. One hundred patients were enrolled into the study and analyzed: 54 in the control group and 46 in the experimental group. Primary outcomes measured were pain as a numerical rating scale, MME, and length of stay in hours. Secondary outcomes were joint pain and stiffness recorded as Knee injury and Osteoarthritis Outcome Score Joint Replacement outcome and overall benefit of analgesia score. No statistically significant between-group differences were observed for any measured outcome. We did not find any supporting evidence that liposomal bupivacaine yields increased pain relief following total knee arthroplasty compared to the control drug, ropivacaine.

Erector Spinae Plane Block for Perioperative Pain Control and Short-term Outcomes in Lumbar Laminoplasty: A Randomized Clinical Trial.

BackgroundSpine surgery causes severe pain and can be associated with significant opioid utilization; however, the evidence for opioid-sparing analgesic techniques such as erector spinae plane (ESP) block from controlled studies is limited. We aimed to investigate the analgesic effects of ESP block in lumbar laminoplasty.MethodsIn this prospective, double-blind, controlled single-center trial, 62 consecutive elective lumbar laminoplasty patients were randomized into either a control group (Group G, N=32) or a treatment group (Group E, N=30). Group G received general anesthesia and multimodal analgesia, similar to group E, while Group E received additional bilateral ESP block after induction of general anesthesia. The primary outcome was postoperative pain scores for the first 48 h after surgery, and the secondary outcomes analyzed included intraoperative anesthetic usage, perioperative analgesic consumption, return of bowel function and satisfaction for acute pain management indicated by overall benefit of analgesia score (OBAS).ResultsSignificant differences in pain scores over time were found between the two groups (P=0.010), with Group E patients having significantly lower pain scores than Group G during the first six hours (P=0.000). The opioid consumption in Group G was significantly higher than in Group E both intraoperatively (P=0.000) and postoperatively (P=0.0005). Group E patients had lower intraoperative sevoflurane requirement, improved satisfaction with pain management, and earlier return of bowel function than Group G patients.ConclusionESP block is effective in reducing postoperative pain scores and lowering opioid utilization (both intraoperatively and postoperatively), resulting in improved patient satisfaction for pain management in lumbar laminoplasty.

Bupivacaine Extended-Release Liposomal Injection Versus Bupivacaine HCl for Early Postoperative Pain Control Following Wrist Operations: A Prospective, Randomized Control Trial

This study evaluated pain control after wrist operations using a long-acting local anesthetic, liposomal bupivacaine, compared with the standard local anesthetic, bupivacaine HCl. Patients undergoing elective carpometacarpal joint arthroplasty and proximal row carpectomy were eligible. Those meeting inclusion criteria were enrolled before surgery and were randomized to receive an intraoperative injection of liposomal bupivacaine or bupivacaine HCl. Primary outcomes included intraoperative and postoperative opioid requirements and pain levels. On the first 4 postoperative days, phone contact assessed pain level by numeric rating scale, number of opioids taken in each 24-hour period, and efficacy of anesthesia and opioid side effects with overall benefit of analgesia score. Postoperative pain scores for 52 patients measured by numeric rating scale demonstrated that liposomal bupivacaine and bupivacaine HCl were similar for pain control. Painscores and opioid use were similar during the first 4 postoperative days. Opioid use on day 1 was slightly lower with liposomal bupivacaine. There were no statistically significant differences in any postoperative outcome between groups. Liposomal bupivacaine and bupivacaine HCl have similar effects in the treatment of early postoperative pain after trapeziometacarpal suspension arthroplasty and proximal row carpectomy. Neither drug demonstrated a clear advantage in this study. Therapeutic II.

