A Dedicated Acute Pain Service Is Associated With Reduced Postoperative Opioid Requirements in Patients Undergoing Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy

Said, Engy T.; Sztain, Jacklynn F.; Abramson, Wendy B.; Meineke, Minhthy N.; Furnish, Timothy; Schmidt, Ulrich; Manecke, Gerard R.; Gabriel, Rodney A.

doi:10.1213/ane.0000000000003342

Cited by 24 publications

(20 citation statements)

References 17 publications

(19 reference statements)

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“…One center estimated establishing APS in their institution at a cost of $3-4 USD per patient [49], however this did not include equipment costs. An effective APS could contribute to improved pain control, improved patient and family satisfaction, decrease opioid consumption, and decrease adverse effects associated with uncontrolled severe pain [51][52][53][54]. In our center, we also provide a significant educational role to nurses and medical services in multi-modal pain management.…”

Section: Implementation Of An Acute Pain Servicementioning

confidence: 99%

A practical guide to acute pain management in children

et al. 2020

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In the pediatric population, pain is frequently under-recognized and inadequately treated. Improved education and training of health care providers can positively impact the management of pain in children. The purpose of this review is to provide a practical clinical approach to the management of acute pain in the pediatric inpatient population. This will include an overview of commonly used pain management modalities and their potential pitfalls. For institutions that have a pediatric acute pain service or are considering initiating one, it is our hope to provide a useful tool to aid clinicians in the safe and effective treatment of pain in children. Keywords Pediatric acute pain • Pain assessment • Acute pain service • Opioid • Multimodal management Approach to pain Effective pain management is ideally practiced in a multidisciplinary model focusing on patient-centered care. The World Health Organization (WHO) [1] analgesic ladder provides a strong foundation for the treatment of pain that can be built upon to reflect more modern thinking and techniques around pain management (Fig. 1). Some of these modifications are presented in an updated WHO ladder with guiding principles on post-operative management of acute pain [2], which advocates 5 recommendations for the correct use of analgesics: (1) use the oral form of medication whenever possible, (2) analgesics should be given at regular intervals, (3) analgesics should be administered based on the severity of pain assessed using a pain intensity scale, (4) medication dosing should be tailored to the individual patient, and (5) attention to detail should be maintained throughout the prescription of pain medications. The acute pain service The acute pain service (APS) is a specialized, multidisciplinary inpatient team consulted to assist with management of severe pain. Within our institution, this team consists of a pediatric anesthesiologist, pediatric anesthesia fellow, clinical nurse specialist, and pediatric psychiatrist. The APS works in collaboration with the patient's primary care team, bedside nurse, family, and pharmacists to provide a patient-centered multi-modal pain plan. Generally, the APS is consulted to assist in pain management when either a patient's analgesic needs have grown beyond standard opioid dosing (Table 1) that their primary service is comfortable prescribing, or there is anticipated need for APS involvement for postoperative patients. Postoperative patients who automatically require APS management in our institution include those with an indwelling regional or neuraxial block catheter, patients who have received a single-shot peripheral nerve block, patients with a patient-controlled analgesia (PCA) technique, or patients receiving a Ketamine infusion.

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Section: Implementation Of An Acute Pain Servicementioning

confidence: 99%

A practical guide to acute pain management in children

et al. 2020

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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%

“…Postoperative management challenges following open abdominal surgeries include ileus, pain, physical therapy, and dehydration, among others. Adequate pain management while concurrently minimizing opioid consumption can decrease the time to reach important milestones [152]. We propose the following components for perioperative pain management in this adult patient population ( Figure 2).…”

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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“…All these could contribute to the development of severe postoperative pain after surgery. Poorly managed postoperative pain could result in elevated stress and anxiety and further affect the quality of life of patients [10]. Due to the huge injury, patients with CRS and HIPEC have a high requirement for analgesia.…”

Section: Introductionmentioning

confidence: 99%

Postoperative pain pathophysiology and treatment strategies after CRS + HIPEC for peritoneal cancer

Wang

2020

World J Surg Onc

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Background: Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is a treatment choice for peritoneal cancer. However, patients commonly suffer from severe postoperative pain. The pathophysiology of postoperative pain is considered to be from both nociceptive and neuropathic origins. Main body: The recent advances on the etiology of postoperative pain after CRS + HIPEC treatment were described, and the treatment strategy and outcomes were summarized. Conclusion: Conventional analgesics could provide short-term symptomatic relief. Thoracic epidural analgesia combined with opioids administration could be an effective treatment choice. In addition, a transversus abdominis plane block could also be an alternative option, although further studies should be performed.

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A Dedicated Acute Pain Service Is Associated With Reduced Postoperative Opioid Requirements in Patients Undergoing Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy

Cited by 24 publications

References 17 publications

A practical guide to acute pain management in children

A practical guide to acute pain management in children

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

Postoperative pain pathophysiology and treatment strategies after CRS + HIPEC for peritoneal cancer

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