Mg Of Acetaminophen Research Articles

Factors associated with pain intensity and analgesic use during inpatient rehabilitation for hip fracture.

Effective pain management is vital for hip fracture recovery, yet the factors influencing pain reporting and pain medication use during inpatient rehabilitation for hip fractures are not well understood. This observational study aimed to (a) determine how cognitive abilities, expressive and receptive language abilities, and age are related to average daily pain intensity and analgesic use and (b) how average daily pain intensity and analgesic use are related to length of stay and functional outcomes in rehabilitation. Data were retrospectively obtained from 163 patients recovering from unilateral trochanteric fractures of the femur. During the first week of rehabilitation, patients received a daily average of 1,147.8 ± 978 mg of acetaminophen and a morphine milligram equivalent of 15.3 ± 18.2. Multivariable regression revealed independent relationships between more intact general cognitive abilities (B = -0.40, 95% CI [-0.70, -0.11]), and older age (B = -0.41, 95% CI [-0.70, -0.11]) with lower average daily pain intensity. Higher average daily pain intensity (B = 0.97, 95% CI [0.75, 1.20]) was independently related to greater opioid use. The length of stay was shorter among patients administered higher daily doses of acetaminophen (B = 0.03, 95% CI [-0.05, -0.01]). Average daily pain intensity and analgesic use were not related to functional outcomes in multivariable models. These findings inform the considerations for assessing and treating pain during inpatient rehabilitation. Supplemental strategies for assessing pain in older patients and alternative pain mitigation strategies for patients with impaired cognitive abilities should be considered. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Effect of Premedication with Oral Acetaminophen on the Prevention of Localized Pain Resulting from Intravenous Propofol Injection: A Randomized Double Blind Placebo Clinical Trial

Background: Propofol is one of the most widely used medications in anesthesia and intensive care. Propofol Intravenous injection is painful for patients at the injection site. The aim of this study was to determine the effect of premedication with oral acetaminophen in prevention of local pain caused by intravenous injection of propofol.
 Methods: This study was a double-blind randomized controlled trial. Data were collected from July 2020 to July 2021 in Shariati Hospital. All stages of premedication and induction of anesthesia were the same in all three groups of patients. Pb, P500 and P1000 groups (patients with oral placebo, 500 or 1000 mg of oral paracetamol, respectively) received the medication 1 hour before transfer to the operating room.
 Results: In this study, 150 patients were included. 44.7% were men, 55.3% women, and mean age of patients was 36.82 ± 10.24. The highest severity of reported pain was in the group of patients receiving placebo. Patients receiving 1 gram of acetaminophen had the lowest reported pain. Patients receiving 500 mg of acetaminophen reported significantly less pain than patients receiving placebo and more pain than patients in the group receiving 1 g of acetaminophen. Age, gender and weight did not have any significant effect on the pain severity.
 Conclusion: When compared to placebo, the use of oral acetaminophen as a premedication considerably lowers discomfort induced by intravenous propofol infusion. A dosage of 1 g of oral acetaminophen is more effective than 500 mg in decreasing pain. The level of pain and acetaminophen's pain-relieving effects were not affected by age, gender or weight.

Near-infrared imaging of in vivo performance of orally administered solid forms to rats: Feasibility study with indocyanine green

This study demonstrates the applicability of near-infrared (NIR) imaging to evaluating in vivo oral formulation performance. As a NIR probe and model drug, indocyanine green (ICG) and acetaminophen (ACE) were selected, respectively. The fluorescence intensity of ICG greatly increased upon dissolution, with the dissolved ICG passing through the gastrointestinal tract over time. Both compounds (0.05 mg of ICG and 0.5 mg of ACE) were encapsulated in gelatin and hydroxypropyl methylcellulose (HPMC) capsules in the solid form. In vitro, the HPMC capsules showed a disintegration lag time, a feature that was not observed for the gelatin capsules. After oral administration of each capsule to rats, blood samples were collected, followed by fluorescent imaging of the abdominal region. At 0.25 h after HPMC capsule administration, the fluorescence area and intensity were significantly small and relatively weak compared to that of the gelatin capsule. These tendencies resulted from the difference in capsule disintegration times, leading to a change in gastric emptying, which corresponded well with the initial time profile of the plasma concentration of ACE. These results indicate that possibility of NIR imaging with ICG to evaluate in vivo performance of orally administered formulations.