2938 Abdominal ICE Following Laparoscopic Hysterectomy: A Randomized Controlled Trial

Study Objective To assess impact of abdominal ice packs on opioid use and pain control following laparoscopic hysterectomy. Design Randomized controlled trial. Setting Academic tertiary care medical center. Patients or Participants One-hundred-forty-two adult women undergoing laparoscopic (either conventional or robotic) hysterectomy were randomized to control (n=69) or intervention (n=73). Exclusion criteria included preoperative opioid use, planned ICU admission or same-day discharge, an incision ³4 cm, and regional anesthesia use. Interventions Subjects in the intervention group had a large ice pack placed directly on the lower abdomen prior to leaving the operating room. The ice pack was maintained continuously for twelve hours post-op, as desired thereafter until discharge, and continued use encouraged after discharge for up to 48 hours. Measurements and Main Results Total opioids administered postoperatively while inpatient and after dismissal were assessed in morphine metabolic equivalents (MME). Postoperative pain, as well as analgesia acceptability and side effects, were assessed using validated measures, the Brief Pain Inventory (BPI) and Overall Benefit of Analgesia Score (OBAS). Median MME was lower in the intervention group compared to controls from inpatient stay on the floor to completion of opioid use as outpatient (22.5 vs 26.2), but was not statistically significant (p=0.79). There was no significant difference between groups in BPI assessment of postoperative pain severity (p=0.80) or pain interference (p=0.36) or OBAS total score (p=0.88). The majority in the intervention group were very satisfied with ice pack use (n=51, 79.7%) and very likely to recommend to friends or family (n=54, 83.1%). There were no adverse events related to ice pack use. Conclusion There was no significant difference in postoperative opioid use or pain assessment with ice pack use following laparoscopic hysterectomy. However, the majority of subjects expressed high satisfaction with this intervention and would recommend use to others, suggesting potential desirability as adjunct therapy in postoperative pain control.

Postoperative Analgesic Requirement and Pain Perceptions after Nonaerodigestive Head and Neck Surgery.

Little data exist on associations between patient factors and postoperative analgesic requirement after head and neck (H&N) surgeries. Such information is important for optimizing postoperative care considering concerns regarding opioid misuse. We analyzed factors associated with narcotic use and pain perception following H&N surgery sparing the upper aerodigestive tract. Prospective cohort. Tertiary referral center. From May to October 2017, data were collected for patients undergoing nonaerodigestive H&N procedures requiring hospitalization. Patients completed a preoperative survey querying chronic pain history, narcotic usage, and postoperative pain expectation. Demographics, surgical data, postoperative narcotic use defined by morphine milligram equivalents (MME), pain scores, and Overall Benefit of Analgesia Score (OBAS) were analyzed. Seventy-six patients, 44 (57.9%) females and 32 (42.1%) males with a mean age of 54.0 years, met inclusion criteria. The most common procedures were parotidectomy (27.6%) and total thyroidectomy (19.7%). Average cumulative 24-hour postoperative MME and calculated MME per hospital day (MME/HD, cumulative MME for hospitalization divided by length of stay) were 40.5 ± 30.6 and 60.8 ± 60.1, respectively. Average pain score throughout the initial 24 hours after surgery was 3.7/10 ± 2.0. Female sex and prior chronic pain diagnosis were associated with higher OBAS after multivariate linear adjustments. Postoperative narcotic requirement in nonaerodigestive H&N surgery is overall low. Female sex and prior chronic pain diagnosis may be associated with higher postoperative OBAS, a validated assessment of pain and opioid-related side effects. This study may serve as a comparison for future studies evaluating narcotic-sparing analgesia and pain perception in nonaerodigestive H&N surgery.

A 3-arm randomized clinical trial comparing interscalene blockade techniques with local infiltration analgesia for total shoulder arthroplasty

