Comprehensive Acute Pain Management in the Perioperative Surgical Home

Pozek, John-Paul J.; Ruyter, Martin De; Khan, Talal W.

doi:10.1016/j.anclin.2018.01.007

Cited by 17 publications

(11 citation statements)

References 40 publications

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“…Acute pain management plays an important role in reducing perioperative morbidity and achieving patient satisfaction [76]. Ineffective pain control plays a major role in prolonging length of stay, increasing the risk of postoperative complications, and compromising the quality of recovery [77].…”

Section: Multimodal Opioid-sparing Analgesiamentioning

confidence: 99%

Enhanced Recovery and Surgical Optimization Protocol for Minimally Invasive Gynecologic Surgery: An AAGL White Paper

Stone¹,

Carey

Fader³

et al. 2021

Journal of Minimally Invasive Gynecology

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This is the first Enhanced Recovery After Surgery (ERAS) guideline dedicated to standardizing and optimizing perioperative care for women undergoing minimally invasive gynecologic surgery. The guideline was rigorously formulated by an American Association of Gynecologic Laparoscopists Task Force of US and Canadian gynecologic surgeons with special interest and experience in adapting ERAS practices for patients requiring minimally invasive gynecologic surgery. It builds on the 2016 ERAS Society recommendations for perioperative care in gynecologic/oncologic surgery by serving as a more comprehensive reference for minimally invasive endoscopic and vaginal surgery for both benign and malignant gynecologic conditions. For example, the section on preoperative optimization provides more specific recommendations derived from the ambulatory surgery and anesthesia literature for the management of anemia, hyperglycemia, and obstructive sleep apnea. Recommendations pertaining to multimodal analgesia account for the recent Food and Drug Administration warnings about respiratory depression from gabapentinoids. The guideline focuses on workflows important to high-value care in minimally invasive surgery, such as same-day discharge, and tackles controversial issues in minimally invasive surgery, such as thromboprophylaxis. In these ways, the guideline supports the American Association of Gynecologic Laparoscopists and our collective mission to elevate the quality and safety of healthcare for women through excellence in clinical practice.

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Section: Multimodal Opioid-sparing Analgesiamentioning

confidence: 99%

Enhanced Recovery and Surgical Optimization Protocol for Minimally Invasive Gynecologic Surgery: An AAGL White Paper

Stone¹,

Carey

Fader³

et al. 2021

Journal of Minimally Invasive Gynecology

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“…anesthesiologists, additional pain specialists, surgeons, palliative care providers, pharmacists, etc.) through either consult services such as an APS [152], protocolized formal pathways such as ERAS [153] or Perioperative Surgical Home [154], or simple pathways led by surgical services. Many of the medications and regional anesthesia techniques discussed in this review should play an integral part of these pathways but is dependent on a myriad of factors, such as the surgery procedure, patient comorbidities (e.g.…”

Section: Expert Opinionmentioning

confidence: 99%

State of the art opioid-sparing strategies for post-operative pain in adult surgical patients

Gabriel

Swisher

Sztain

et al. 2019

Expert Opinion on Pharmacotherapy

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Introduction: There are various important implications associated with poorly controlled postoperative pain in the adult surgical patientthis includes cardiopulmonary complications, opioid-related side effects, unplanned hospital admissions, prolonged hospital stay, and the subsequent development of chronic pain or opioid addiction. With the ongoing national opioid crisis, it is imperative that perioperative providers implement pathways for surgical patients that reduce opioid requirements and painrelated complications. Areas covered: In this review, the authors discuss the components of a multimodal opioid-sparing analgesia pathway as it pertains to the perioperative environment. Medications reviewed include gabapentinoids, acetaminophen, non-steroidal anti-inflammatory drugs, ketamine, intravenous lidocaine, dexmedetomidine, and glucocorticoids. The use of peripheral nerve blocks and neuraxial analgesia are also discussed. Expert opinion: In appropriate cases, regional anesthetic interventions are extremely useful for postoperative analgesia, including peripheral nerve blocks and neuraxial analgesia and while newer postoperative analgesics have been postulated, the literature on such is presently controversial. Coordinated approaches to pain management are recommended to reduce the need for opioids and to improve patient satisfaction post-surgery.

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“…There is an extensive literature on the importance of pain and pain management in patient care, which stems from its biological, psychological and economic consequences [ 1 , 2 ]. First, pain is a burdensome subjective feeling, defined as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage,” by the International Association for the Study of Pain [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…Chronic pain, i.e. pain that lasts for more than three months [ 2 ], can result in increased nociceptive sensitivity through multiple signaling pathways. This peripheral sensitization leads to allodynia and hyperalgesia, which in turn result in central sensitization by decreasing inhibitory modulation in the dorsal horn and the brainstem [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Acute Pain Service in Hungarian hospitals

et al. 2021

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Background Surgical procedures play an increasing role among health technologies to treat diseases. Pain often accompanies such diseases, both as a result of their pathology, but also as the side-effect of the intervention itself, and it is not only a burdensome subjective feeling, but adversely affects the recovery process, can induce complications and increases treatment costs. Acute Pain Service Teams are becoming increasingly widespread in hospitals to address post-operative pain, yet we have so far no data on how many hospitals have actually adopted this technology in Hungary. Objectives The main objectives of our study were to assess the prevalence of Acute Pain Service Teams, map their structure and operation, as well as to understand the barriers and conducive factors of their establishment in Hungarian hospitals. Methods We carried out a survey among the 72 hospitals with surgical departments. The questionnaire was filled in by 52 providers, which gave us a response rate of 72.2%. Results Our results show, that only two of the responding hospitals have Acute Pain Service Teams albeit their structure and operation are in line with the literature. In the 50 hospitals without such teams, financing difficulties and human resources shortages are mentioned to be the most important obstacles of their establishment, but the lack of initiative and interest on the part of the specialities concerned are also an important barrier. Conclusions Lagging behind the more affluent EU member states, but similarly to other Central and Eastern European countries, Acute Pain Service has been hardly adopted by Hungarian hospitals. Hungarian health professionals know the technology and would support its wider introduction, if the technical feasibility barriers could be overcome. Health policy should play a more active role to facilitate change in this area, the investment in which promises a substantial return in terms of health gains and cost savings.

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Comprehensive Acute Pain Management in the Perioperative Surgical Home

Cited by 17 publications

References 40 publications

Enhanced Recovery and Surgical Optimization Protocol for Minimally Invasive Gynecologic Surgery: An AAGL White Paper

Enhanced Recovery and Surgical Optimization Protocol for Minimally Invasive Gynecologic Surgery: An AAGL White Paper

State of the art opioid-sparing strategies for post-operative pain in adult surgical patients

Acute Pain Service in Hungarian hospitals

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