Pain Management during Rehabilitation after Distal Radius Fracture Stabilized with Volar Locking Plate: A Prospective Cohort Study

Luo, Pengbo; Lou, Jinjie; Yang, Shengwu

doi:10.1155/2018/5786089

Cited by 16 publications

(10 citation statements)

References 16 publications

(16 reference statements)

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“…In a study of 315 adults who underwent distal radius fracture repaired with volar locking plate fixation, patients underwent the conventional six-week rehabilitation program following surgery. 30 Pain medication was administered for the initial two weeks of this rehabilitation and then discontinued. For these first two weeks, the prospective cohort study assigned groups to either 200 mg celecoxib twice a day (n=149), transdermal buprenorphine 5 μg/h (n=89), or codeine/ibuprofen 13/200 mg twice a day (n=77).…”

Section: Resultsmentioning

confidence: 99%

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Transdermal Buprenorphine for Acute Pain in the Clinical Setting: A Narrative Review

Pergolizzi¹,

Magnusson²,

LeQuang³

et al. 2021

JPR

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Transdermal buprenorphine is indicated for chronic pain management, but as its role in the clinical management of acute pain is less clear, this narrative review examines studies of the patch for acute pain, mainly in the postoperative setting. Although perhaps better known for its role in opioid rehabilitation programs, buprenorphine is also an effective analgesic that is a Schedule III controlled substance. Although buprenorphine is a partial agonist at the μ-opioid receptor, it is erroneous to think of the agent as a partial analgesic; it has full analgesic efficacy and unique attributes among opioids, such as a ceiling for respiratory depression and low "drug likeability" among those who take opioids for recreational purposes. Transdermal buprenorphine has been most thoroughly studied for acute pain control in postoperative patients. Postoperative pain follows a distinct and predictable trajectory depending on the type of surgery and patient characteristics. Overall, when the patch is applied prior to surgery and left in place for the prescribed seven days, it was associated with reduced postoperative pain, lower consumption of other analgesics, and patient satisfaction. Transdermal buprenorphine has been evaluated in clinical studies of patients undergoing gynecological surgery, hip fracture surgery, knee or hip arthroscopy/ arthroplasty, shoulder surgery, and spinal surgery. Transdermal buprenorphine may also be appropriate pain medication for controlling pain during postsurgical orthopedic rehabilitation programs. Transdermal buprenorphine may result in typical opioid-associated side effects but with less frequency than other opioids. Despite clinical reservations about transdermal buprenorphine and its potential role in acute pain management in the clinical setting, clinical acceptance may be hampered by the fact that it is off-label and buprenorphine is better known as an opioid maintenance agent rather than an analgesic.

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Section: Resultsmentioning

confidence: 99%

“…Patients who received the transdermal buprenorphine patch or took the combination codeine/ibuprofen medication had greater pain control during rehabilitation, better compliance with the rehabilitation program, and faster functional recovery. 30 …”

Section: Resultsmentioning

confidence: 99%

Transdermal Buprenorphine for Acute Pain in the Clinical Setting: A Narrative Review

Pergolizzi¹,

Magnusson²,

LeQuang³

et al. 2021

JPR

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show abstract

“…Although our study used ibuprofen, other investigators have suggested a variety of viable nonopioid options such as acetaminophen, transdermal buprenorphine, and cannabinoids. 20 , 21 , 22 Nonopioid medications are a major component of multimodal analgesia, which is gaining popularity in the orthopedic community because of its opioid-sparing effect. 23 , 24 , 25 Additionally, recent investigations into various non-narcotic perioperative medications have shown the potential to further reduce a patient’s overall need for pain medicine in the immediate postoperative period and improve outcomes.…”

Section: Discussionmentioning

confidence: 99%

Opioid Use Is Reduced in Patients Treated with NSAIDs After Arthroscopic Bankart Repair: A Randomized Controlled Study