The ideal analgesic modality for total shoulder arthroplasty (TSA) remains controversial. We hypothesized that a multimodal analgesic pathway incorporating continuous interscalene blockade (ISB) provides better analgesic efficacy than both single-injection ISB and local infiltration analgesia. This single-center, parallel, unblinded, randomized clinical trialevaluated 129 adults undergoing primary TSA. Patients were allocated to single-injection ISB, continuous ISB, or local infiltration analgesia. The primary outcome was the Overall Benefit of Analgesia Score (range, 0 [best] to 28 [worst]) on postoperative day 1. Additional outcomes included pain scores, opioid consumption, quality of life, and postoperative complications in the first 24 hours, at 3 months, and at 1 year. We analyzed 125 patients (42 with single-injection ISB, 41 with continuous ISB, and 42 with local infiltration analgesia). The Overall Benefit of Analgesia Score was significantly improved in the continuous group (median [25th percentile, 75th percentile], 0 [0, 2]) compared with the single-injection group (2 [1, 4]; P = .002) and local infiltration analgesia group (3 [2, 4]; P < .001). Pain scores were significantly lower in the continuous group compared with the local infiltration analgesia group (P < .001 for all time points)and after 12 hours from ward arrival compared with the single-injection group (median [25th percentile, 75th percentile], 1.0 [0.0, 2.8] vs. 2.5 [0.0, 4.0]; P = .016). After postanesthesia recovery discharge, opioid consumption (oral morphine equivalents) was significantly lower in the continuous group (median [25th percentile, 75th percentile], 7.5 mg [0.0, 25.0 mg]) than in the local infiltration analgesia group (30 mg [15.0, 52.5 mg]; P < .001) and single-injection group (17.6 mg [7.5, 45.5 mg]; P = .010). No differences were found across groups for complications, 3-month outcomes, and 1-year outcomes. Continuous ISB provides superior analgesia compared with single-injection ISB and local infiltration analgesia in the first 24 hours after TSA.

Comparison of different methods of postoperative analgesia after thoracotomy-a randomized controlled trial.

Continuous thoracic epidural analgesia (TEA) is a preferred method of postoperative analgesia in thoracic surgery. Intravenous patient-controlled analgesia (IVPCA) may be an effective alternative. One of the most commonly used opioids in PCA is morphine. It has high antinociceptive efficacy but is associated with many adverse events. Oxycodone can be an alternative. A small number of scientific reports comparing morphine and oxycodone in PCA for the treatment of acute postoperative pain after thoracotomy was the reason to conduct this study. Prospective, randomised, observational study. In total of 99 patients scheduled for elective thoracotomy were randomized into three study groups. TEA group received continuous TEA as a method of postoperative pain management, morphine (MF) group received morphine IVPCA, and morphine (OXY) group oxycodone IVPCA. For 48 hours' hemodynamic parameters, level of pain, sedation and the need for rescue analgesia were monitored. After 48 hours' patients were asked about their satisfaction with pain treatment using Likert scale and assessment of opioid related adverse events via overall benefit of analgesia score (OBAS). The level of pain in visual analogic score (VAS) and Prince Henry Hospital Pain Score (PHHPS) scales was significantly lower in TEA group with no significant difference between groups MF and OXY. Using morphine in PCA was associated with a significantly higher likelihood of need of rescue analgesia. The level of sedation in Ramsay scale was significantly higher in MF compared to OXY and TEA group. There were no significant differences between groups in OBAS scale. TEA group was characterized by the highest degree of patient satisfaction. TEA provided superior anaesthesia compared to PCA in our study group. Use of PCA oxycodone in postoperative pain management after open thoracotomy provides similar nociception control compared to morphine but is associated with less sedation and patients using oxycodone IVPCA require smaller doses of rescue analgesia compared to systemic morphine IVPCA.

Pruritus and postoperative nausea and vomiting after intrathecal morphine in spinal anaesthesia for caesarean section: Prospective cohort study

Background: Spinal anaesthesia is a common anaesthetic technique for caesarean sections. Neuraxial opioids such as intrathecal morphine may cause common adverse effects (pruritus, post-operative nausea and vomiting). Objectives: We investigated the incidence, severity and need for treatment of pruritus and post-operative nausea and vomiting following administration of intrathecal morphine in spinal anaesthesia for caesarean section at KK Women’s and Children’s Hospital, Singapore. Methods: We conducted a prospective study involving 124 parturients who received intrathecal morphine in spinal anaesthesia for caesarean section from October 2012 to October 2014. Results: Seventy patients (56.5%) had moderate or severe pruritus (score 4–10), while 54 patients (43.5%) had no or mild pruritus (score 0–3). Mean (SD) value of the worst pruritus score reported on a scale of 0–10 was 4 (2.59). Only seven out of the 124 patients (5.6%) required treatment for pruritus. With respect to distress and bother from itching in the past 24 hours on a score of 0–4, the mean score reported was 1.7 (1.23). Fourteen (11.2%) patients reported vomiting, dry-retching and nausea. Six (4.8%) patients had nausea that interfered with activities of daily living. Four (3.2%) patients had clinically significant post-operative nausea and vomiting. Seven (5.6%) patients received anti-emetics. The average Overall Benefit of Analgesia Score was 3.8 (SD 2.6, min–max: 0–15). The average (SD) maternal satisfaction with pain relief and side effects was 84.9% (9.9%). Conclusion: There is a high incidence of pruritus, with most women reporting moderate to severe pruritus. The incidence of post-operative nausea and vomiting is low, and women reported good maternal satisfaction.

