Acute Pain Management in the Postanesthesia Care Unit

Gandhi, Kishor; Baratta, Jaime L.; Heitz, James W.; Schwenk, Eric S.; Vaghari, Benjamin; Viscusi, Eugene R.

doi:10.1016/j.anclin.2012.09.001

Cited by 26 publications

(16 citation statements)

References 51 publications

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“…Good pain management improves participant satisfaction and facilitates shorter PACU/hospital stay [1]. Although pain management in the PACU has been improving with opioid-free strategies, opioids are still commonly used of analgesia for surgical participants with moderate to severe pain [2]. Intravenous opioids can provide rapid and effective analgesia but their undesired side effects, including pruritus, nausea and vomiting, urinary retention, and respiratory depression, result in discomfort or even lethal consequences [3, 4].…”

Section: Introductionmentioning

confidence: 99%

Bilateral thoracic Paravertebral block for immediate postoperative pain relief in the PACU: a prospective, observational study

2017

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BackgroundTo investigate the feasibility, effectiveness and safety of bilateral thoracic paravertebral block (TPVB) in the post anesthesia care unit (PACU) for pain relief in participants after laparotomy.MethodsA single shot of bilateral TPVB with 25 ml of 0.2% ropivacaine and 5 mg dexamethasone in combination for both sides at the 8th thoracic transverse level (T8) was performed on 201 participants who complained moderate to severe pain on arrival to PACU after laparotomy. The visual analog scale (VAS) pain scores at rest and on cough, heart rate, blood pressure, and pulse oximetry before and after bilateral TPVB for up to 1 h were recorded. The VAS Pain scores at rest and on cough at 24 h after bilateral TPVB were also recorded.ResultsBilateral TPVB was carried out successfully in all participants. The VAS pain scores at rest and on cough were 7.9 ± 1.6 and 8.7 ± 1.3 respectively pre-bilateral TPVB. The VAS pain scores at rest and on cough were significantly decreased to 1.1 ± 1.2 and 2.1 ± 1.6 respectively (P < 0.001) at 60 min after bilateral TPVB and to 2.1 ± 1.7 and 3.8 ± 1.9 at rest and on cough respectively ((P < 0.001) at 24 h after bilateral TPVB. At 10 min post-bilateral TPVB, only systolic blood pressure was reduced from 122 ± 19 mmHg to 111 ± 18 mmHg (P = 0.007) but then gradually became stable. No complications related to bilateral TPVB were observed.ConclusionBilateral TPVB can be provided for pain relief to the participants who suffer from moderate to severe pain after upper laparotomy in the PACU.Trial registrationChinese Clinical Trial Registry: ChiCTR-ONN-16009229, Registered on 10 September 2016.

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Section: Introductionmentioning

confidence: 99%

Bilateral thoracic Paravertebral block for immediate postoperative pain relief in the PACU: a prospective, observational study

2017

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“…In the US, intravenous (IV) opioid agonists such as morphine, hydromorphone, and fentanyl have traditionally been important analgesics in the treatment of pain in the immediate perioperative and critical care settings [11–13]. In the first half of 2015, over 70% of surgical inpatients and outpatients in the US received opioid monotherapy for acute pain management [14].…”

Section: Introductionmentioning

confidence: 99%

Estimating the Effect of Intravenous Acetaminophen for Postoperative Pain Management on Length of Stay and Inpatient Hospital Costs

et al. 2016

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IntroductionThe provision of safe, effective, cost-efficient perioperative inpatient acute pain management is an important concern among clinicians and administrators within healthcare institutions. Overreliance on opioid monotherapy in this setting continues to present health risks for patients and increase healthcare costs resulting from preventable adverse events. The goal of this study was to model length of stay (LOS), potential opioid-related complications, and costs for patients reducing opioid use and adding intravenous acetaminophen (IV APAP) for management of postoperative pain.MethodsData for this study were de-identified inpatient encounters from The Advisory Board Company across 297 hospitals from 2012–2014, containing 2,238,433 encounters (IV APAP used in 12.1%). Encounters for adults ≥18 years of age admitted for cardiovascular, colorectal, general, obstetrics and gynecology, orthopedics, or spine surgery were included. The effects of reducing opioids and adding IV APAP were estimated using hierarchical statistical models. Costs were estimated by multiplying modeled reductions in LOS or complication rates by observed average volumes for medium-sized facilities, and by average cost per day or per complication (LOS: US$2383/day; complications: derived from observed charges).ResultsAcross all surgery types, LOS showed an average reduction of 18.5% (10.7–32.0%) for the modeled scenario of reducing opioids by one level (high to medium, medium to low, or low to none) and adding IV APAP, with an associated total LOS-related cost savings of $4.5 M. Modeled opioid-related complication rates showed similar improvements, averaging a reduction of 28.7% (5.4–44.0%) with associated cost savings of $0.2 M. In aggregate, costs decreased by an estimated $4.7 M for a medium-sized hospital. The study design demonstrates associations only and cannot establish causal relationships. The cost impact of LOS is modeled based on observed data.ConclusionsThis investigation indicates that reducing opioid use and including IV APAP for postoperative pain management has the potential to decrease LOS, opioid-related complication rates, and costs from a hospital perspective.FundingMallinckrodt Pharmaceuticals.

