Request For Pain Medication Research Articles

Discharge Opioids are Unnecessary Following Radical Cystectomy

OBJECTIVETo show that zero-opioid discharges after both open and robotic cystectomy are feasible and to examine the impact of zero-opioid discharges on patient interaction with the physician's office. MATERIALS AND METHODSOne hundred seven patients who underwent either open or robotic radical cystectomy from March 1, 2020 to December 30, 2020 were identified. Patient demographics, perioperative data, and 30 day pain related outcomes including phone calls, office visits, requests for pain medication, emergency department visits, and readmissions were abstracted from the chart. We then examined variables associated with a zero-opioid discharge. RESULTSThirty-two patients were discharged with an opioid prescription (Median Oral Morphine Equivalents Prescribed = 90) and 75 were discharged without an opioid prescription. On regression analysis, age (OR 1.07, 95% CI [1.02-1.12]) and pathology (OR 0.36, 95% CI[0.14-0.9]) remained significantly associated with post-operative opioid prescriptions. There were no differences in the percent of patients presenting to the emergency department, being readmitted, calling the office, calling the office regarding pain, or requesting opioid prescriptions within 30 days of discharge, or the number of post-operative office visits (P >.05 for all). CONCLUSIONPatients can safely be discharged home without opioids following cystectomy, regardless of robotic or open approach. Age and pathology are predictors of the need for an opioid prescription on discharge. These patients did not have increased follow-up visits, phone calls, or requests for pain medication.

Evaluation of postoperative analgesic effects of infraorbital nerve block by levobupivacaine vs. Ropivacaine after cleft palate surgery: A double-blinded randomized trial

Background: Both ropivacaine and levobupivacaine have been used for the peripheral block in children for surgical pain. The present study is aimed to compare the effectiveness of 0.375% levobupivacaine and 0.375% ropivacaine in the infraorbital block for cleft palate surgery. Patients and Methods: Eighty patients between the age group of 2–12 years planned for elective surgery for cleft palate were included in the study. The solution for Group L was a mixture of 0.375% levobupivacaine and the solution for Group R was a mixture of 0.375% ropivacaine. Infraorbital nerve blocks were conducted by landmark-guided technique. We used the Verbal Rating Scale (VRS) to assess the postoperative pain. Results: There was a statistically significant difference in the time interval until the first request for pain medication was made by the participants in the two groups (10.6 [8.4, 12.8] vs. 8.5 [6.1, 10.8] h, P = 0.002). There were differences in pain scores calculated at regular intervals after surgery comparing the two groups (2.7 ± 0.3 vs. 3.6 ± 0.3, P = 0.01). There were differences in the need for rescue analgesics comparing the two groups. Conclusion: The analgesic effects of levobupivacaine are statistically better than ropivacaine in the infraorbital block in children who underwent cleft palate surgery.

Small Dose-Clonidine Prolongs Postoperative Analgesia after Sciatic-Femoral Nerve Block With 0.75% Rovpivacaine for Foot Surgery

Background: Foot surgery is associated with severe pain that can extend significantly up to 48 hours and often requires large amounts of parenteral opioids. . The benefit of adding clonidine to LAs for peripheral nerve blocks is less clear, although it is widely believed that clonidine improves quality and duration of a LA block. The aim of this study was to evaluate the effects of adding 1 mg/kg clonidine to 0.75% ropivacaine during combined sciatic-femoral nerve block for hallux valgus repair. Subjects and Methods: Thirty six ASA physical status I and II patients, scheduled for elective hallux  valgus repair under combined sciatic-femoral nerve block, were enrolled in the study. By using a sealed envelope technique, patients were randomly allocated to receive sciatic-femoral nerve block with 30 mL of either 0.75% ropivacaine alone (group Ropivacaine, n 5 15) or 0.75% ropivacaine plus 1 mg/kg clonidine (group Ropivacaine- Clonidine, n 5 15). Standard monitoring was used throughout the study, including noninvasive arterial blood pressure, heart rate, and pulse oximetry. The time from the end of anesthetic injection to resolution of motor block at the ankle of the operated foot and first request for postoperative analgesic was recorded. At discharge from the orthopedic ward and 3 wk after hospital discharge, patients were also evaluated regarding the occurrence of neurological complications. Results: No differences in the time required to achieve surgical anesthesia were observed between patients receiving only 0.75% ropivacaine (10 [5–20] min) and those receiving the ropivacaine-clonidine mixture (10 [5–30] min).  The mean time from block placement to first request for pain medication was shorter in group Ropivacaine than in group Ropivacaine- Clonidine (P = 0.03,. No differences in postoperative consumption of ketoprofen were observed between patients. Conclusion: Adding 1mg/kg clonidine to 0.75% ropivacaine provided a 3-h delay in first request for pain medication after hallux valgus repair, with no clinically relevant side effects.