Multimodal Analgesia in Outpatient Head and Neck Surgery

Importance Perioperative analgesia strategies that rely solely on narcotics may contribute to adverse effects and concerns about opioid abuse or dependence. Multimodal analgesia protocols incorporating nonnarcotic agents may reduce the need for postoperative narcotic use. Objective To evaluate the feasibility and safety of a multimodal analgesia protocol for outpatient head and neck surgical procedures and to identify the association of the multimodal analgesia protocol with postoperative pain perception scores and patient satisfaction. Design, Setting, and Participants Retrospective evaluation of prospectively collected data on adults who underwent outpatient thyroid, parathyroid, and parotid surgery between July 2016 and February 2017 at the head and neck surgery service of a tertiary care hospital using a multimodal analgesia strategy with use of immediate preoperative acetaminophen and gabapentin, and intention to treat with a nonnarcotic postoperative outpatient analgesia strategy. Main Outcomes and Measures Overall patient satisfaction scores, Overall Benefit of Analgesia Score (OBAS), and median resting and peak pain scores were recorded. Incidence of reliance on a narcotic-based postoperative outpatient analgesia strategy and adverse events related to altered analgesia strategy were identified. Results Sixty-four patients (48 [75%] female; mean [SD] age, 54.6 [14.3] years) underwent outpatient thyroid, parathyroid, or parotid surgery with use of a multimodal analgesia protocol. On a 10-point rating scale, patients reported low resting pain perception scores (median, 2 [range, 0-8]) and peak pain scores (median, 4 [range, 0-9]). The OBAS assessment for composite effectiveness of analgesia indicated a favorable median score of 1 (range, 0-10; permissible range, 0-28, with lower scores better). Thirty-nine (61%) patients were able to avoid postoperative narcotic use on discharge. Fifty-six (88%) patients reported “high” or “very high” satisfaction with the multimodal analgesia strategy. No complications related to bleeding, hematoma, significant adverse events, or readmissions were observed. Conclusion and Relevance A multimodal analgesia strategy was feasible and safe in patients undergoing outpatient head and neck surgery and may reduce the need for narcotic use. It was associated with low pain perception scores, favorable OBAS, and overall satisfaction scores. The role of multimodal analgesia needs additional evaluation through comparative effectiveness assessment vs conventional pain management strategies.

Pharmacogenetics-guided analgesics in major abdominal surgery: Further benefits within an enhanced recovery protocol

