Postoperative Pain Medication Research Articles

Battlefield Acupuncture Does Not Provide Additional Improvement in Pain When Combined With Standard Physical Therapy After Shoulder Surgery: A Randomized Clinical Trial.

Shoulder stabilization surgery is common among military personnel, causing severe acute postoperative pain that may contribute to the development of chronic pain, thereby reducing military readiness. Battlefield Acupuncture (BFA) has shown promise as a non-pharmaceutical intervention for acute postoperative pain. The purpose of this study was to determine the effectiveness of BFA combined with standard physical therapy on pain, self-reported mood, self-reported improvement, and medication use in patients after shoulder stabilization surgery. The study design was a single-blind, randomized clinical trial, approved by the Naval Medical Center Portsmouth Institutional Review Board and registered with ClinicalTrials.gov (NCT04094246). Ninety-five participants were recruited after shoulder stabilization surgery. Participants were randomized via concealed allocation into a standard physical therapy (PT) group or a group receiving standard PT and BFA. Both groups received standard postoperative pain medication. The BFA intervention followed a standard protocol with the insertion of gold aiguille d'acupuncture emiermanente needles at 5 specific points in the ear. At 4 time points (baseline [24-48 hours], 72 hours, 1 week, and 4 weeks post-surgery), participants reported worst and average pain using a Visual Analog Scale (VAS), self-reported mood using the Profile of Mood States (POMS), self-recorded medication intake between study visits, and self-reported improvement in symptoms using a Global Rating of Change (GROC) Scale. Outcome assessors were blinded to treatment allocation. An alpha level of 0.05 was set a priori. For pain, a mixed-model analysis of variance was used to analyze the interaction effect between group and time. Differences in baseline data, total opioid usage, and pain change scores between groups were analyzed using independent t-tests. Of the 95 participants enrolled, 7 failed to provide complete study visits after the baseline, leaving 88 patients (43 BFA, 45 control, mean age 21.8 (2.1) years, 23% female). There were no significant group-by-time interactions for VAS worst pain (F = 0.70, P = .54), VAS average pain (F = 0.99, P = .39), the POMS (F = 1.04, P = .37), or GROC (F = 0.43, P = 0.63). There was a significant main effect of time for VAS worst pain (F = 159.7, P < .001), VAS average pain (F = 122.4, P < .001), the POMS (F = 11.4, P < .001), and the GROC (F = 78.5, P < .001). While both groups demonstrated statistically significant and clinically meaningful improvements in pain and self-reported mood over time, BFA did not provide any additional benefit compared to standard physical therapy alone. There was no significant difference in opioid usage between groups at 4 weeks (t = 0.49, P = .63). Finally, both groups also demonstrated statistically significant and clinically meaningful self-reported improvements in function, but again, there was no additional benefit when adding BFA to standard physical therapy. The results of this study do not support the effectiveness of BFA for postsurgical pain management as there were no significant differences in pain, self-reported mood, self-reported improvement, and medication use between participants who received BFA and those who did not. As this is the only known study of BFA in postsurgical participants, continued research is needed to determine if BFA is effective for pain reduction in that setting. ClinicalTrials.gov, NCT04094246. Registered September 16, 2019, http://clinicaltrials.gov/NCT04094246.

Mouse strain-specific habituation to oral metamizole administration.

When pain might occur during an animal experiment, sufficient analgesia is necessary. Metamizole is the third most used postoperative pain medication in animal research. The analgesic effect of metamizole is supposed to last 6-8 h in rodents. Therefore, the supplementation of drinking water with metamizole should be the preferred method to ensure permanent pain relief without unnecessary stressors. The present exploratory study compared the voluntary intake of metamizole-supplemented drinking water (3 mg/ml) between healthy mice of three different mouse strains. After the addition of metamizole to the drinking water, a marginal reduction in body weight was observed in C57BL/6J and BALB/c mice. However, NSG mice displayed a significantly higher body weight loss and reduction of drinking behavior compared with the C57BL/6J and BALB/c strains. The acceptance of metamizole in NSG mice did not increase with a different metamizole formulation. Thus, the mice of the inbred strains C57BL/6J and BALB/c seemed to be able to adapt to the taste of metamizole, while NSG mice were not able to accustom to analgesia within 1 week. Strain-specific habituation should be considered in future animal studies when analgesia is applied via drinking water.