Selective Inhibition of NaV1.8 with VX-548 for Acute Pain

BackgroundThe NaV1.8 voltage-gated sodium channel, expressed in peripheral nociceptive neurons, plays a role in transmitting nociceptive signals. The effect of VX-548, an oral, highly selective inhibitor of NaV1.8, on control of acute pain is being studied.MethodsAfter establishing the selectivity of VX-548 for NaV1.8 inhibition in vitro, we conducted two phase 2 trials involving participants with acute pain after abdominoplasty or bunionectomy. In the abdominoplasty trial, participants were randomly assigned in a 1:1:1:1 ratio to receive one of the following over a 48-hour period: a 100-mg oral loading dose of VX-548, followed by a 50-mg maintenance dose every 12 hours (the high-dose group); a 60-mg loading dose of VX-548, followed by a 30-mg maintenance dose every 12 hours (the middle-dose group); hydrocodone bitartrate–acetaminophen (5 mg of hydrocodone bitartrate and 325 mg of acetaminophen every 6 hours); or oral placebo every 6 hours. In the bunionectomy trial, participants were randomly assigned in a 2:2:1:2:2 ratio to receive one of the following over a 48-hour treatment period: oral high-dose VX-548; middle-dose VX-548; low-dose VX-548 (a 20-mg loading dose, followed by a 10-mg maintenance dose every 12 hours); oral hydrocodone bitartrate–acetaminophen (5 mg of hydrocodone bitartrate and 325 mg of acetaminophen every 6 hours); or oral placebo every 6 hours. The primary end point was the time-weighted sum of the pain-intensity difference (SPID) over the 48-hour period (SPID48), a measure derived from the score on the Numeric Pain Rating Scale (range, 0 to 10; higher scores indicate greater pain) at 19 time points after the first dose of VX-548 or placebo. The main analysis compared each dose of VX-548 with placebo.ResultsA total of 303 participants were enrolled in the abdominoplasty trial and 274 in the bunionectomy trial. The least-squares mean difference between the high-dose VX-548 and placebo groups in the time-weighted SPID48 was 37.8 (95% confidence interval [CI], 9.2 to 66.4) after abdominoplasty and 36.8 (95% CI, 4.6 to 69.0) after bunionectomy. In both trials, participants who received lower doses of VX-548 had results similar to those with placebo. Headache and constipation were common adverse events with VX-548.ConclusionsAs compared with placebo, VX-548 at the highest dose, but not at lower doses, reduced acute pain over a period of 48 hours after abdominoplasty or bunionectomy. VX-548 was associated with adverse events that were mild to moderate in severity. (Funded by Vertex Pharmaceuticals; VX21-548-101 and VX21-548-102 ClinicalTrials.gov numbers, NCT04977336 and NCT05034952.)

Fixed and on-demand regimens of acetaminophen in periodontal surgery

Aim: to evaluate the clinical efficacy of an acetaminophen analgesic by comparing its prescription in fixed versus ondemand schedules after periodontal surgery. The hypothesis of the study was that the fixed regimen would be more effective than the on-demand regimen for postoperative analgesics following periodontal surgery. Methods: An open randomized clinical trial was conducted. The 68 patients who needed total flap surgery to restore supracrestal tissue attachment or surgical treatment of periodontitis were randomized”. Visual Analogue Scale was used to assess pain. The fixed group (n = 34) received 500 mg of acetaminophen every 4 hours for 2 days. The on-demand group (n = 34) was instructed to use the acetaminophen “as needed,” at intervals of no less than 4 hours between doses. Ibuprofen was the rescue medication for both groups. Pain scores and medication use were recorded 2, 6, 12, 24 and 48 hours after the surgical procedure. The study was registered at the Brazilian Registry of Clinical Trials under RBR-7wv259. Results: The two groups did not differ in relation to the frequency or the intensity of pain in a 48-hour period (n=20 in the fixed group, and n=22 in the on-demand group), or even in the intention-to-treat (n=34 in each group). Individuals who experienced moderate to severe pain used rescue medication more frequently in both groups. No adverse events were reported. Conclusion: Both regimens were effective in controlling postoperative pain after periodontal surgery.