The Effect of Distraction during Labor Induction on Timing of Analgesia Request: A Randomized Clinical Trial.

To assess whether distraction using music and/or video games influences timing of analgesia request and improves pain outcomes in women undergoing labor induction. A total of 219 pregnant women with singleton gestation undergoing labor induction with a Foley bulb (FB) at term were randomized to distraction with music and video games via iPod (n = 109) or no iPod (n = 110). The primary outcome was the time from FB placement to request for pain medication. Secondary outcomes included number of patients requesting pain medication within 6 and 12 hours, type of pain medication received, pain visual analog scale scores, and patient satisfaction. Mann-Whitney's, chi-square, Kaplan-Meier's curves, and Pearson's product moment correlation were used for statistical analysis (significance: p < 0.05). Baseline characteristics were similar between the two groups. There was no difference in the time from FB placement until pain medication request between the groups. There were no significant differences in secondary outcomes. Increased per cent time of iPod use correlated with a longer time until pain medication request (R 2 = 0.22, p = 0.03). We were not able to show that distraction using music and video games delays timing of analgesia request or improve pain outcomes in pregnant women undergoing mechanical labor induction at term.

Double-Blind Randomized Placebo-Controlled Trial of Single-Dose Intravenous Acetaminophen for Pain Associated With Adenotonsillectomy in Pediatric Patients With Sleep-Disordered Breathing.

Adequate pain control is an important component in the postoperative outcome for pediatric adenotonsillectomy patients with sleep-disordered breathing (SDB). Intravenous acetaminophen appears to be a favorable analgesic adjunct owing to its predictable pharmacokinetics and opioid-sparing effects; however, its role in pediatric adenotonsillectomy pain management remains unclear. In this prospective, randomized, double-blinded, controlled study, subjects with the diagnosis of SDB, aged 2 to 8 years, who required extended postoperative admission, received intravenous acetaminophen (15 mg/kg) or saline placebo intraoperatively in addition to morphine (0.1 mg/kg) for postoperative surgical analgesia. Pain scores in the postanesthesia care unit (PACU) using the FLACC (Faces, Leg, Activity, Cry, Consolability) score were used to determine the need for supplemental analgesic agents in the PACU. The PACU time and time to the first request for pain medication on the inpatient ward were also measured. A total of 239 patients were included in the final data analysis (118 in the intravenous acetaminophen group and 121 in the saline placebo group). The 2 groups did not differ in the proportion of patients reaching FLACC scores = 4 in the PACU (p = 0.223); mean FLACC scores in the PACU (p = 0.336); mean PACU time (p = 0.883); or time to requesting pain medication on the inpatient ward (p = 0.640). A single intraoperative dose of intravenous acetaminophen did not alter the postoperative course of pediatric patients with SDB following adenotonsillectomy.

Perceptions of Reasons Call Lights Are Activated Pre- and Postintervention to Decrease Call Light Use

Patients were assessed regarding the reasons for activating call lights. Top reasons were requests for pain medication, monitor/device alarms, and needing assistance. Nurse perceptions of the top 10 reasons for patients to activate call lights matched patient perceptions. After implementing interventions that anticipated patient needs, the likelihood of patients activating a call light decreased significantly for most needs, but call lights for nonspecific reasons, such as having caregivers check something, increased.