Analgesic Effects of Magnesium Sulphate In Patients Undergoing Laparoscopic Cholecystectom

Objective: To assess the effectiveness of intraoperative administration of MgSO4 in achieving satisfactory postoperative pain relief following laparoscopic surgery. Study Design: Quasi-experimental research. Place and Duration of Study: Combined Military Hospital, Rawalpindi Pakistan, Apr to Sep 2021. Methodology: A total of 200 patients gave their informed consent before being split into two groups of 100. Patients were given Tablet Alprazolam 0.25mg and Omeprazole 20mg the night before surgery and again on the morning of surgery, and were asked for NPO for 8 hours before to surgery. Group 1 got 50 mg/kg of magnesium sulphate diluted in 250 ml of isotonic 0.9% normal saline intravenously during surgery, while Group 2 received the same volume of isotonic 0.9% normal saline. Results: Administering intravenous magnesium sulphate at an intravenous dose of 50 milligrams per kilogram of body weight before laryngoscopy and intubation significantly reduces the need for post-operative pain medication by reducing post-operative pain and delaying its onset. Additionally, it reduces the amount of pain medication required after surgery. Therefore, overall, pretreatment with magnesium sulphate has a significant impact on post-operative pain management. Conclusion: Magnesium sulphate is an excellent analgesic for people undergoing laparoscopic cholecystectomy.

Surgical Recovery Among Patients With Chronic Pain Undergoing Pelvic Reconstructive Surgery.

Limited data exist on postoperative recovery among patients with chronic pain undergoing pelvic reconstructive surgical procedures. The objective of this study was to evaluate if patients with versus without self-reported chronic pain experience different recovery after pelvic reconstructive surgery. From September 2022 to May 2023, this prospective cohort study enrolled patients with and without chronic pain, who were undergoing vaginal or laparoscopic procedures for pelvic organ prolapse. Preoperative pain was assessed using the Brief Pain Inventory (BPI) and Pepper Assessment Tool for Disability (PAT-D). Postoperative recovery was evaluated at 2, 4, and 12 weeks using the Postdischarge Surgical Recovery (PSR) scale, Global Surgical Recovery (GSR) index, and PAT-D questionnaire. The primary outcome was PSR scores at 4 weeks postoperatively. Ninety patients were recruited, with 43 reporting chronic pain and 47 without. Demographics were similar. Patients with chronic pain had higher preoperative BPI and PAT-D scores. Perioperative outcomes and hospital stay were similar. Patients with chronic pain used more postoperative opioids in the hospital (27.0 ± 27.8 vs 24.3 ± 60.3 morphine milligram equivalents [MME]; P = 0.03) and at home (40.1 ± 54.7 vs 19.9 ± 39.0 MME; P = 0.03). The PSR scores at 4 weeks were not significantly different. No differences were observed in PSR or GSR scores at all time points. Patients with chronic pain had a higher PAT-D score at 12 weeks. Fewer chronic pain patients returned to work by 12 weeks and desired more time off work. Patients with and without chronic pain had similar surgical outcomes and recovery. However, chronic pain patients required more postoperative opioid pain medication and preferred more time off work.

Variability in treatment of postoperative pain in children with severe neurologic impairment.

Treatment of postoperative pain for children with severe neurologic impairment (SNI) is challenging. We describe the type, number of classes, and duration of postoperative pain medications for procedures common among children with SNI, as well as the variability across children's hospitals in pain management with an emphasis on opioid prescribing. This retrospective cohort study included children with SNI ages 0-21 years old who underwent common procedures between January 1, 2019 and December 31, 2019 within 49 children's hospitals in the Pediatric Health Information System. We defined SNI using previously described high-intensity neurologic impairment diagnosis codes and identified six common procedures which included fracture treatment, tracheostomy, spinal fusion, ventriculoperitoneal shunt placement (VP shunt), colostomy, or heart valve repair. Medication classes included benzodiazepines, opioids, and other nonopioid pain medications. Acetaminophen and nonsteroidal anti-inflammatory drugs were excluded from analysis. All findings were summarized using bivariate statistics. A total of 7184 children with SNI underwent a procedure of interest. The median number of classes of pain medications administered varied by procedure (e.g., VP shunt: 0 (interquartile range [IQR] 0-1); tracheostomy: 3 (IQR 2-4)). Across all procedures, opioids and benzodiazepines were the most commonly prescribed pain medications (48.8% and 38.7%, respectively). We observed significant variability in the percentage of postoperative days with opioids across hospitals by procedure (all p < .001). There is substantial variability in the postoperative delivery of pain medications for children with SNI. A standardized approach may decrease the variability in postoperative pain control and enhance care for children with SNI.