Acetaminophen changes Mu rhythm power related to pain empathy

Empathy is an intricate ability that entails the subjective feeling and understanding of emotions someone else may be experiencing. Acetaminophen, the active ingredient found in Tylenol, is among the most common pain medications consumed. There is new evidence, however, that suggests this common analgesic may also dampen empathic processes. However, no previous study has investigated the effect acetaminophen may have on pain empathy or mu power during a pain empathy task. Therefore, participants were randomly assigned to either an experimental (acetaminophen) or control (sugar) group in a double-blinded experimental research design aimed to measure mu power, using EEG, and behavioral responses to painful and non-painful images. Participants in the experimental group were administered 1000 mg of acetaminophen, and it was verified that participants were unaware of their group assignment. We found that mu suppression was greater in the acetaminophen group, which was strongest at electrode C3. Additionally, mu power differences between painful and non-painful images were related to trait empathy, and mu power during the painful images was positively correlated with empathy behavioral rating scores. Results from this study suggest that in addition to reducing physical pain, acetaminophen may also change the neural response when perceiving others in pain. The implications of these findings could possibly lead to changes in how we prescribe and administer this common drug.

A RARE CAUSE OF URTICARIA IN AN NSAID TOLERANT PATIENT

<h3>Introduction</h3> Acetaminophen is one of the most used anti-pyretics to mitigate fever. Few cases have been reported of hypersensitivity reactions to acetaminophen without non-steroidal anti-inflammatory drug (NSAID) intolerance. It is recommended that if there is suspected drug hypersensitivity then the patient should undergo an oral drug challenge. <h3>Case Description</h3> A 49-year-old male presented for evaluation of urticaria that occurred with acetaminophen ingestion. He reported several episodes where he developed diffuse urticaria within 15 minutes of ingestion, but no other symptoms concerning for anaphylaxis. He was unsure of the dose. He also noted urticaria with Excedrin migraine, which contains acetaminophen, aspirin, and caffeine. He tolerated NSAIDs alone. An oral drug challenge was performed. He was administered 250mg of acetaminophen, which he tolerated. After taking his second dose of 250mg, he developed pruritus and 4 urticarial lesions within 30 minutes. He did not have any other signs of anaphylaxis. He was treated with 20mg of loratadine. Upon re-evaluation, he had more diffuse urticarial lesions, but no other symptoms and he remained hemodynamically stable. He was serially monitored every 15 minutes for a total of 90 minutes, with near resolution of his urticaria. <h3>Discussion</h3> Pseudoallergy is an immediate systemic reaction that resembles anaphylaxis but is non IgE-mediated. NSAIDs are a common cause of pseudoallergy. There are cases of acetaminophen hypersensitivity reactions in NSAID intolerant patients due to cross-reactivity. If a patient is NSAID tolerant and develops symptoms with acetaminophen, it is more likely to be IgE-mediated. Acetaminophen challenge should be done with caution and avoided if positive.

S3300 Acetaminophen Toxicity Amplified: Drug-Induced Liver Injury in a Malnourished Patient