What Really Matters in Pain Management for Terminally Ill Cancer Patients in Taiwan

The paradox of patients who are in pain yet satisfied with their pain management has been documented repeatedly. Pain relief constitutes only one part of patient satisfaction with pain management. The quality of cancer pain management in Taiwan has not been evaluated from the patient's perspective. A cross-sectional design was used to survey 1,370 terminally ill cancer patients in Taiwan to characterize the status of, and satisfaction with cancer pain management by investigating the relative importance of pain intensity, pain relief experiences, and clinicians' pain management practices. Cancer patients with pain had unsatisfactory pain relief within one week of admission (47.4 percent) and inadequate pain medication (23.6 percent). However, these patients perceived that clinicians adequately informed them about pain treatment. Patient satisfaction with pain management was primarily determined by examining the perceptions that medication dose was just right, responses to requests for pain medication were prompt, and understandable and consistent information about pain treatment was offered. In conclusion, Taiwanese cancer patients' satisfaction with pain management was influenced more by perceived pain management practices than by pain relief itself.

The use of hypnosis to improve pain management during voluntary interruption of pregnancy: An open randomized preliminary study

Abstract Objective This report describes an open randomized study that aims to determine whether a brief hypnotic intervention during first-trimester surgical abortion reduces requests for pain medication. Methods Thirty women undergoing first-trimester surgical abortion at the family planning clinics of a large hospital in Quebec City were randomized into a control group that received standard care and a hypnosis group that received, in addition to standard care, an intervention of hypnosis, including analgesia suggestions 20 min before and throughout the surgical procedure. Patients in both groups were given the option to control their pain with nitrous oxide (N 2 O) sedation administered through a nose mask as often and for as long as they wanted during the procedure. N 2 O sedation as the primary outcome was assessed at each step of the procedure. The patient's self-reported anxiety and pain were also assessed during the procedure as secondary outcomes. Results Thirty-six percent of patients in the hypnosis group requested N 2 O sedation during the procedure versus 87% in the control group (p Conclusion These results suggest that hypnosis can be integrated into standard care and reduces the need for N 2 O in patients undergoing first-trimester surgical abortion. This reduction in N 2 O consumption did not lead to significant changes in pain or anxiety, and a larger sample size is required to assess the possible effects of hypnosis on those variables.

Analgesic Efficacy of Perioperative Celecoxib in Ambulatory Arthroscopic Knee Surgery: A Double-Blind, Placebo-Controlled Study

To examine whether celecoxib, administered perioperatively, reduces opioid consumption and opioid-related adverse effects, and provides effective analgesia, in patients undergoing ambulatory arthroscopic knee meniscectomy. Patients (> or = 18 years) with diagnosed knee meniscus disease were given celecoxib (400 mg; n = 99) or placebo (n = 101) 1 hour before they underwent arthroscopic knee surgery; this was followed by celecoxib (200 mg) or placebo given postoperatively at their first request for pain medication. Surgery was performed with patients under general anesthesia (fentanyl, 1 to 3 microg/kg plus 0.25% intra-articular bupivacaine, 10 to 20 mL) administered at the index joint. Every 4 to 6 hours, patients were allowed 1 to 2 tablets of hydrocodone bitartrate 5 mg/acetaminophen 500 mg (and optional opioids as needed). All efficacy analyses were conducted in the modified intent-to-treat population. In the 24 hours following surgery, total opioid consumption was significantly reduced in the celecoxib group (3.6 tablets) compared with the placebo group (4.6 tablets; P = .009). Celecoxib was associated with significant reductions in opioid consumption compared with placebo at 10 to 12 hours (P = .005) and at 12 to 24 hours (P = .012). The percentage of placebo-treated patients (41%) who required opioid analgesics was significantly greater than the percentage of celecoxib-treated patients who required opioids (22%; P = .008) at 10 to 12 hours. Adverse events (AEs) were experienced by more patients in the placebo group (37%) than in the celecoxib group (18%). Incidences of opioid-related events, such as central nervous system disorders (12% v 3%, respectively) and constipation (5% v 1%, respectively), were higher in placebo-treated patients than in those given celecoxib. Perioperative administration of celecoxib plus optional opioids reduces the use of opioids and the occurrence of opioid-related AEs compared with treatment with placebo plus optional opioids given to patients undergoing arthroscopic knee meniscectomy. Level I, randomized, double-blind, placebo-controlled, parallel-group study.

Oral misoprostol vs. vaginal gemeprost prior to surgical termination of pregnancy in nulliparae.

