Perioperative analgesia outcomes and strategies

Prabhakar, Amit; Mancuso, Kenneth; Owen, Christopher Paul; Lissauer, Jonathan; Merritt, Christopher K.; Urman, Richard D.; Kaye, Alan D.

doi:10.1016/j.bpa.2014.04.005

Cited by 45 publications

(29 citation statements)

References 49 publications

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“…Acute pain after surgery can have a significant impact on clinical outcomes. Inadequate pain management in the postoperative period may lead to adverse events, including myocardial ischemia, myocardial infarction, impaired pulmonary function, paralytic ileus, urinary retention, thromboembolism, impaired immune function, and anxiety . These events have the potential to produce unfavorable clinical, economic, and patient‐related outcomes.…”

mentioning

confidence: 99%

“…Opioids have been a mainstay of postoperative pain management, but they are associated with adverse events (eg, gastrointestinal events, pruritus, respiratory depression) and other risks (eg, dependency, overdose, and diversion) . Despite these concerns, the limited number of treatment alternatives has led to a reliance on opioids in pain management regimens .…”

mentioning

confidence: 99%

“…Inadequate pain management in the postoperative period may lead to adverse events, including myocardial ischemia, myocardial infarction, impaired pulmonary function, paralytic ileus, urinary retention, thromboembolism, impaired immune function, and anxiety. 1,2 These events have the potential to produce unfavorable clinical, economic, and patientrelated outcomes. Although effective and well-tolerated pain control is an important component of postoperative care, a large proportion of patients continue to report significant postoperative pain.…”

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confidence: 99%

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A Phase 3, Randomized, Placebo‐Controlled Evaluation of the Safety of Intravenous Meloxicam Following Major Surgery

Bergese

Melson

Candiotti

et al. 2019

Clinical Pharm in Drug Dev

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An intravenous (IV) formulation of meloxicam is being studied for moderate to severe pain management. This phase 3, randomized, multicenter, double‐blind, placebo‐controlled trial evaluated the safety of once‐daily meloxicam IV 30 mg in subjects following major elective surgery. Eligible subjects were randomized (3:1) to receive meloxicam IV 30 mg or placebo administered once daily. Safety was evaluated via adverse events, clinical laboratory tests, vital signs, wound healing, and opioid consumption. The incidence of adverse events was similar between meloxicam IV– and placebo‐treated subjects (63.0% versus 65.0%). Investigators assessed most adverse events as mild or moderate in intensity and unrelated to treatment. Adverse events of interest (injection‐site reactions, bleeding, cardiovascular, hepatic, renal, thrombotic, and wound‐healing events) were similar between groups. Over the treatment period, meloxicam IV was associated with a 23.6% (P = .0531) reduction in total opioid use (9.2 mg morphine equivalent) compared to placebo‐treated subjects. The results suggest that meloxicam IV had a safety profile similar to that of placebo with respect to numbers and frequencies of adverse events and reduced opioid consumption in subjects with moderate to severe postoperative pain following major elective surgery.

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confidence: 99%

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confidence: 99%

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confidence: 99%

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A Phase 3, Randomized, Placebo‐Controlled Evaluation of the Safety of Intravenous Meloxicam Following Major Surgery

Bergese

Melson

Candiotti

et al. 2019

Clinical Pharm in Drug Dev

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“…This includes a decreased neuroendocrine stress response, reduced levels of circulating catecholamines and cortisol, and preload and afterload reduction with resultant improvement in cardiac function in patients with CAD. 16,17 The advantages of RA for the pulmonary system include avoidance of endotracheal intubation with mechanical ventilation and reduced postoperative pulmonary complications. 9 Regional anesthesia also leads to sympathectomy with resultant peripheral vasodilation and increased blood flow, a potentially lower risk of arterial and venous thrombosis, and a reduced requirement of blood transfusion.…”

Section: Discussionmentioning

confidence: 99%

The Use of Regional or Neuraxial Anesthesia for Below-Knee Amputations May Reduce the Need for Perioperative Blood Transfusions

Malik

Brovman

Urman

2018

Regional Anesthesia and Pain Medicine

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“…In the limbs, vasoconstriction leads to venous stasis, increasing the risk for thromboembolic events. 1,2 The sympathetic response can also lead to urinary retention, respiratory compromise, catabolic stress, inflammation, immunosuppression, sleep disturbance, and postoperative ileus. These comorbidities can prolong hospital stay and increase health care expenditures.…”

Section: Introductionmentioning

confidence: 99%

Physiologic Advantages of Peripheral Nerve Blockade Translate to Decreased Length of Stay and Improved Patient Satisfaction

Kerfeld¹,

Hambsch²,

McEntire³

et al. 2016

Anesthesiol Open J

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Review ABSTRACTPeripheral nerve blockade is an effective modality involved in controlling perioperative pain. When compared with patient controlled analgesia, neuraxial analgesia, and other anesthetic methods such as periarticular infiltration, peripheral nerve blocks yield superior pain control and reduce length of hospitalization. Not only do these techniques help with patient satisfaction and health care costs, they also have physiologic advantages. In murine models, peripheral nerve blockade reduces expression of different inflammatory markers such as IL-1, IL-6, TNFα and cortisol. Such advantages make this an attractive modality for pain control.

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Perioperative analgesia outcomes and strategies

Cited by 45 publications

References 49 publications

A Phase 3, Randomized, Placebo‐Controlled Evaluation of the Safety of Intravenous Meloxicam Following Major Surgery

A Phase 3, Randomized, Placebo‐Controlled Evaluation of the Safety of Intravenous Meloxicam Following Major Surgery

The Use of Regional or Neuraxial Anesthesia for Below-Knee Amputations May Reduce the Need for Perioperative Blood Transfusions

Physiologic Advantages of Peripheral Nerve Blockade Translate to Decreased Length of Stay and Improved Patient Satisfaction

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