Introduction: Acetaminophen toxicity is a leading cause of acute liver injury and failure in the U.S. Excess acetaminophen results in formation of N-acetyl-p-benzoquinoneimine (NAPQI) which causes irreversible oxidative hepatocyte injury and cell necrosis. Treatment with N-acetylcysteine (NAC) replenishes glutathione stores which inactivate NAPQI. In a healthy adult, acetaminophen doses less than 4 g per 24 hours are considered safe. Toxicity from therapeutic doses of acetaminophen, in the setting of malnourishment, has been rarely reported and is presented here. Case Description/Methods: A 37-year-old female with a history of gastroparesis and chronic malnutrition was admitted for elevated liver enzymes on routine blood work. She reported symptoms of fatigue, nausea, and poor oral intake from suspected gastroparesis. She also admitted to taking 1300 mg of acetaminophen intermittently during the past week for myalgias. Exam revealed normal mentation without evidence of hepatic encephalopathy (HE), cachexia with a BMI of 15.2, and mild epigastric and left upper quadrant tenderness. Laboratory data (36 hours after last ingestion of acetaminophen) revealed an ALT of 1180 u/L, AST of 1950 u/L, ALP of 121 u/L, total bilirubin of 2.7 mg/dL, direct bilirubin of 2.5 mg/dL and INR of 1.6. Her acetaminophen level was 15.8 mcg/mL. A liver ultrasound was unremarkable. NAC was subsequently administered as per protocol 21 hour infusion. She was ruled out for other etiologies of acute liver injury. She never developed HE and her liver enzymes, along with INR, normalized at discharge. Discussion: This case highlights the lower threshold for toxicity of acetaminophen in a malnourished patient. In previous case reports, acetaminophen doses less than 2 g per 24 hours are listed as being safe in a nutritionally deficient patient. Our case questions this assertion given our patient ingested 65% of this amount. Evidence in the relatively limited pool of literature suggests that malnourished patients generally have low stores of glutathione, thereby limiting the metabolic clearance of acetaminophen ingested even at normal dosages, amplifying total acetaminophen levels, and leading to increased NAPQI. Prospective study is limited to rat models and single case reports. Fortunately, our patient was promptly treated with NAC and did not progress to liver failure. This case highlights the narrow therapeutic window of acetaminophen in malnourished patients, one that warrants close observation by clinicians.

Response to Moderate and Vigorous Aerobic/Resistance Exercise in a Woman With Long-COVID

Response to Moderate and Vigorous Aerobic/Resistance Exercise in a Woman With Long-COVID

Efficacy of Preemptive Analgesia on Tourniquet and Postoperative Pain Relief in Open Carpal Tunnel Release: A Prospective Randomized Control Trial

Preemptive analgesia has been used to reduce postsurgery pain and improve patient satisfaction. The effectiveness of multimodal preemptive analgesia in open carpal tunnel release under local anesthetic with a tourniquet is still debated. This study aimed to determine the effectiveness of preemptive analgesia on the postoperative tourniquet site and the surgical site. A total of 44 patients were randomly assigned to one of 2 groups. An experimental group was given 300 mg of gabapentin, 200 mg of celecoxib, and 500 mg of acetaminophen 2 hours before surgery. Placebos were given to the control group. All surgeries were done under local anesthetic by a specialist hand surgeon. A tourniquet was inflated to the recommended pressure. The outcomes included the immediate postoperative tourniquet site pain scores, surgical site pain scores (at 1, 6, 12, 18, and 24 hours after surgery), and acetaminophen consumption in the first 48 hours. The immediate postoperative tourniquet site pain score in the experimental group was significantly lower than in the placebo group. Although the surgical site pain score in the experimental group was significantly lower than the placebo group at 1, 6, 12, and 18 hours after surgery, these differences were not clinically significant. In addition, there was no statistically significant difference in surgical site pain score at 24 hours after surgery. The amount of acetaminophen consumed during the first 48 hours after surgery was significantly lower in the experimental group than in the placebo group. Multimodal preemptive analgesia effectively reduced immediate postoperative pain at the tourniquet site in open carpal tunnel release. It also reduced postoperative acetaminophen consumption. Therapeutic II.

Hemorrhagic enlargement of the mandibular gingiva

A 50-year-old woman sought treatment for a 4-month history of pain and bleeding of the mandibular anterior gingiva. She reported a swelling on the back of the mandibular anterior teeth that had increased in size over time. She also reported numbness and increased mobility of the mandibular anterior teeth that had begun 2 months earlier. The patient had self-medicated with 500 mg of acetaminophen without significant improvement of symptoms. Her medical history was significant for leukemia, in remission for 3 years after chemotherapy.

Preemptive analgesia for endoscopic sinus surgery: a retrospective study.

