Patient-controlled analgesia. Does a concurrent opioid infusion improve pain management after surgery?

Parker, Robert K.; Holtmann, Barbel; White, Paul F.

doi:10.1001/jama.266.14.1947

Cited by 137 publications

(58 citation statements)

References 29 publications

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“…11 Lastly, opioids may not be particularly effective in controlling postoperative pain as they provide an initial analgesic effect but subsequently cause rapid development of tolerance and a reduction in pain threshold (i.e., opioidinduced hyperalgesia). 12,13 Given the importance of effective analgesia and the significance of opioid-related side effects, multimodal postoperative analgesia has become a key element of ERAS pathways. Multimodal analgesia is defined as the use of more than one modality of pain control to achieve effective analgesia while reducing opioid-related side effects.…”

Section: Introductionmentioning

confidence: 99%

Optimizing pain management to facilitate Enhanced Recovery After Surgery pathways

Tan

Law

Gan

2014

Can J Anesth/J Can Anesth

277

206

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Section: Introductionmentioning

confidence: 99%

Optimizing pain management to facilitate Enhanced Recovery After Surgery pathways

Tan

Law

Gan

2014

Can J Anesth/J Can Anesth

277

206

View full text Add to dashboard Cite

“…Also, given that patients need to stay awake to use their PCA device for nocturnal pain treatment, administration of appropriate evening doses 21 of oral sustained-release opioids might be a safer, more effective strategy for minimizing sleep disturbance than continuous intravenous opioid infusions. 22,23 For example, Reuben et al 24 reported less sleep interference with sustained-release oxycodone compared to shortacting oxycodone in an outpatient knee surgery trial and it would be important to learn if similar benefits could be realized in the setting of PCA.…”

Section: Discussionmentioning

confidence: 99%

Chronobiological characteristics of postoperative pain: Diurnal variation of both static and dynamic pain and effects of analgesic therapy

Boscariol

Gilron

Orr

2007

Can J Anesth/J Can Anesth

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Background: Previous postoperative investigations report morning peaks in analgesic administration. However, few studies have examined diurnal variation of both pain and analgesic consumption and little is known about dynamic pain in this context. Methods:The diurnal pattern of postoperative pain is described using pain intensity and analgesic consumption data from a recently published hysterectomy trial. Results:In the presence of patient-controlled analgesia with morphine, pain at 8 a.m. was significantly higher (P < 0.05) than at noon, 4 p.m. or 8 p.m. on postoperative day one (for rest pain and pain evoked by sitting, forced expiration and cough) and on postoperative day two (for pain evoked by forced expiration and cough only). This temporal pattern was observed both with and without the co-administration of non-opioid analgesics (gabapentin and/or rofecoxib). Morphine use during the four hours preceding 8 a.m. on either postoperative day was not significantly lower than any of the other corresponding time intervals. Conclusions: Based on data from our post-hysterectomy analgesic clinical trial, static and dynamic pain in the morning appears to be more intense than pain later in the day. This pattern was observed in the presence of substantial nocturnal morphine use. Based on these and other previous observations, specifically designed investigations are needed to better characterize the clinical, neurohormonal and neurophysiological features of postoperative circadian pain variation -including pain during sleeping hours. If the above observations are replicated, future study of nocturnal sustained-release opioids as well as time-shifting the administration of non-opioid co-analgesic drugs to the very early morning may be warranted.

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“…[57][58][59] According to a review by Liu and Wu,60 there is "insufficient evidence to conclude that analgesic techniques influence postoperative mortality or morbidity" due to the low incidences of anesthetic complications. On the contrary, excessive administration of opioids for perioperative analgesia may contribute to acute opioid tolerance and hyperalgesia, [61][62][63] and may also contribute to dose-related opioid side effects such as respiratory depression, sedation, urinary retention, nausea and vomiting, and ileus. These side effects and complications may delay discharge time, add to the overall cost of care, and decrease patient satisfaction.…”

Section: Optimizing Pain Managementmentioning

confidence: 99%

Advances in the use of intravenous techniques in ambulatory anesthesia

Eng¹,

White²

2015

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Summary statement: Advances in the use of intravenous techniques in ambulatory anesthesia has become important for the anesthesiologist as the key perioperative physician in outpatient surgery. Key techniques and choices of anesthetics are important in accomplishing fast track goals of ambulatory surgery. Purpose of review:The anesthesiologist in the outpatient environment must focus on improving perioperative efficiency and reducing recovery times while accounting for patients' well-being and safety. This review article focuses on recent intravenous anesthetic techniques to accomplish these goals. Recent findings: This review is an overview of techniques in intravenous anesthesia for ambulatory anesthesia. Intravenous techniques may be tailored to accomplish outpatient surgery goals for the type of surgical procedure and individual patient needs. Careful anesthetic planning and the application of the plans are critical to an anesthesiologist's success with fast-track ambulatory surgery. Conclusion: Careful planning and application of intravenous techniques are critical to an anesthesiologist's success with fast-track ambulatory surgery.

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Patient-controlled analgesia. Does a concurrent opioid infusion improve pain management after surgery?

Abstract: --The routine use of a continuous opioid infusion in combination with a standard PCA regimen does not improve pain management compared with PCA alone after abdominal hysterectomy.

Cited by 137 publications

References 29 publications

Optimizing pain management to facilitate Enhanced Recovery After Surgery pathways

Optimizing pain management to facilitate Enhanced Recovery After Surgery pathways

Chronobiological characteristics of postoperative pain: Diurnal variation of both static and dynamic pain and effects of analgesic therapy

Advances in the use of intravenous techniques in ambulatory anesthesia

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