To compare the efficacy and side-effects of intravaginal gemeprost with those of oral misoprostol for cervical ripening prior to first-trimester pregnancy termination in nulliparous women. Retrospective analysis of surgical terminations of pregnancy performed before 90 days of gestation. Intravaginal gemeprost 1 mg or oral misoprostol 800 micro g was administered 2 h before the procedure. In total, 746 women were enrolled into the study, 84 received intravaginal gemeprost and 662 oral misoprostol. Median baseline cervical dilatation was significantly greater in women who received misoprostol before the operation than in those who received gemeprost (7 mm vs. 3 mm; p < 0.0001). The incidence of fever, vomiting and diarrhea was not different between the two groups. The incidence of abdominal pain with request for pain medication, emergency admission to operating room due to vaginal bleeding, hospital stay longer than 24 h and surgical repair of cervical injury due to Hegar dilatation was significantly higher among the gemeprost group than the misoprostol group. In cervical priming prior to first-trimester pregnancy termination in nulliparous women, oral misoprostol is more effective and is associated with fewer side-effects and complications than intravaginal gemeprost.

Oral misoprostol vs. vaginal gemeprost prior to surgical termination of pregnancy in nulliparae

Background. To compare the efficacy and side-effects of intravaginal gemeprost with those of oral misoprostol for cervical ripening prior to first-trimester pregnancy termination in nulliparous women. Methods. Retrospective analysis of surgical terminations of pregnancy performed before 90 days of gestation. Intravaginal gemeprost 1 mg or oral misoprostol 800 µg was administered 2 h before the procedure. Results. In total, 746 women were enrolled into the study, 84 received intravaginal gemeprost and 662 oral misoprostol. Median baseline cervical dilatation was significantly greater in women who received misoprostol before the operation than in those who received gemeprost (7 mm vs. 3 mm; p < 0.0001). The incidence of fever, vomiting and diarrhea was not different between the two groups. The incidence of abdominal pain with request for pain medication, emergency admission to operating room due to vaginal bleeding, hospital stay longer than 24 h and surgical repair of cervical injury due to Hegar dilatation was significantly higher among the gemeprost group than the misoprostol group. Conclusions. In cervical priming prior to first-trimester pregnancy termination in nulliparous women, oral misoprostol is more effective and is associated with fewer side-effects and complications than intravaginal gemeprost.

Anesthesia (18)

Small‐dose clonidine prolongs postoperative analgesia after sciatic‐femoral nerve block with 0.75% ropivacaine for foot surgery. (University of Milan, Milan, Italy) Anesth Analg 2000;91:388–392.This study evaluated the effects of adding small‐dose clonidine to 0.75% ropivacaine during peripheral nerve blocks, 30 ASA physical status I and II patients undergoing hallux valgus repair under combined sciatic‐femoral nerve block were randomly allocated in a double‐blinded fashion to receive block placement with 30 mL of either 0.75% ropivacaine alone (Group Ropivacaine, n = 15) or 0.75% ropivacaine plus μg/kg clonidine (Group Ropivacaine‐Clonidine, n = 15). Hemodynamic variables, oxygen saturation, and levels of sedation, as well as the time required to achieve surgical block and time to first analgesic request, were recorded by a blinded observer. Time to surgical blockade required 10 min in both groups. Patients in the Ropivacaine‐Clonidine Group were more sedated than patients in the Ropivacaine Group only 10 min after block placement. No differences in oxygen saturation and hemodynamic variables, degree of pain measurement at first analgesic request, and consumption of postoperative analgesics were observed between the two groups. The mean time from block placement to first request for pain medication was shorter in Group Ropivacaine (13.7 h; 25th–75th percentiles: 11.8–14.5 h) than in Group Ropivacaine‐Clonidine (16.8; 25th–75th percentiles: 13.5–17.8 h) (P = 0.038). Conclude that adding 1 μg/kg clonidine to 0.75% ropivacaine provided a 3‐h delay in first request for pain medication after hallus valgus repair, with no clinically relevant side effects.