Chronic rhinosinusitis (CRS) is a common disease, and endoscopic sinus surgery (ESS) is widely performed. However, there is no consensus regarding postoperative pain control after ESS, and postoperative opioid abuse is a problem in many countries. Acetaminophen is reportedly effective for postoperative pain control. Preemptive analgesia has received more attention lately, wherein pain is prevented before it occurs. In this study, we assessed the use of acetaminophen for preemptive analgesia during the perioperative period in ESS. This is a retrospective study of 175 patients who underwent ESS, septoplasty, and bilateral inferior turbinate mucosal resection at our hospital from April 2016 to February 2018. In total, 82 patients received 1,000 mg of acetaminophen during surgery and 4 hours after the first dose, while 93 patients did not receive it routinely. We compared these two groups. The primary outcome was the need to use additional analgesics prescribed by the ward physician and the secondary outcomes included postoperative pain, postoperative bleeding, reoperation, blood pressure, and body temperature. The use of additional oral and intravenous analgesics was significantly reduced in the patients who received acetaminophen perioperatively. Preemptive analgesia during the perioperative period of ESS could lead to satisfactory postoperative pain control.

Effects of Intrathecal vs. oral Multimodal analgesia on pain scores following total knee and hip arthroscopy procedures

Background Postoperative pain management practices vary widely among anesthetists in hospitals despite evidence-based pain management guidelines. This study explores a specific practice in managing acute post-operative pain by comparing the use of intrathecal bupivacaine (ITB) and morphine (ITBM) combined with oral multi-modal analgesia (MMA) versus ITB and oral MMA in patients who have undergone total knee arthroscopy (TKA) and total hip arthroscopy (THA) and the effect on pain scores. This study seeks to determine whether the practice of using ITBM is beneficial to patients during the post-operative phase. A total of 153 patients undergoing TKA and THA orthopedic surgery were randomly assigned to one of the two pain management techniques: (1) 3.5ml of 0.5% isobaric bupivacaine injected intrathecally and MMA (500mg of acetaminophen, 200mg gabapentin, 200mg of celecoxib, 10mg of controlled release oxycodone, and 5-15mg of immediate release oxycodone) was initiated on postop day 0; and (2) 3.5ml of 0.5% isobaric bupivacaine and 0.1mg of morphine was injected intrathecally and MMA (500mg of acetaminophen, 200mg gabapentin, 200mg of celecoxib, 10mg of controlled release oxycodone, 5-15mg of immediate release oxycodone). Verbal pain scores were monitored for the first 24 hours post-operatively using the Visual Analog Scale (VAS). Side effects of nausea and vomiting were also monitored for each patient for the first 24 hours post operatively. Results The VAS were similar in the ITBM group and the ITB group during the first 24 hours post-operative. The mean VAS 24 hours post-operative for TKA patients who received ITBM was 4.98, and 5.45 for patients who received ITB. Post-operative nausea and vomiting (PONV) in the TKA group varied according to the treatment group, 12.7% of patients in the ITBM group reported nausea or vomiting, compared to 13.2% in the group of patients who received ITB. The significance is set at P value < 0.05, based off this set value, the significance is shown to be P=0.629 (N.S.). There was no significance in VAS when treated with ITB or ITBM. The mean pain score 24-hour post-operative for THA patients who received ITBM was 3.63 and 4.04 for patients who received ITB. In the THA group, 9.1% of patients in the ITBM group reported PONV, whereas no one experienced PONV in the ITB group. The significance is set at P value < 0.05, based off this set value, the significance is shown to be 0.708 (N.S.). There is no significance in pain scores when treated with ITB or ITBM in patients who have undergone a total hip arthroplasty. In Conclusion, the use of ITBM fails to show superior analgesic effect on patients undergoing TKA and THA compared to ITB combined with MMA. Without superior pain control benefits and mild increase risk of causing nausea and vomiting post operatively in the TKA group, intrathecal morphine shows to provide no additional superior benefits to patients in managing their pain or significantly decreasing severity of onset of pain post operatively.

Effect of perioperative acetaminophen on pain management in patients undergoing rotator cuff repair: a prospective randomized study.