Effects of Intraoperative Epidural Steroid-Soaked Gelatin Sponge in Lumbar Spine Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

This systematic review and meta-analysis evaluated the impact of intraoperative epidural steroid-soaked gelatin sponge in lumbar spine surgery for conditions like spinal stenosis and nerve root compression. Surgery often involves removing structures to decompress the nerves. Steroids are used to alleviate inflammation and pain, with gelatin sponges serving as carriers to extend their effect. While epidural steroid injections have been effective, the combined use of gelatin sponges remains controversial. The study systematically searched databases including PubMed, MEDLINE, and Cochrane Central Registry of Controlled Trials databases involving lumbar surgeries using steroid-soaked gelatin sponges. Seven studies with 620 patients were included, focusing on postoperative pain scores, analgesic use, hospital stay, and complications. The quality of the studies was assessed using the Cochrane Risk of Bias 2 tool. Results showed no significant difference in pain scores between the steroid and control groups on postoperative day 1 and at three months. However, there was a trend toward reduced pain in the steroid group. Notably, patients in the steroid group required fewer analgesics, indicating a significant reduction in postoperative pain medication use. Other factors, such as surgery time, blood loss, and hospital stay, showed no statistically significant differences between the groups. The findings suggest that while the use of steroid-soaked gelatin sponges does not significantly change immediate postoperative pain levels, it may contribute to improved pain management. This approach is safe, with minimal risk of complications, and may provide prolonged, localized effects due to the slow release of steroids. Future large-scale randomized trials are needed to further validate these findings. In conclusion, the use of steroid-soaked gelatin sponges in lumbar spine surgery is a feasible option to consider, with potential benefits in postoperative pain management and reduced analgesic consumption.

Short-term Outcomes in Infants after General Anesthesia with Low-dose Sevoflurane/Dexmedetomidine/Remifentanil versus Standard-dose Sevoflurane (the TREX Trial).

The Trial Remifentanil DEXmedetomidine (TREX) trial aimed to determine whether, in children less than 2 yr old, low-dose sevoflurane/dexmedetomidine/remifentanil anesthesia is superior to standard-dose sevoflurane anesthesia in terms of global cognitive function at 3 yr of age. The aim of the current secondary analyses was to compare incidence of intraoperative hypotension and bradycardia, postoperative pain, time to recovery, need for treatment of intraoperative hypotension and bradycardia, incidence of light anesthesia and need for treatment, need for postoperative pain medications, and morbidity and mortality outcomes at 5 days between the two arms. This phase III randomized active controlled, parallel group, assessor blinded, multicenter, superiority trial was performed in 20 centers in Australia, Italy, and the United States. A total of 455 infants less than 2 yr of age expected to undergo general anesthesia for at least 2 h were enrolled. They were randomized between low-dose sevoflurane/dexmedetomidine/remifentanil anesthesia and standard-dose sevoflurane. The short-term perioperative outcomes noted above were compared between these two groups. There was less hypotension (risk difference, -11.6%; 95% CI, -18.9 to -4.3%) and more bradycardia (risk difference, 18.2%; 95% CI, 8.8 to 27.7%) in the low-dose sevoflurane/dexmedetomidine/remifentanil anesthesia compared to the standard-dose sevoflurane arm. There were more patients with episodes of light anesthesia (89 vs. 4), and protocol abandonments (1 vs. 0) in the low-dose sevoflurane/dexmedetomidine/remifentanil anesthesia arm. Time from eye opening to postanesthesia care unit discharge was similar in both arms, as were morbidity and mortality. One patient in each arm suffered a life-threatening event, but neither suffered long-term sequelae. These early postoperative results suggest that in children less than 2 yr of age receiving greater than 2 h of general anesthesia, the low-dose sevoflurane/dexmedetomidine/remifentanil anesthesia technique and the standard sevoflurane anesthesia technique are broadly clinically similar, with no clear evidence to support choosing one technique over the other.

Clinical outcomes for minimally invasive sacroiliac joint fusion with allograft using a posterior approach.

Sacroiliac joint (SIJ) dysfunction can occur as a result of injury, degeneration, or inflammation. This dysfunction presents symptoms of pain at various locations, including the low back, hips, buttocks, and legs. The diagnosis of SIJ dysfunction is challenging and cannot be achieved solely with imaging studies such as X-rays, MRI, or CT. The current gold standard diagnostic modality is intra-articular SIJ blocks using two differing local anesthetics. Current treatments for SIJ dysfunction may be beneficial for short-term relief but lack long-term efficacy. The purpose of our study was to examine the outcomes of patients who underwent minimally invasive, posterior SIJ fusion using allograft at a single center. This was a retrospective study which received exemption from the WCG IRB. Data regarding preoperative and postoperative pain levels, surgical time, complications, and medication usage were obtained retrospectively from patient electronic medical records and prescription drug monitoring program reports. No mapping was completed prior to the procedure. Pain was assessed with the 11-point (0-10) Visual Analogue Scale (VAS) and medication usage was assessed using Morphine Milligram Equivalents (MME). Patients were included if they had been diagnosed with SIJ dysfunction using two intra-articular diagnostic blocks that resulted in at least an 80% decrease in pain and had failed conservative management. Patients with sacral insufficiency fractures were excluded. VAS scores reduced from 8.26 (SD = 1.09) at baseline to 2.59 (SD = 2.57), 2.55 (SD = 2.56), 2.71 (SD = 2.88), and 2.71 (SD = 2.88) at 3, 6, 9, and 12 months, respectively. MME reduced from 78.21 mg (SD = 51.33) to 58.95 mg (SD = 48.64), 57.61 mg (SD = 47.92), 61.71 mg (SD = 45.64), and 66.29 mg (SD = 51.65) at 3, 6, 9, and 12 months, respectively. All reductions in VAS scores and MME were statistically significant. No adverse events occurred, and the average operating room time was 40.16 min (SD = 6.27). Minimally invasive, posterior SIJ fusion using allograft is a safe and efficacious method for managing SIJ dysfunction.

