Consequences of Inadequate Postoperative Pain Relief and Chronic Persistent Postoperative Pain

Joshi, Girish P.; Ogunnaike, Babatunde

doi:10.1016/j.atc.2004.11.013

Cited by 489 publications

(305 citation statements)

References 82 publications

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“…Adequate postoperative pain management is not only indispensable for patient comfort, but it has also been reported that there is a strong association between effective postoperative pain management and the prevention of postoperative complications (22,27). In this regard, TLDG for gastric cancer in the Table IV.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of totally laparoscopic distal gastrectomy for gastric cancer in elderly patients

Kasahara

Tsujimoto

Hiraki

et al. 2016

Molecular and Clinical Oncology

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Abstract. Elderly patients are often considered as high-risk for major abdominal surgery due to reduced functional reserve and increased comorbidities. We herein evaluated the efficacy of totally laparoscopic distal gastrectomy (TLDG) in elderly patients with gastric cancer by measuring the postoperative systemic responses and postoperative analgesic consumption. A total of 102 patients with gastric cancer [57 who underwent TLDG and 45 who underwent laparoscopy-assisted distal gastrectomy (LADG)] were enrolled in this study. The patients were classified as elderly (aged ≥75 years) and non-elderly (aged <75 years) groups. The surgical outcome and postoperative analgesic consumption were evaluated. The elderly group exhibited a higher incidence of comorbidities and a longer postoperative hospital stay compared with those of younger patients, although there was no difference in the incidence of postoperative complications. In addition, the total consumption of additional analgesics until postoperative day 5 in patients who underwent TLDG was significantly lower compared with that in patients who underwent LADG in the elderly group; there was no such difference in the non-elderly group. The results suggested that TLDG was better for the management of postoperative pain in elderly patients with gastric cancer, who exhibit the highest mortality rates in the adult surgical population.

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Section: Discussionmentioning

confidence: 99%

Efficacy of totally laparoscopic distal gastrectomy for gastric cancer in elderly patients

Kasahara

Tsujimoto

Hiraki

et al. 2016

Molecular and Clinical Oncology

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“…Good postoperative pain relief improves patient's satisfaction and decreases morbidity [2,3]. Inadequately controlled pain is often overlooked [4] and has undesirable physiological and psychological consequences.…”

Section: Introductionmentioning

confidence: 99%

Pre-Incisional Intravenous Low-Dose Ketamine Does Not Cause Pre- Emptive Analgesic Effect Following Caesarean Section under Spinal Anaesthesia

Ej¹,

Cn²,

Fyneface-Ogan³

2011

J Anesthe Clinic Res

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Background: Adequate postoperative pain relief is one of the commonest challenges faced by women who deliver by caesarean section.Aim: This study was aimed at finding out the effect of pre-incisional administration of low dose intravenous ketamine on the post-operative analgesia demand time. Patients and Methods:Following approval from the Hospital's Ethical Committee, a prospective, randomised double-blind study was carried out to evaluate the pre-emptive effect of low-dose ketamine on women undergoing elective caesarean section under plain bupivacaine/fentanyl spinal anaesthesia.Results: Eighty women completed (83.33%) the study. The results were comparable in both groups for maternal age, weight, height, gestational age and parity. There was no statistical difference in the patient characteristics between the two groups under study.The mean time taken to achieve a maximal sensory level was 9.3±0.91 mins in Group-A and in Group-B 8.35±1.49 mins, p=0.260. The regression time to two segments was also the same in the two groups of women. The mean in the Group-A was 28.1±1.52 mins while the Group-B had 27.6±2.10 mins, p=0.161.The time to first analgesic request in the Ketamine Group was 193.44±26.53 mins while that for the Placebo group was 140.14±22.34 mins. The difference in the duration was statistically significant, p=0.0001. Conclusion:It is concluded that the pre-incisional administration of low-dose intravenous ketamine only demonstrated a delayed time to first analgesic request in the women who had plain bupivacaine/fentanyl spinal anaesthesia and not a pre-emptive analgesic effect.