ObjectiveEffective, narcotic sparing analgesia is a major component of Enhanced Recovery Protocols (ERP), however the risk of poor analgesia and opioid related side effects (ORADE) remains an issue related to poor outcomes and satisfaction, and is strongly related to the risk of narcotic dependence after surgery. A variety of genes can impact narcotic and non-steroidal (NSAID) drug efficacy including: the CYP family (drug metabolism-narcotics and NSAID), or COMT/ABCB1/OPRM1 (functional receptor and transport activity for analgesia vs side effects). The purpose of this study was to perform the first assessment of the impact of a pharmacogenetics (PGx) guided selection of analgesics following major abdominal surgery within an ERP. MethodsA consecutive series of open and laparoscopic colorectal resections or major ventral hernia repair (PGx group) had a guided analgesic protocol based upon assessment of CYP1A2, CYP2C19, CYP2C9, CYP2D6, CYP3A4, CYP3A5, COMT, OPRM1, and ABCB1 genes. Study patients were compared to a recent historical series of patients (H group) managed using our well validated ERP. The primary outcome measure was the Overall Benefit of Analgesia Score (OBAS). Pain scores were also assessed. ResultsThe data demonstrated a similar mix of procedures and gender between groups and more than half of the PGx group had revised analgesia from the standard ERP. The PGx group demonstrated significantly lower OBAS scores (p = 0.0.1) from POD1 (3.8 vs 5.4) through POD 5 (3.0 vs 4.5) Analgesia was also superior for the PGx group from POD1 through POD 5 (p = 0.04). ConclusionPharmacogenetics guidance resulted in frequent modifications of the analgesic program, resulting in excellent analgesia with a 50% reduction in narcotic consumption, and a reduced incidence of analgesic related side effects compared to our standard ERP. These data suggest further improvement in ERP resulting from a patient centric analgesic, reduced narcotic regimen which provides early and durable pain control with fewer narcotic related side effects.

Comparison of Visual Analog Scale for Pain with the Overall Benefit of Analgesia Score and the Brief Pain Inventory with Narcotic Usage and Opioid-Related Adverse Events

Comparison of Visual Analog Scale for Pain with the Overall Benefit of Analgesia Score and the Brief Pain Inventory with Narcotic Usage and Opioid-Related Adverse Events

Effects of parecoxib on analgesia benefit and blood loss following open prostatectomy: a multicentre randomized trial.

BackgroundThis multi-centre, prospective, randomized, double-blind, placebo-controlled study was designed to test the hypotheses that parecoxib improves patients’ postoperative analgesia without increasing surgical blood loss following radical open prostatectomy.Methods105 patients (64 ± 7 years old) were randomized to receive either parecoxib or placebo with concurrent morphine patient controlled analgesia. Cumulative opioid consumption (primary objective) and the overall benefit of analgesia score (OBAS), the modified brief pain inventory short form (m-BPI-sf), the opioid-related symptom distress scale (OR-SDS), and perioperative blood loss (secondary objectives) were assessed.ResultsIn each group 48 patients received the study medication for 48 hours postoperatively. Parecoxib significantly reduced cumulative opioid consumption by 24% (43 ± 24.1 mg versus 57 ± 28 mg, mean ± SD, p=0.02), translating into improved benefit of analgesia (OBAS: 2(0/4) versus 3(1/5.25), p=0.01), pain severity (m-BPI-sf: 1(1/2) versus 2(2/3), p < 0.01) and pain interference (m-BPI-sf: 1(0/1) versus 1(1/3), p=0.001), as well as reduced opioid-related side effects (OR-SDS score: 0.3(0.075/0.51) versus 0.4(0.2/0.83), p=0.03). Blood loss was significantly higher at 24 hours following surgery in the parecoxib group (4.3 g⋅dL−1 (3.6/4.9) versus (3.2 g⋅dL−1 (2.4/4.95), p=0.02).ConclusionsFollowing major abdominal surgery, parecoxib significantly improves patients’ perceived analgesia. Parecoxib may however increase perioperative blood loss. Further trials are needed to evaluate the effects of selective cyclooxygenase-2 inhibitors on blood loss.Trial registrationClinicalTrials.gov Identifier: NCT00346268

Parecoxib and Paracetamol for Pain Relief following Minor Day-Stay Gynaecological Surgery

Paracetamol and non-steroidal anti-inflammatory drugs are often administered for postoperative analgesia. Dilatation and curettage, with or without hysteroscopy, is a common day-stay procedure that is associated with pain that is partly mediated by prostaglandins. This study aimed to investigate the analgesic efficacy of adjunctive paracetamol and parecoxib in this setting. A randomised, blinded, placebo-controlled, single-centre trial was conducted among 240 women undergoing dilatation and curettage. Patients were randomised intraoperatively into one of four groups, to receive either intravenous paracetamol 2 g, intravenous parecoxib 40 mg, both in combination, or placebos, post-induction and with intravenous fentanyl. The primary endpoints were pain score one hour postoperatively and the Overall Benefit of Analgesia Score. There were no statistically significant differences in primary outcomes across groups. The area under the curve for pain scores to two hours postoperatively was significantly lower in the group receiving paracetamol (P=0.018) and the need for rescue analgesia with tramadol was less in the combination group (P=0.02). There were no significant differences in patient satisfaction or recovery. We conclude that paracetamol or parecoxib does not produce a clinically important reduction in pain in this setting. Women having uterine curettage and receiving intravenous fentanyl do not appear to benefit from administration of these non-opioid analgesics.