Liposomal Bupivacaine Versus Bupivacaine and Dexamethasone Intercostal Nerve Blocks for Robotic Thoracic Surgery: A Randomized Clinical Trial.

Introduction For peripheral nerve blocks, using either the liposomal formulation of bupivacaine or plain bupivacaine with epinephrine and dexamethasone as an adjuvant has been shown to improve postoperative pain scores. In a single-blinded, randomized controlled study of patients undergoing robotic-assisted thoracoscopic surgery, we determined if bupivacaine with epinephrine and dexamethasone was noninferior to liposomal bupivacaine mixed with plain bupivacaine when administered intraoperatively as an intercostal nerve block (INB). Methods A total of 34 patients undergoing robotic-assisted thoracoscopic surgery were randomized to receive one of two injectate mixtures during their intraoperative INB. Group LB was administered 266 mg of 13.3 mg/mL liposomal bupivacaine with 24 mL of 0.5% plain bupivacaine, while Group BD was given 42 mL of 0.5% bupivacaine with epinephrine and 8 mg of dexamethasone. The primary outcomes were mean postoperative numerical pain ratings and mean postoperative opioid analgesic requirements. Secondary outcomes included adjuvant pain medication consumption, hospital length of stay, and total opioid use in oral morphine equivalents. Results Group LB exhibited no significant difference in pain scores (p = 0.437) and opioid analgesic requirement (p = 0.095) within the 72-hour postoperative period when compared to Group BD. The median total postoperative opioid requirement was 90 mg in Group LB, compared to 45 mg in Group BD. There were no significant differences in the use of postoperative adjuvant pain medications (gabapentin, p = 0.833; acetaminophen, p = 0.190; ketorolac, p = 0.699). Hospital length of stay did not differ between the groups. Conclusions INBs with the addition of dexamethasone as an adjuvant to 0.5% bupivacaine with epinephrine provided noninferior postoperative analgesia compared to liposomal bupivacaine mixed with plain 0.5% bupivacaine.

Effectiveness of implementing a standardized perioperative pain management protocol in children undergoing tonsillectomy: A quality improvement project.

Tonsillectomy procedures are commonly performed worldwide. At our academic tertiary care facility, we perform approximately 1000 tonsillectomy procedures annually. We have found inconsistent pain management strategies in pediatric tonsillectomy patients have contributed to variability in postoperative complications and the number and types of postoperative pain medications required in the Post Anesthesia Care Unit (PACU). This project aimed to assess the impact of implementing a standardized perioperative pain management protocol on reducing postoperative complications in pediatric patients who underwent a tonsillectomy procedure. A pre-post-intervention design was utilized, comparing characteristics and outcomes of pediatric patients for whom a standardized perioperative pain management protocol was implemented over a 12-week period compared to those who did not. The standardized perioperative pain management protocol was utilized intraoperatively by the anesthesiologists, nurse anesthetists, and residents. A Qualtrics survey was used by the Post Anesthesia Care Unit (PACU) nurses to gather data as they cared for patients who underwent tonsillectomy. Four outcomes were measured: (1) postoperative pain medication administration, (2) rate of postoperative respiratory complications, (3) rate of adherence, and (4) usability of a standardized pain management protocol. Data were compared between pre and post-implementation groups. During the quality improvement project, 180 children underwent tonsillectomy, with 81 in the control group and 99 in the intervention group. The median age did not differ between groups. The control group had higher postoperative opioid medication usage (93.8% vs. 54.5%) and a higher number of opioids administered in the recovery room. Postoperative IV fentanyl was reduced in the intervention group (49.4% vs. 28.3% in the intervention, p = .004). Respiratory interventions were more frequent in the control group (24.7% vs. 7.1%), with increased respiratory team activation. Respiratory team activation in the Post Anesthesia Care Unit (PACU) includes a 511 page for anesthesia provider assistance. Respiratory interventions included bag-mask ventilation, lidocaine, propofol or succinylcholine administration, and reintubation. The intervention group had 100% adherence to the pain management protocol, and providers found it easy to use. The quality improvement project highlighted notable improvements in the intervention group for whom a standardized perioperative pain management protocol was used, including reduced opioid medication administration, lower incidence of respiratory interventions, and high adherence to the pain management protocol. These findings underscore the effectiveness and feasibility of standardized protocols in enhancing patient outcomes.