Thompson

Klein

Alaia

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose To evaluate the efficacy of oral nonsteroidal anti-inflammatory drugs (NSAIDs) as the primary postoperative pain medication compared with standard oral opioids after arthroscopic shoulder capsulolabral (Bankart) repair for recurrent anterior shoulder instability. Methods This was a single-center, prospective, randomized controlled study. Patients aged 18 to 65 years indicated for arthroscopic shoulder capsulolabral repair for recurrent anterior shoulder instability were included. Postoperatively, patients were prescribed 1 of 2 analgesic regimens: (1) 30 ibuprofen (600 mg every 6 to 8 hours as needed) and 10 tablets of oxycodone/acetaminophen (5/325 mg every 6 hours as needed for breakthrough pain) or (2) 30 tablets oxycodone/acetaminophen (5/325 mg every 6 hours as needed). Subjects completed questionnaires at 24, 48, and 96 hours and 1 week after surgery, which included questions about analgesic medication usage, visual analog scale (VAS) pain score, incidence of adverse events, and patient satisfaction. Results Between December 2017 and May 2019, 80 patients (mean age 31.3 ± 10.4 years) were enrolled. Overall there were no significant differences in VAS pain score or patient satisfaction between the 2 groups. Patients in the opioid-only group had a significantly higher mean opioid consumption on postoperative days (PODs) 2 to 4 (5.5 versus 2.9, P = .05) and after 1 week (11.7 versus 7.9 tablets, P = .05) compared with patients in the NSAID group. Of patients in the NSAID group, 17.5% experienced adverse effects, compared with 35% in the opioid-only group. Conclusions Use of oral NSAIDs with limited breakthrough opioids results in significantly less opioid use after arthroscopic Bankart repair in the first postoperative week compared with opioids only. Both groups used limited amounts of opioids to control postoperative pain. There were no differences in pain levels at any time point postoperatively or satisfaction between patient groups. Level of Evidence II, nonblinded randomized control trial.

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“…Luo et al looked specifically at various pain regimens following DRF and found no difference in pain management with the use of celecoxib versus transdermal buprenorphine patches versus codeine/ibuprofen postoperatively. 12 This suggests that the type of pain regimen may not have a large impact on overall pain control.…”

Section: Discussionmentioning

confidence: 99%

Pain Management following Open Reduction and Internal Fixation of Distal Radius Fractures

et al. 2020

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Background Distal radius fractures (DRF) are commonly treated with open reduction and internal fixation (ORIF). Few studies address perioperative and postoperative pain control for this procedure. Questions/Purpose We attempt to demonstrate efficacy of pain management modalities during the perioperative and acute postoperative period after ORIF. Specifically, does the type of perioperative anesthesia used during fixation of DRF affect pain control postoperatively? Does the quantity of narcotic pain medication prescribed or type of pain medication given postoperatively affect pain management? Methods We retrospectively reviewed 294 adult (≥18 years old) patients who underwent outpatient ORIF of acute DRF between December 2012 and December 2014. All procedures were performed with a standard volar plating technique through a flexor carpi radialis approach. Patient demographics, fracture laterality, severity of fracture, type of operative anesthesia, and details regarding postoperative oral pain medications were recorded. We reviewed the number and timing of patient phone calls regarding postoperative pain and refills of pain prescriptions. Results Two-hundred ninety-four patients (average age 48.7 years) were included. One-hundred twenty-two injuries were right-sided (41.5%), 168 were left-sided (57.1%), and four were bilateral (1.4%). One-hundred fifty-one patients (51.4%) received regional anesthesia prior to surgery. Average number of narcotics tablets prescribed was 58. There were 66 patients who called the orthopaedic patient hotline regarding pain-control issues at a median of 7.0 days postoperatively. One-hundred twenty-nine (43.9%) patients required refills of narcotic pain medication postoperatively. There was no significant difference in the number of calls or refills given with regard to the type of anesthesia used or postoperative pain regimen prescribed. Conclusions More than one-fifth of patients who underwent ORIF experienced pain severe enough to call our institution's orthopaedic hotline to ask for help at a median of 7 days after fixation. Clinical Relevance Our study demonstrates poor pain control regardless of intraoperative anesthesia or utilization of varying postoperative pain regimens.

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Pain Management during Rehabilitation after Distal Radius Fracture Stabilized with Volar Locking Plate: A Prospective Cohort Study

Cited by 16 publications

References 16 publications

Transdermal Buprenorphine for Acute Pain in the Clinical Setting: A Narrative Review

Transdermal Buprenorphine for Acute Pain in the Clinical Setting: A Narrative Review

Opioid Use Is Reduced in Patients Treated with NSAIDs After Arthroscopic Bankart Repair: A Randomized Controlled Study

Pain Management following Open Reduction and Internal Fixation of Distal Radius Fractures

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