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“…Postoperatif erken dönemde ortaya çıkan ağrıyı azaltmak için multimodal analjezi tekniğinin bir parçası olarak lokal infiltrasyon analjezisi önerilir. Periferik sinir bloklarına bağlı olarak kaslarda ortaya çıkan zayıflık özellikle mobilizasyon sırasında düşmelere neden olabilir (45)(46)(47)(48)(49)(50)(51)(52)(53). Bunun önüne geçmek için bu hasta grubunda periartiküler enjeksiyon önerilir.…”

Section: Artroplastide Anesteziunclassified

Current Approaches in Hip and Knee Arthroplasty Anaesthesia

Güler¹,

Atıcı²,

Kurt³

et al. 2015

Turk J Anesth Reanim

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Anestezist için artroplastide risk belirlemesi, preoperatif hastanın kullandığı ilaçların düzenlenmesi, kullanılacak anestezi ve analjezi yöntemleri çok önemlidir ve cerrahinin başarısına etkisi büyüktür. Bu nedenle; artroplastide güncel bilgilerin ışığında bu konuların derlemesi sunulmuştur.Anahtar Kelimeler: Artroplasti, preoperatif değerlendirme, risk belirlemesi, anestezi, analjezi Risk assesment, preoperative drug regulation, the anesthesia and analgesia techniques are very important and the effectivity on success of surgery is grade. So, these topics in arthroplasty were review under current knowledge. 188A rtroplasti; ekleme ağrısız hareket sağlamak ve eklemi kontrol eden yapılara optimal fonksiyonu kazandırmak için implant yerleştirilerek eklemi oluşturan kemik yapılara yeniden yüzey oluşturma girişimidir. Artroplastide Risk DeğerlendirmesiArtroplastide mortalite ve morbidite riski taşıyan hastaların belirlenmesi, intraoperatif ve postoperatif komplikasyonların tahmin edilmesi ve önlenmeye çalışılması, dikkatli preoperatif hazırlık ve postoperatif bakım sağlanması başarı oranını artı-rarak, sağlık harcamalarını büyük oranda azaltır (1). Hastanın yaşı, kardiyovasküler hastalık ve kronik obstrüktif akciğer hastalığı (KOAH) varlığı, geçirilmiş tromboembolik olaylar, böbrek fonksiyonları ve kullanılan ilaçların sorgulanması ve fonksiyonel kapasitenin belirlenmesi, perioperatif yaşanabilecek komplikasyonların sıklığı hakkında önemli bilgiler verir (2). Fizik muayene hastada önemli durumları açığa çıkarmak için çok önemlidir. Vital bulgular hipo veya hipertansiyon, bradi veya taşikardi, aritmi, hipoksi, juguler ven distansiyonu, S3 gallop ritmi, kalpte üfürümler, karotis, femoral veya abdominalde duyulan anormal oskültasyon bulgularının varlığı araştırılmalıdır. Ameliyat öncesi tam kan sayımı, hemoglobin, elektrolitler, kan glikoz düzeyi, üre, kreatin, karaciğer enzimleri, kanama pıhtılaşma zamanları, idrar tetkikleri yapılmalı, akciğer grafisi ve elektrokardiografi (EKG) görülmelidir. EKG'de iskemi ve sol ventrikül hipertrofisi bulguları veya sistolik üfürüm var ise ekokardiyografi istenmelidir. Ekokardiyografide risk belirlemek için en önemli bulgu ejeksiyon fraksiyonudur, %35'in altında olması yüksek risk göstergesidir. Kalpte komplikasyonlar artroplasti sırası ve sonrasında görülen mortalite ve morbidite nedenlerinin başında gelir. Yüksek American Society of Anaesthesiologists (ASA) değerleri ve fonksiyonel kapasitenin azalmış olması en önemli risk faktörleridir. Son 30 yılda nonkardiyak cerrahide perioperatif kardiyak mortalite ve morbidite insidansını belirleyebilmek için Lee İndeksi, Revize Kardiyak İndeks ve Modifiye Goldman İndeksi gibi birkaç risk indeksi gelişti-rilmiştir. Modifiye Goldman İndeksinde yüksek riskli cerrahi, iskemik kalp hastalığı, konjestif kalp yetmezliği, geçirilmiş serebrovasküler olay, preoperatif insülin tedavisi, preoperatif serum kreatin değerinin 2 mg dL -1 'nin üzerinde olması en önemli

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Acute Pain Management in the Postanesthesia Care Unit

Cited by 26 publications

References 51 publications

Bilateral thoracic Paravertebral block for immediate postoperative pain relief in the PACU: a prospective, observational study

Bilateral thoracic Paravertebral block for immediate postoperative pain relief in the PACU: a prospective, observational study

Estimating the Effect of Intravenous Acetaminophen for Postoperative Pain Management on Length of Stay and Inpatient Hospital Costs

Current Approaches in Hip and Knee Arthroplasty Anaesthesia

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