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“…Adequate treatment of acute pain following surgery is a key aspect of perioperative care, as under-treatment of acute pain can trigger greater use of healthcare resources and ultimately lead to poor outcomes, which can include the development of chronic postsurgical pain [1][2][3][4][5]. Intravenous (IV) non-steroidal anti-inflammatory drugs (NSAIDs) are considered an increasingly important element of postoperative pain management, either exclusively or as a component of a multimodal regimen [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Clinical and Laboratory Hematologic Findings in Patients Receiving Repeated-Dose Injectable HPBCD-Diclofenac for Acute Postoperative Pain: Pooled Analysis of Two Randomized Controlled Phase III Clinical Trials

Gan¹,

Singla²,

Daniels³

et al. 2015

J Anesth Clin Res

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Objective: While the non-steroidal anti-inflammatory drugs (NSAIDs) represent an important option for the management of acute postoperative pain, their use can be limited due to potential safety concerns, including bleeding risks. This study examined the bleeding-related safety of injectable diclofenac formulated with hydroxypropyl-β-cyclodextrin (HPβCD-diclofenac) when used for postoperative pain management. Methods:Data from two randomized, double-blind, placebo-and active comparator-controlled phase III trials were pooled. Patients in both studies received HPβCD-diclofenac, placebo, or the active comparator ketorolac via intravenous injection every 6 hours for ≤ 5 days following abdominal/pelvic or orthopedic surgery. Bleeding adverse events (AEs) were evaluated through the treatment period and follow-up (≤ 37 days), and relative bleeding AE risks (RR) were estimated. Changes in hematology laboratory values were also assessed.Results: Overall, 608 surgical patients received ≥ 1 dose of study medication. Bleeding AEs occurred in n=9/318 (2.8%) patients receiving HPβCD-diclofenac, n=8/142 (5.6%) patients receiving ketorolac, and n=4/148 (2.7%) patients receiving placebo. Over the period examined, HPβCD-diclofenac was not associated with increased bleeding AE RR versus placebo (1.05 [0.33, 3.35]; p=0.93), nor was ketorolac (2.08 [0.64, 6.77]; p=0.22). Bleeding AEs were predominantly mild or moderate in severity. No treatment-related bleeding AEs occurred in the HPβCD-diclofenac group (1 in both the placebo and ketorolac groups). Among the subset of patients receiving concomitant anticoagulants, bleeding AEs occurred in n=3/60 (5.0%) patients receiving HPβCD-diclofenac, n=2/29 (6.9%) patients receiving ketorolac, and n=0/35 patients receiving placebo. In the HPβCD-diclofenac group, postsurgical shifts to low hematocrit and hemoglobin occurred in 35.7% and 28.3% of patients, respectively (versus 31.4% and 21.5%, respectively, with placebo). Postsurgical shifts in platelet count were uncommon (<3.0% across treatment groups). Conclusions:While follow-up studies in larger populations are warranted, this analysis suggests that HPβCD-diclofenac may not present a significant incremental bleeding AE risk versus placebo when used for acute postoperative pain management.

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Consequences of Inadequate Postoperative Pain Relief and Chronic Persistent Postoperative Pain

Cited by 489 publications

References 82 publications

Efficacy of totally laparoscopic distal gastrectomy for gastric cancer in elderly patients

Efficacy of totally laparoscopic distal gastrectomy for gastric cancer in elderly patients

Pre-Incisional Intravenous Low-Dose Ketamine Does Not Cause Pre- Emptive Analgesic Effect Following Caesarean Section under Spinal Anaesthesia

Clinical and Laboratory Hematologic Findings in Patients Receiving Repeated-Dose Injectable HPBCD-Diclofenac for Acute Postoperative Pain: Pooled Analysis of Two Randomized Controlled Phase III Clinical Trials

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