Limiting opioid use in perioperative pain management is currently an important focus in orthopedic surgery. The ability of acetaminophen to reduce postoperative opioid consumption while providing acceptable pain management has not been thoroughly investigated in patients undergoing rotator cuff repair (RCR). Patients undergoing primary arthroscopic RCR were prospectively randomized to 1 of 3 treatment groups: Group 1 (control) received both 5 mg of oxycodone every 6 hours as needed and 1000 mg of acetaminophen orally every 6 hours as needed after surgery and had the option to take either medication or both. Group 2 (control) received only 5 mg of oxycodone every 6 hours as needed without any additional acetaminophen after surgery. Group 3 received 1000 mg of acetaminophen orally every 6 hours for 1 day prior to and after surgery, which was subsequently decreased to administration every 8 hours during postoperative days 2-5. Group 3 patients were also allowed to take 5 mg of oxycodone every 6 hours as needed after surgery. All patients received interscalene blocks with liposomal bupivacaine (Exparel). Opioid use, pain scores, side effects, and overall satisfaction were assessed daily for the first week after surgery. A total of 57 patients (mean age, 57.8 ± 9.55 years) were included in this study. Baseline demographic characteristics including age, sex, and body mass index were similar between the groups (P > .05). Patients in group 3 took significantly fewer narcotics overall (P = .017) and took significantly fewer pills each day compared with group 2. Group 3 also reported significantly better overall pain control compared with the other groups (P = .040). There were no significant differences in overall patient satisfaction between the groups (P > .05). Additionally, there were no significant differences between groups regarding postoperative medication-associated side effects (P > .05). Perioperative acetaminophen represents an important component of multimodal analgesia in appropriately selected patients undergoing shoulder surgery. In this study, the use of perioperative acetaminophen significantly decreased opioid consumption and improved overall pain control after primary arthroscopic RCR.

Electrocortical Effects of Acetaminophen during Emotional Picture Viewing, Cognitive Control, and Negative Feedback.

Acetaminophen, the active ingredient in Tylenol, may have psychological effects, such as reducing social and emotional pain. The current study (N = 173) used electroencephalography (EEG) to extend past research on acetaminophen. Healthy undergraduate students (64.7% women, age M = 18.15, SD = 3.33) were randomly assigned to ingest 1,000 mg of acetaminophen or placebo before completing emotional picture viewing (n = 143), a flanker task (n = 69), and a probabilistic learning task (n = 143) while EEG was recorded. (Sample sizes used for the analyses of each task differ from the total N due to data loss.) We observed standard event-related potentials (ERPs), including emotion-modulated late positive potentials during picture viewing and feedback-related negativity during feedback on the probabilistic learning task. We also observed standard error-related and conflict-related ERPs in the flanker task but could not adequately assess acetaminophen's effect on flanker ERPs due to excessive data loss. Acetaminophen did not alter any of the ERPs, in contrast to predictions based on prior research. Exploratory analyses revealed that acetaminophen reduced the relationship between trait behavioral inhibition system sensitivity and emotion-modulated late positive potentials. Together these findings suggest that a standard dose of acetaminophen did not reliably alter neural indicators of emotional or feedback processing. Instead, preliminary findings from our study suggested that a more nuanced relationship may exist between acetaminophen and individual differences in emotional processing, although this latter finding calls for further replication.

994 Concurrent use of prostaglandin E2 and acetaminophen is associated with longer duration of labor induction

Acetaminophen (APAP) is widely used for pain management during pregnancy with a mechanism known to selectively suppresses peripheral prostaglandin E2 (PGE2) release. Dinoprostone is a naturally occurring PGE2 used for induction of labor. This study sought to determine if acetaminophen's suppressive activity on peripheral PGE2 effects the efficacy of dinoprostone for induction of labor. We conducted a 5 year retrospective cohort study and reviewed charts on women who received dinoprostone for induction of labor at term. Term pregnancies were defined as pregnancies between 40-42 weeks gestational age without onset of labor and a bishop score of 6 or less. Patients were included in the study if there received dinoprostone vaginally in doses of 10mg every 12 hours as needed for induction for a late term pregnancy and received between 2000-4000mg of APAP per day over the course of their induction. Patients receiving magnesium sulfate in the context of preeclampsia with severe features excluded. The study included 631 patients, with 303 receiving at least 2000mg of acetaminophen and 328 who did not. Baseline characteristics were not significantly different between treatment groups. Patients receiving acetaminophen experienced a longer duration of induction of labor 9.2±0.9 (1.6-13.7) hours as compared with those not receiving acetaminophen 6.3±1.1 (0.8-10.3), p = 0.02. In crude analysis, compared to those not receiving acetaminophen, receiving acetaminophen was associated with a 32% increased risk of requiring a second dose of dinoprostone (RR 1.78, 95% CI 1.42-1.93, p = 0.04.) After adjusting for BMI, initial cervical dilation at presentation, bishop score, diabetes mellitus, gestational blood pressure >140/90, race, advanced maternal age ( >34 y), and parity, this risk remained significant. APAP use ranging between 2000-4000mg over the course of a patient's labor induction with vaginal dinoprostone appears to be associated with a longer duration of induction. In such cases, other methods of cervical ripening may be a more suitable choice.