Changes in lymph node surgery in breast cancer and preoperative drug prescription analysis for postoperative pain management: A retrospective, cross-sectional study.

This study aimed to investigate the changes in lymph node surgery types and prescription patterns of postoperative medications for pain management in patients with breast cancer using national health insurance claim data from South Korea. The study population comprised patients with at least one record of a principal diagnosis of breast cancer (ICD-10 code: C50) from the national health insurance claim database between 2010 and 2019. Patients who underwent mastectomy or lumpectomy only once were selected for the analysis. Patients who underwent axillary lymph node dissection (ALND) with mastectomy or lumpectomy on the day of surgery were included in the ALND group, whereas those who underwent sentinel lymph node biopsy (SLNB) were included in the SLNB group. Prescription records of opioids before, after and on the date of breast cancer surgery were collected and categorized according to the opioid type. Multivariate logistic regression modeling was used to compare postoperative opioid prescriptions. The proportion of those undergoing ALND among 3,080 patients decreased consistently after 2014, while the proportion undergoing SLNB increased. Although the rate of pain medication prescription on the day of surgery was similar between the two groups, the rate of prescription of postoperative pain medication and anticancer agents was lower in the SLNB group than in the ALND group. Logistic regression modeling showed that the SLNB group had lower odds of receiving opioids than did the ALND group (Odds ratio (OR) = 0.727, Confidence Interval (CI) = 0.546-0.970). A consistent trend was observed when the model was adjusted for neoadjuvant chemotherapy and the use of preoperative pain medications (OR = 0.718, CI = 0.538-0.959). To manage postoperative pain and prevent chronic pain with minimal side effects, sufficient discussion among clinicians, patients, and other healthcare professionals is imperative, along with adequate treatment planning.

347 Short-Term Pain Outcomes and Pain Medication Utilization Among Urine Toxicology-Identified Opioid and Marijuana Users Following Elective Spine Surgery

INTRODUCTION: Postoperative pain outcomes may be influenced by preoperative substance use, which is often underreported due to associated stigma. METHODS: Patients undergoing elective spinal surgery between September 2020 and May 2022 were recruited for this prospective cohort study. Detailed chart review was completed to collect demographic, urine toxicology, VAS, and pain medication regimen data. Comparisons between self-reported and urine toxicology-identified substance use, pre- and post-operative VAS ratings, and postoperative pain medication use were made using χ2 tests, student’s t-tests, and logistic regression, respectively. Models were adjusted for age, sex, and race. RESULTS: Among 111 participants (mean age 58 years, 59% female, 95% with &gt;1 comorbidity), urine toxicology overestimated drug use (47% vs 16%, p &lt; 0.001) and underestimated alcohol use (16% vs 56%, p &lt; 0.001) at preoperative baseline relative to patient reports. Two-weeks postoperatively, participants on preoperative opioids as determined by urine toxicology reported no significant improvements in pain from baseline (6.67 preop vs 5.92 postop, p = 0.288) unlike non-users (6.56 preop vs 4.61 postop, p &lt; 0.001). They also had worse postoperative VAS (5.92 vs 4.61, p = 0.030) and heavier reliance on opioid medications (OR = 3.09, 95% CI = 1.21-7.89, p = 0.019). Conversely, participants on preoperative marijuana reported similar improvements in pain from baseline (users: 6.88 preop vs 4.36 postop, p = 0.001; non-users: 6.49 preop vs 5.07 postop, p = 0.001), similar postoperative pain (4.36 vs 5.07, p = 0.238), and similar postoperative reliance on opioid medications (OR = 0.96, 95% CI = 0.38-2.44, p = 0.928). CONCLUSIONS: While urine toxicology-identified preoperative opioid use was associated with poor postoperative pain relief and continued reliance on postoperative opioids for pain management following elective spinal surgery, preoperative marijuana use was not. Preoperative marijuana use, hence, should not delay or be a contraindication to elective spinal surgery.