The 2012 British Association of Neuroscience Nurses Annual Conference

British Journal of Neuroscience NursingVol. 8, No. 6 BANN PagesThe 2012 British Association of Neuroscience Nurses Annual ConferenceNeal Cook, Mary BraineNeal CookSearch for more papers by this author, Mary BraineSearch for more papers by this authorNeal Cook; Mary BrainePublished Online:27 Sep 2013https://doi.org/10.12968/bjnn.2012.8.6.358AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Bennett MI, Smith BH, Torrance N, Potter J (2005) The S-LANSS score for identifying pain of predominantly neuropathic origin: validation for use in clinical and postal research. J Pain 6(3): 149–58 Crossref, Google Scholar Grisso T, Appelbaum PS, Hill-Fotouhi C (1997) The MacCAT-T: a clinical tool to assess patients' capacities to make treatment decisions.Psychiatr Serv 48(11): 1415–9 Crossref, Google Scholar Lehmann N, Joshi GP, Dirkmann D et al. (2010) Development and longitudinal validation of the overall benefit of analgesia score: a simple multi-dimensional quality assessment instrument. Br J Anaesthesiol 105(4): 511–8 Crossref, Google Scholar Mioshi E, Dawson K, Mitchell J, Arnold R, Hodges JR (2006) The Addenbrooke's Cognitive Examination Revised (ACE-R): a brief cognitive test battery for dementia screening. Int J Geriatr Psychiatry 21(11): 1078–85 Crossref, Google Scholar NHS Quality Improvement Scotland (2009) Neurological Health Services. Clinical Standards ∼ October 2009. NHS Quality Improvement Scotland, Edinburgh Google Scholar FiguresReferencesRelatedDetails 1 December 2012Volume 8Issue 6ISSN (print): 1747-0307ISSN (online): 2052-2800 Metrics History Published online 27 September 2013 Published in print 1 December 2012 Information© MA Healthcare LimitedPDF download

Development and longitudinal validation of the overall benefit of analgesia score: a simple multi-dimensional quality assessment instrument

BackgroundThe goal of this study was to develop and validate the overall benefit of analgesic score (OBAS), which assesses pain intensity and the opioid-related adverse effects. MethodsThe score was developed and validated in four trials (n=1470 patients). Data from randomized trial I were used to develop the OBAS (factor analysis). Data from randomized trial II were used to compare the resolution of rofecoxib’s analgesic effects between OBAS and pain scores. Randomized trial III (spine surgery) was conducted to evaluate prospectively the reliability of the OBAS and to compare its resolution of analgesic treatment with the opioid-related symptom distress scale (OR-SDS) and the modified brief pain inventory short form (m-BPI-sf). Trial IV was conducted to evaluate in patients with a moderate-to-high level of postoperative pain (after major abdominal surgery) the relation of OBAS and pain scores for patients’ satisfaction with analgesic therapy. ResultsThe seven-item OBAS yielded a higher resolution of analgesic treatment effects than pain scores, the OR-SDS and m-BPI-sf. The OBAS has a fair inter-rater reliability (concordance correlation of 0.71 c) and is more sensitive (P=0.03) in indicating the delivery of opioid boluses than the dedicated OR-SDS. The OBAS, but not pain scores at rest or pain scores during movement, explained significant variance in patients’ satisfaction with postoperative pain therapy. ConclusionsThe OBAS is a simple, multi-dimensional quality assessment instrument to measure patients’ benefit from postoperative pain therapy. Opioid symptom distress, pain relief, and patients’ satisfaction are combined in a reliable and valid tool.