Opioid-prescribing patterns among shoulder and elbow surgeons: considerations for future prescription guidelines.

Although the achievement of adequate analgesia is critical to patient comfort and recovery following orthopedic procedures, no standard protocol exists to dictate the appropriate duration and quantity of narcotic prescription in the postoperative period. Therefore, the purpose of this survey was to determine patterns of opioid prescribing among orthopedic shoulder and elbow providers. In March 2020, a survey was distributed through a LISTSERV to 989 members of the American Shoulder and Elbow Surgeons orthopedic society. Survey recipients were asked to describe their personal and practice characteristics. Additionally, they were asked to list their 3 most commonly performed procedures and, for each operation, to list which narcotic pain medication they most commonly prescribe postoperatively, along with the corresponding number of tablets typically given. Similarly, respondents were asked to record frequently recommended alternative strategies for postoperative pain control, factors influencing the respondents' prescribing practices, and methods of patient counseling regarding opioid use and disposal. A total of 177 providers responded to the survey. Across all selected procedures, Percocet (5 mg of oxycodone hydrochloride and 325 mg of acetaminophen) was the most commonly prescribed drug, with 21-30 tablets being the most commonly prescribed amount. The majority of surgeons (82%) indicated that previous opioid prescriptions influence their decision to prescribe opioids. Respondentsmost frequently reported patient age (48%) and duration of the patient's symptoms (32%) as additional influential factors. Most surgeons (93%) reported counseling their patients regarding the use of opioid medications. However, only 30% of surgeons reported providing information regarding how to dispose of unused opioids. In lieu of opioids, nearly all investigators reported the use of ice as a pain-relief strategy, with rest and the use of nonsteroidal anti-inflammatory drugs reported as other commonly recommended alternatives. Of 137 respondents who were aware of prescription guidelines, 21% reported using recommendations from the American Academy of Orthopaedic Surgeons, 21% used institutional policies, and 20% used personal guidelines, whereas the remaining respondents used other literature findings in their prescription decisions. Of particular concern, 21% of overall respondents were unaware of any type of guidelines. To prevent both misuse and abuse of opioid prescribing, this analysis serves as a starting point for the establishment of more consistent, evidence-based opioid prescription guidelines for surgical procedures on the shoulder and elbow. In addition to recommending safe, procedure-specific opioid dosages and standardizing pain management strategies, these guidelines should include effective methods of educating both providers and patients regarding the use of opioid medication.

Comparative study between oral acetaminophen and lidocaine spray on endotracheal tube-related sore throat in adult intensive care

ackground/Purpose: Endotracheal tube (ETT)-related sore throat is a common source of stress in intensive care. Quantitative studies on therapy for ETT-related sore throat remain limited. The current study evaluated the therapeutic effects of oral acetaminophen (ACT) and lidocaine (LIDO) spray on pain relief for ETT-related sore throat in intensive care. Methods: Patients who could communicate with caregivers non-verbally and who had acquired ETT-related sore throat at a medical intensive care unit (ICU) were enrolled. The medications were dispensed at the request of the patients. The intensity of ETT-related throat pain was recorded for quantitative comparison before and after patients received 500 mg of ACT orally or one dose of 10% LIDO spray locally. Before leaving the ICU, the patients were interviewed by a research nurse to assess the effect of these interventions on satisfaction with pain management for ETT-related sore throat. Results: We enrolled 89 patients during the study period, and the intensity of ETT-related throat pain significantly decreased after treatment (6.97 in 5 min before vs. 3.60 in 120 min after oral ACT, P &lt; 0.001; 8.56 in 5 min before vs. 4.12 in 120 min after LIDO application, P &lt; 0.001). The degree of pain reduction over time differed between the ACT and LIDO groups. Patients in the LIDO group made more requests for additional therapy compared with patients in the ACT group (1 LIDO spray per request for an average of 4.7 requests vs. 1 ACT dose per request for an average of 1.3 requests, P &lt; 0.001). Patients in both the ACT and LIDO groups reported high satisfaction with pain management for ETT-related sore throat (87.3 of 100 vs. 86.5 of 100, respectively, P = 0.805). Conclusion: ACT and LIDO treatment can effectively attenuate ETT-related sore throat. Patients were highly satisfied with pain management for ETT-related sore throat after both oral ACT and local LIDO application.