Chronic postsurgical pain (CPSP): an underestimated problem after incisional hernia treatment

BackgroundChronic postsurgical pain (CPSP) is a potential long-term problem following open incisional hernia repair which may affect the quality of life of patients despite successful anatomical repair of the hernia. The aim of this manuscript was to identify the incidence and outcome of patients following open incisional hernia repair in respect of risk factors to develop CPSP.MethodsA single-center retrospective analysis of patients who underwent open incisional hernia repair between 2015 and 2021 was performed. Pre-existing conditions (e.g., diabetes mellitus and malignancy), hernia complexity, postoperative complications, and postoperative pain medication were analyzed using the local database. Quality of life and CPSP were assessed using the EuraHS Quality of Life (QoL) questionnaire.ResultsA total of 182 cases were retrospectively included in a detailed analysis based on the complete EuraHS (QoL) questionnaire. During the average follow-up period of 46 months, this long-term follow-up revealed a 54.4% incidence of CPSP and including a rate of 14.8% for severe CPSP (sCPSP) after open incisional hernia surgery. The complexity of the hernia and the demographic variables were not different between the group with and without CPSP. Patients with CPSP reported significantly reduced QoL. The analgesics score which includes the need of pain medication in the initial days after surgery was significantly higher in patients with CPSP than in those without (no CPSP: 2.86 vs. CPSP: 3.35; p = 0.047).ConclusionThe presence of CPSP after open incisional hernia repair represents a frequent and underestimated long-term problem which has been not been recognized to this extent before. CPSP impairs QoL in these patients. Patients at risk to develop CPSP can be identified in the perioperative setting by the need of high doses of pain medication using the analgesics score. Possibly timely adjustment of pain medication, even in the domestic setting, could alleviate the chronicity or severity of CPSP.

Parental knowledge and attitude of postoperative paediatric pain: stepwise linear regression analysis.

Despite the fact that mothers care for their children's pain in most cases, it has been noted that mothers have limited knowledge and attitude about paediatric pain. This study aims to assess parental knowledge and attitude of postoperative paediatric pain (POPP). This is institutional based cross sectional study conducted with 102 parents at Nigist Eleni Mohamed Memorial Comprehensive Specialized Hospital (NEMMCSH). A convenience sampling technique was used to select parents. This study has used a questionnaire (Parental Pain Expression Perception (PPEM), examine parents' attitudes and knowledge about how their children exhibit their pain and Medication Attitude Questioner (MAQs), focuses on how parents feel about giving their child analgesic medication to alleviate post-operative pain). Descriptive statistics were utilized to analyse the parent's response and presented with frequency and percentage. Factor analysis to analyze factor structure and stepwise linear regression analysis to examine the impact of socio-demographic factors in predicting parental knowledge and attitude about POPP were done. The statistical tests were performed at 95% confidence interval and 5% significance level. A total of 102 parents fulfilling the inclusion criteria were included. About 78% of parents agreed that children always express pain by crying or whining. The majority of parents (75.6%) believe children who are playing are not in pain. Regarding parental attitudes about pain medications, majority of parents (61%) believe that children should be given pain medication as little as possible because of its side effects. According to about 26.8% of parents, giving children pain medication for pain might teach them to use drugs for other issues. On the other hand, 63.4% of parents say that giving children pain medication as little as possible is the most effective way to manage their pain. Parents of younger children and parents from rural area are more likely to score higher in attention seeking sub-score of PPEP while parents from urban residence and those parents who are employed are more likely to perceive about the side effects of pain medications (Side effects factors). The overall knowledge and attitude of parents about postoperative pain and pain medications were poor.

Enhancing Pain Management for Open Inguinal Hernia Repair With a Novel Long-Acting Bupivacaine Drug Device (Xaracoll®) in Multimodal Pain Control: A Quality Improvement Initiative to Reduce Post-Operative Opioid Prescribing.

Background Xaracoll® is a Food and Drug Administration (FDA) approved Type 1 Bovine collagen-based bupivacaine hydrochloride (HCl) implant developed to provide postoperative pain management for up to 24 hours after open inguinal hernia repair in adults. This retrospective review examinedthe efficacy of Xaracoll® in the management of postoperative pain compared to injectable Bupivacaine. Methods This retrospective study examines 54 patients who underwent unilateral open inguinal hernia repair by a single surgeon over three years. The control group consisted of 36 patients who received injectable Bupivacaine as the local anesthetic. Eighteen patients received the Xaracoll® drug device intra-operatively following the FDA-approved manufacturer's guidelines. Intra-operative analgesics administered and quantified by oral morphine equivalents (OME), opioid administration for pain control postoperatively, opioid prescriptions upon discharge, postoperative pain scores, and turnaround time (TAT) were compared. Results The use of Xaracoll® in inguinal hernia repair is associated with a decrease in the rate of opioid administration in the post-anesthesia care unit (PACU) (22.2% vs. 52.8%; p = 0.043). In addition, patients requiring opioids in the outpatient setting needed significantly less OME in the Xaracoll® group compared to the control group (52.50 vs. 136.15; p < .001). Conclusion This study demonstrates compelling evidence that Xaracoll® is a useful analgesia adjuvant for inguinal hernia repair, significantly reducing the need for opioids in the PACU and decreasing doses of opioid medications upon discharge.Xaracoll® is effective in minimizing postoperative pain and opioid medication dosages upon discharge as part of a multimodal approach to pain and improving patient experience. Further research is warranted to evaluate Xaracoll®'s role in pain control in the PACU and on discharge.