Combined sciatic-femoral nerve block with 0.75% ropivacaine: effects of adding a systemically inactive dose of fentanyl

To evaluate the effects of adding low-dose fentanyl to 0.75% ropivacaine during peripheral nerve blocks, 30 ASA physical status I-II patients undergoing hallux valgus repair under combined sciatic-femoral nerve block were randomly allocated in a double-blind fashion to receive nerve block placement with 30 mL of either 0.75% ropivacaine alone (group: ropivacaine, n = 15) or 0.75% ropivacaine plus fentanyl 1 μg kg−1 (group: ropivacaine-fentanyl, n=15). A blinded observer recorded haemodynamic variables and sedation, as well as the time required to achieve surgical block and the first request for analgesia. Readiness to surgery required 10 min (5-20 min) with 0.75% ropivacaine and 10 min (3-20 min) with the ropivacaine-fentanyl mixture. No differences in the degree of sedation, peripheral oxygen saturation, and haemodynamic variables were observed between the two groups. The degree of pain measured at first analgesic request, and the consumption of postoperative analgesics, was similar in the two groups, while the mean time from block placement to the first request for pain medication was 13.7 h (25-75th percentiles: 11.8-14.5 h) in the ropivacaine group and 13.9 h (25-75th percentiles: 10.5-14.5 h) in the ropivacaine-fentanyl group (P = not significant). We conclude that adding fentanyl 1 μg kg−1 to 0.75% ropivacaine did not provide clinically relevant advantages in terms of onset time, quality and duration of combined sciatic-femoral nerve block in patients undergoing elective hallux valgus repair.

A clinical comparison of ropivacaine 0.75%, ropivacaine 1% or bupivacaine 0.5% for interscalene brachial plexus anaesthesia

In order to compare interscalene brachial plexus block performed with ropivacaine or bupivacaine, 45 healthy, unpremedicated patients, undergoing elective shoulder surgery, were randomly allocated to receive interscalene brachial plexus anaesthesia with 20 mL of either ropivacaine 0.75% (n = 15), ropivacaine 1% (n = 15), or bupivacaine 0.5% (n = 15). Readiness for surgery (loss of pinprick sensation from C4 to C7 and inability to elevate the limb from the bed) was achieved later with bupivacaine 0.5% (28 ±15 min) than with ropivacaine 1% (10±5 min) (P = 0.005) and ropivacaine 0.75% (15±8 min) (P=0.0005). No differences in success rate were observed between the three groups; however, seven patients receiving bupivacaine 0.5% required intra-operative analgesic supplementation (fentanyl 0.1 mg intravenous) compared with one patient receiving ropivacaine 0.75%, and two patients treated with ropivacaine 1% (P=0.02). The time from the block placement to first request for pain medication was similar in the three groups (10.7 ± 2 h, 11 ± 2.4 h, and 10.9 ± 3.9 h after 0.75% and 1% ropivacaine or 0.5% bupivacaine, respectively). We conclude that interscalene brachial plexus block performed with 20 mL of either 0.75% or 1% ropivacaine allows for a prolonged post-operative pain relief, similar to that provided by bupivacaine 0.5%, with short onset time of surgical anaesthesia.

Spinal Anesthesia Using Hyperbaric 0.75% Versus Hyperbaric 1% Bupivacaine for Cesarean Section

Although 0.75% hyperbaric bupivacaine is commonly administered to provide spinal anesthesia for cesarean section in the United States, in some countries, only the 1% hyperbaric solution of spinal bupivacaine is available. The aim of this study was to compare 0.75% with 1% hyperbaric spinal bupivacaine for cesarean section. In this prospective study, 50 patients undergoing elective cesarean section were randomized to receive a spinal anesthetic with either 1.5 mL of 0.75% bupivacaine (n = 25) or 1.125 mL of 1% bupivacaine (n = 25). There were no statistically significant differences in patient demographics, time to onset of block, or intraoperative pain. All patients had a successful block for surgery. The time from injection of the spinal anesthetic to first request for pain medication in the postanesthesia care unit was longer in the women who received 0.75% bupivacaine (4.3 vs 3 h; P < 0.05). Six women (24%) who received 1% bupivacaine versus one woman (4%) who received 0.75% bupivacaine complained of postoperative backache (P < 0.05). In addition, postdural puncture headache occurred in four women, all of whom received 1% bupivacaine (P = 0.04). In conclusion, our data suggest that 0.75% bupivacaine results in fewer postoperative problems and offers several significant benefits compared with the 1% concentration. Implications: Although 0.75% bupivacaine is usually used to provide spinal anesthesia for cesarean section in the United States, a more concentrated solution is popular in Europe. In this study, we compared 0.75% bupivacaine with 1% bupivacaine when administered for cesarean section and found that the 0.75% solution offers several significant benefits. (Anesth Analg 1998;87:1099-1104)