Intraoperative Analgesic Regimen Research Articles

Are There Racial Disparities in Perioperative Pain? A Retrospective Study of a Gynecological Surgery Cohort

PurposeThe purpose of this study was to examine whether racial disparities exist in immediate postoperative pain scores and intraoperative analgesic regimens in a single surgical cohort. DesignA single-center, retrospective analysis. MethodsThis retrospective study of a single surgical cohort was conducted via chart review of the existing electronic health record. A total of 203 patients who underwent minimally invasive hysterectomy were included in the analysis. Three initially reviewed patient records were excluded from the final analysis due to the small size of their racial cohorts (two Asian or Pacific Islander and one Native American). The White patients (n = 103) and Black patients (n = 100) were compared for differences in pain scores in the postanesthesia care unit (PACU). The patients’ intraoperative analgesic regimens were also compared. FindingsThere were no significant differences between races in the postoperative pain scores in the PACU or in the analgesia administered by the anesthesia provider intraoperatively. ConclusionsIn this specific population, there was no evidence of racial disparities in postoperative pain or intraoperative analgesia administration. Further research is needed to understand the unique factors of the perioperative period, to see if the absence of disparities in this study is repeated in other cohorts, and to mitigate any disparities that are found.

Impact of Eliminating Local Anesthesia on Immediate Postoperative Analgesia in Pediatric Ambulatory Adenotonsillectomy.

Introduction:Our goal was to standardize intraoperative analgesic regimens for pediatric ambulatory tonsillectomy by eliminating local anesthetic use and to determine its impact on postoperative pain measures, while controlling for other factors.Methods:We assembled a quality improvement team at an ambulatory surgery center. They introduced a standardized anesthetic protocol, involving American Society of Anesthesiologists Classification 1 and 2 patients undergoing adenotonsillectomy. Local anesthesia elimination was the project’s single intervention. We collected pre-intervention data (79 cases) from July 5 to September 17, 2019 and post-intervention data (59 cases) from September 25 to December 17, 2019. The intervention requested that surgeons eliminate the use of local anesthetics. The following outcomes measures were evaluated using statistical process control charts and Shewhart’s theory of variation: (1) maximum pain score in the post-anesthesia care unit, (2) total post-anesthesia care unit minutes, and (3) postoperative opioid rescue rate.Results:No special cause variation signal was detected in any of the measures following the intervention.Conclusions:Our data suggest that eliminating intraoperative local anesthetic use does not worsen postoperative pain control at our facility. The intervention eliminated the added expenses and possible risks associated with local anesthetic use. This series is unique in its standardization of anesthetic regimen in a high-volume ambulatory surgery center with the exception of local anesthesia practices. The study results may impact the standardized clinical protocol for pediatric ambulatory adenotonsillectomy at our institution and may hold relevance for other centers.

Letter to the Editor. Intraoperative analgesic regimens and surgical duration after spine surgery.

Letter to the Editor. Intraoperative analgesic regimens and surgical duration after spine surgery.

Intraoperative analgesic regimens may affect postoperative pain: single-port versus multi-port video-assisted thoracic surgery

Intraoperative analgesic regimens may affect postoperative pain: single-port versus multi-port video-assisted thoracic surgery

Development of Acute Opioid Tolerance During Infusion of Remifentanil for Pediatric Scoliosis Surgery

We tested the hypothesis that continuous intraoperative infusion of remifentanil is associated with the development of clinically relevant acute opioid tolerance in adolescents undergoing scoliosis surgery. Thirty adolescents were randomly assigned to receive an intraoperative analgesic regimen consisting of continuous remifentanil infusion or intermittent morphine alone. Postoperative analgesic consumption was assessed with a patient-controlled analgesia device that was used to self-administer morphine. Cumulative postoperative morphine consumption, pain scores, and sedation scores were recorded by a blinded investigator every hour for the first 4 h postoperatively and then every 4 h for a total of 24 h. Cumulative morphine consumption in the remifentanil group was significantly more than that in the morphine group at each time point in the initial 24 h after surgery (P < 0.0001). At 24 h after surgery, cumulative morphine consumption was 30% greater in the remifentanil group (1.65 +/- 0.41 mg/kg) than in the morphine group (1.27 +/- 0.32 mg/kg) (95% confidence interval for the difference, 0.11 to 0.65 mg/kg). Differences in pain and sedation scores were not statistically significant. These data suggest that intraoperative infusion of remifentanil is associated with the development of clinically relevant acute opioid tolerance in adolescents undergoing scoliosis surgery.

Postoperative pain scores and analgesic requirements after thyroid surgery: Comparison of three intraoperative opioid regimens

This study was designed to compare the effect on postoperative pain, opioid consumption and the length of stay in postoperative care unit (PACU) after three different intraoperative analgesic regimens in thyroid surgery. Seventy five patients were enrolled into the study and assigned to one of three groups, fentanyl, sufentanil or remifentanil (n=25 for each group). Before the end of surgery, paracetamol 1 gr and nefopam 20 mg was also administered in all patients. Pain scores, opioid demand and the length of stay in PACU were assessed in a blind manner. Post operative pain scores were significantly lower in the fentanyl and sufentanil groups compared to remifentanil group (55 +/- 15, and 60 +/- 10 versus 78+/- 12, P < 0.05). Patients in the remifentanil group stayed longer in the PACU 108+/- 37 min versus 78+/-31 and 73 +/- 25 min, (P< 0.05). After remifentanil based analgesia, anticipation of postoperative pain with opioid analgesic appears mandatory even for surgery rated as being moderately painful, otherwise longer opioid titration due to higher pain scores might delay discharge time.

Bilateral paravertebral analgesia for major abdominal vascular surgery: a preliminary report

Paravertebral analgesia is highly effective in blocking unilateral afferent input from the trunk, but its bilateral use does not appear to have been described. Eight patients undergoing major abdominal vascular surgery had pre-operative bilateral paravertebral catheters inserted. A dose of 25 ml of bupivacaine 0.5% divided between the two catheters provided the basis of an effective intra-operative analgesic regimen which was continued postoperatively by infusion of bupivacaine for 4 days. Diclofenac and morphine completed a balanced analgesic regimen which was started pre-operatively and continued for 5 and 3 days respectively. Cardiovascular stability was notable throughout surgery, even with aortic clamping and all patients were extubated at the end of surgery. Good quality analgesia was obtained as assessed by low postoperative pain scores at rest and on movement. Three patients were not admitted to the intensive care unit, where mean stays for the group was 10 h (range 0-24 h) and mean hospital stay was 10 days (range 7-14). There were no additional demands made on the nursing staff and no postoperative pain-related complications occurred. We conclude that bilateral paravertebral analgesia, as part of a balanced analgesic technique, is an alternative method of providing effective afferent blockage for major abdominal surgery.