Optimizing Recovery After Carpal Tunnel Syndrome Release Surgery: The Role of Counseling in Pain Management and Perioperative Functional Enhancement.

Preoperative patient education is pivotal in improving patient outcomes during the perioperative phase, involving a thorough explanation of what patients can expect. This enhances adherence and reduces perioperative anxiety. In orthopedics, carpal tunnel syndrome, a common and painful hand condition, is effectively managed through surgical release under local anesthesia. Inadequate counseling before such procedures may intensify intraoperative anxiety and increase pain responses. Thus, this research aims to investigate the effects of comprehensive preoperative counseling on various parameters in carpal tunnel release surgery. A case-control study design was adopted for this study. A retrospective analysis of patients who underwent carpal tunnel release surgery was performed. These patients were categorized into two distinct groups: one group received comprehensive counseling during their clinic visits, while the other group reported receiving less effective counseling. Evaluation encompassed patient-related factors, disease-related aspects, and perioperative variables for both groups. The study comprised 681 participants, with 526 (77.2%) being females, 421 (61.8%) undergoing surgery on the right side, and 519 (76.2%) employed in non-manual occupations. Moreover, 559 (82.1%) were non-smokers, while approximately two-thirds of the cohort had both diabetes and hypertension. The average age of participants was 52 years, and they reported a mean functional disability score of 7.2 out of 10. The comprehensive preoperative counseling group consisted of 333 patients, while the other group included 348 patients. The analysis revealed statistically significant differences between the two groups, including reduced intra-procedural anxiety (p = 0.043), decreased intraoperative pain (p = 0.005), lower rates of wound complications (p = 0.022), and improved self-reported pain relief (p = 0.3). Our study emphasizes the crucial role of preoperative counseling in improving patient experiences during perioperative care, leading to reduced anxiety, milder pain responses, fewer complications, decreased reliance on postoperative pain medication, and increased self-reported pain relief. Level III, Case-control retrospective study.

Patient-reported pain, satisfaction, adverse effects, and deviations from ambulatory surgery pain medication.

Addressing the challenges of ambulatory surgery involves balancing effective pain relief with minimizing the side effects of pain medication. Due to the heightened risk of opioid abuse, Helsinki University Hospital (Finland) has had a stringent oxycodone prescription policy. This policy prompts an exploration into whether ambulatory surgery patients experience severe post-surgical pain and whether an increase in prescribed opioids would cause elevation in adverse effects. This prospective cohort study, with a 1-week follow-up, included 111 adult ambulatory surgery patients (orthopaedics, urology). The patients documented their pain levels within the first postoperative week (using a numerical rating scale [NRS] of 0-10) and pain medication intake up to two days postoperatively. Furthermore, they completed a questionnaire assessing their satisfaction with pain relief, medication-related adverse effects, and adherence to instructions. Medication intake was cross-referenced with the provided instructions and prescriptions. A notable 56% of patients reported experiencing intense pain (NRS ≥5) within a week following surgery. Of these, 52% received a single dose of slow-release oxycodone (5-20 mg) at discharge for use on the night of surgery. Predominantly prescribed pain medications included a combination of paracetamol and codeine (64%) or ibuprofen (62%). Satisfaction rates were high, with 87% expressing satisfaction with pain medication given at hospital discharge and 90% expressing contentment with the prescribed medication. The most common adverse effects were tiredness/grogginess (45%), sleep disturbances (38%), nausea (37%), and constipation (27%). Also, 24% of patients self-reported deviations from medication instructions. A comparison of self-reported and instructed medications revealed that 14% exceeded prescribed dosages, and 28% opted for preparations different from those prescribed. Notably, patients who self-reported deviations from instructions differed from those objectively deviating from instructions. Although 56% of patients had intense pain, the majority expressed satisfaction with the provided pain relief. Instances of non-adherence to medication instructions were prevalent, often going unnoticed by the patients themselves.

Analysis of Pain Management after Anatomic VATS Resection in Austrian Thoracic Surgery Units.