The Influence of Ibuprofen on the Healing of Nonsurgically Treated Colles' Fractures.

Nonsteroidal anti-inflammatory drugs can delay bone healing. This knowledge is mainly derived from retrospective and animal studies. The authors therefore conducted a human study to investigate whether ibuprofen affects radiological, functional, densitometrical, and biochemical outcomes following a Colles' fracture, as well as the analgesic effect of ibuprofen. This was a single-center, triple-blinded, randomized, placebo-controlled clinical trial with a total of 96 patients. All of the patients received basic treatment with 1000 mg of acetaminophen 4 times daily. The placebo group received a placebo for 7 days. The 3-day ibuprofen group received 600 mg of ibuprofen 3 times daily for the first 3 days and a placebo for the following 4 days. The 7-day ibuprofen group received ibuprofen 3 times daily for 7 days. The primary outcome was the fragment migration for a period of 5 weeks. The secondary outcomes were changes in the wrist's range of motion; Disabilities of the Arm, Shoulder and Hand score; bone mineral density of the injured wrist; changes in serum CrossLaps (Roche Diagnostics) and osteocalcin; and analgesic effects. Analyses were performed according to an intention-to-treat approach. No significant differences in radiological migration or functional, densitometrical, and biochemical effects were established among the treatment groups (.06≤P≤.9). During the first 3 days, the pain score was lower (P=.02) in the ibuprofen groups than in the placebo group. The findings of this study offer an indication for ibuprofen as a bone-safe analgesic treatment after Colles' fracture and may be translated into other fields of cancellous bone fracture treatment. [Orthopedics. 2021;44(2):105-110.].

Analgesic efficacy of morphine sulfate immediate release vs. oxycodone/acetaminophen for acute pain in the emergency department.

Previous research demonstrated that administration of Morphine Sulfate Immediate Release (MSIR) results in similar analgesic efficacy to Oxycodone but with significantly lesser degrees of euphoria and reward. The purpose of this study sit to investigate if MSIR combined with Acetaminophen can serve as an opioid analgesic alternative to Oxycodone combined with acetaminophen (Percocet) for acute pain in the Emergency Department (ED). A prospective, randomized, double-blind trial of ED patients aged 18 to 64years presenting with moderate to severe acute pain as defined by an 11-point numeric rating scale (NRS) with an initial score of ≥5 (0=no pain and 10=very severe pain). Patients were randomized to receive either 15mg MSIR combined with 650mg of Acetaminophen or 10mg Oxycodone combined with 650mg Acetaminophen. Patients were assessed at baseline, 30, 45 and 60min. The primary outcome was reduction in pain at 60min. Secondary outcomes include drug likeability and adverse events. 80 patients were enrolled in the study (40 per group). Demographic characteristics were similar between the groups (P>0.05). Mean NRS pain scores at baseline were 8.44 for the MSIR group and 8.53 for the Percocet group (P=0.788). Mean pain scores decreased over time but remained similar between the groups: 30min (6.03 vs. 6.43; P=0.453), 45min (5.31 vs. 5.48; P=0.779), and 60min (4.22 vs. 4.87; P=0.346). Reduction in mean NRS pain scores were statistically significant from baseline to 30, 45 and 60min within each group (P<0.0001 at each time point for both groups). The largest NRS mean difference was from baseline to 60min: 4.2 (95% CI: 3.43 to 5.01) for MSIR group and 3.61 (95% CI: 2.79 to 4.43) for Percocet group. No clinically significant changes or any serious adverse events were observed in either group. MSIR provides similar analgesic efficacy as Percocet for short-term pain relief in the ED, similar rates of nausea/vomiting, and lower rates of likeability of the drug.