Postoperative pain influences rehabilitation, postoperative complications and quality of life. Despite its impact, there are no uniform treatment guidelines. Different centers seem to use various strategies. This study aims to analyze pain management regimens used after anatomic VATS resections in Austrian thoracic surgery units, with a special interest in opioid usage and strategies to avoid opioids. A questionnaire was designed to assess the use of regional anesthesia, postoperative pain medication and characteristics of individual pain management regimens. The questionnaire was sent to all thoracic surgery units in Austria, with nine out of twelve departments returning them. All departments use regional anesthesia during the procedure. Four out of nine centers use epidural analgesia or an intercostal catheter for postoperative regional anesthesia in at least 50% of patients. Two departments follow an opioid restrictive regimen, five depend on the visual analogue scale (VAS) and two administer opioids on a fixed schedule. Three out of nine departments use NSAIDs on a fixed schedule. The most used medication is metamizole (eight out of nine centers; six on a fixed schedule, two depending on VAS) followed by piritramide (six out of nine centers; none as a fixed prescription). This study reflects the heterogeneity in postoperative pain treatment after VATS anatomic lung resections. All departments use some form of regional anesthesia in the perioperative period; prolonged regional anesthesia is not utilized uniformly to reduce opioid consumption, as suggested in enhanced recovery after surgery programs. More evidence is needed to optimize and standardize postoperative pain treatment.

Bleeding risk from nonsteroidal anti-inflammatory drugs after functional endoscopic sinus surgery: Analysis of the TriNetX database.

Postoperative pain medications and aspirin before undergoing functional endoscopic sinus surgery (FESS) are managed carefully due to concern for bleeding. Little is known regarding the increase in the risk of bleeding for patients unable to stop aspirin as trials are limited in this area. We compared outcomes for patients undergoing FESS who were managed postoperatively with nonsteroidal anti-inflammatory drugs (NSAIDs) versus opioids. We also determined the epistaxis rate for patients on aspirin at the time of surgery compared to those who were not on aspirin. Retrospective analysis of patients undergoing FESS using the TriNetX database. Patients were propensity-matched, and the odds of bleeding complications between the patients prescribed postoperative NSAIDs were compared to those prescribed opioids. We also compared postoperative odds of bleeding in patients unable to halt aspirin use at the time of surgery to those who were not on aspirin before surgery. A total of 51,361 patients received opioids after FESS compared to 1923 patients who received NSAIDs. After propensity matching, 1918 patients were in each group and odds of epistaxis were similar between the NSAIDgroup and the opioid group (odds ratio [OR]: 1.32, 95% confidence interval (CI): 0.90-1.94); 7.67% of the NSAIDgroup required rescue opioids. Patients on aspirin who were unable to hold aspirin at surgery showed bleeding rates of 14.67% compared to 9.00% in propensity-matched controls who were not on aspirin (OR: 1.74, 95%CI: 1.20-2.51). NSAIDuse appears to be a safe alternative to opioids for patients without pre-existing risk factors for bleeding. Patients who remained on aspirin in the week before FESS had an increased risk of postoperative epistaxis.

Opioid-prescribing Practices among Otolaryngology Physicians in Saudi Arabia: A Cross-sectional Study

Abstract Background: Understanding opioid prescription patterns among otolaryngologists is crucial due to the complexity of procedures and associated pain profiles. This study aims to identify opioid prescription patterns among otolaryngologists in Saudi Arabia and the factors that influence these practices. Materials and Methods: This descriptive, cross-sectional study was conducted in secondary and tertiary centers in Saudi Arabia from July 2022 to August 2023. Otolaryngologists, including consultants, fellows, and residents, were invited to participate. The eligibility criteria included actively practicing otolaryngologists in Saudi Arabia, regardless of their position or nationality. Otolaryngologists not involved in clinical practice within Saudi Arabia during the study period were excluded. Simple random sampling was employed to select the participants. Results: In this study, 214 otolaryngologists participated. The majority were in the age group of 25–34 years (61.2%) and male (71.5%). Resident otolaryngologists represented 48.6% of the participants. Paracetamol was the most commonly prescribed postoperative pain medication (87.9%), whereas high opioid prescriptions were limited (4.7%), with tramadol being the most prescribed opioid (48.1%). Head-and-neck cancer resection surgeries accounted for the highest opioid prescription rate (65.4%). Otolaryngologists in academic settings had significantly higher rates of prescribing high opioid prescriptions compared to those in the community (P = 0.025). Other sociodemographic characteristics and prescribing behaviors showed no significant associations with opioid prescription patterns (P &gt; 0.05). Conclusion: This study revealed limited high opioid prescriptions among otolaryngologists in Saudi Arabia, with higher rates in academic settings.