Preventive analgesia for postoperative pain control: a broader concept

Vadivelu, Nalini; Mitra, Sukanya; Schermer, Erika; Kodumudi, Vijay; Kaye, Alan D.; Urman, Richard D.

doi:10.2147/lra.s62160

Cited by 90 publications

(72 citation statements)

References 49 publications

(52 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Pain is also one of the primary concerns of the surgeon because of its close ties with clinical outcome and acute postoperative patient well-being. Studies have indicated such negative clinical outcomes to include decreases in vital capacity and alveolar ventilation, pneumonia, tachycardia, hypertension, myocardial ischemia, myocardial infarction, transition to chronic pain, poor wound healing, and insomnia 5 .…”

Section: Discussionmentioning

confidence: 99%

Preemptive use of oral gabapentin or pregabalin for acute postoperative pain following lower limb orthopaedic surgery under spinal anaesthesia

Acharya

Ghimire

Bhattarai

et al. 2019

J. Kathmandu Med. Coll.

View full text Add to dashboard Cite

Background: Postoperative pain is a major cause of perioperative morbidity and functional impairment. Preemptive analgesia is an analgesia regimen instituted before the surgery, to desensitize the pain pathways. Pregabalin and gabapentin have been claimed to be effective in reducing postoperative pain without significant alterations in hemodynamics. Objectives: This study was conducted to compare the effectiveness of pregabalin and gabapentin in reducing postoperative pain, total opioid consumption, postoperative nausea and vomiting and sedation in patients undergoing lower limb orthopaedic surgeries under spinal anaesthesia. Methodology: Eighty patients undergoing lower limb orthopaedic surgeries under spinal anaesthesia were divided into two groups, to either receive 300mg gabapentin or 150mg pregabalin, one hour before surgery. The patients were evaluated at one, two, six, 12 and 24 hours postoperatively and Visual Analogue Scale score for pain, postoperative nausea vomiting, and sedation score were monitored. Tramadol 50 mg was used as rescue analgesic and total consumption over 24 hours was recorded. Results: The mean duration of postoperative analgesia was significantly higher with pregabalin (282±106 minutes versus 234 ± 97minutes, p=0.009). The sedation score was significantly higher with pregabalin in the first hour (p=0.001). The total tramadol consumption was higher with gabapentin; however, it was statistically insignificant. The occurrence of postoperative nausea and vomiting was comparable between the groups. Minor adverse effects such as dizziness, sedation and headache were observed in both groups. Conclusion: Pregabalin 150 mg orally significantly increases the duration of postoperative analgesia than gabapentin 300mg following lower limb orthopaedic surgeries. Although sedation is frequently observed, it doesn’t alter the hemodynamics and thus, may be used safely.

show abstract

Section: Discussionmentioning

confidence: 99%

Preemptive use of oral gabapentin or pregabalin for acute postoperative pain following lower limb orthopaedic surgery under spinal anaesthesia

Acharya

Ghimire

Bhattarai

et al. 2019

J. Kathmandu Med. Coll.

View full text Add to dashboard Cite

show abstract

“…Nerve blockade could reduce the risk of persistent postoperative opioid use through one of two mechanisms. The first, a theory known as preventative analgesia, 73–75 suggests that nerve blockade can prevent the transition from acute to chronic pain by directly blocking transmission of pain impulses during the perioperative period and thereby preventing central sensitization and chronic neuropathic pain. Second, nerve blocks are a well-established modality for treating acute post-operative pain, which when severe, is predictive of the development of chronic pain.…”

Section: Strategies To Promote Opioid Cessation After Surgerymentioning

confidence: 99%

Chronic Opioid Use After Surgery: Implications for Perioperative Management in the Face of the Opioid Epidemic

Hah

Bateman

Ratliff³

et al. 2017

Anesthesia &Amp; Analgesia

529

221

View full text Add to dashboard Cite

Physicians, policymakers, and researchers are increasingly focused on finding ways to decrease opioid use and overdose in the United States both of which have sharply increased over the past decade. While many efforts are focused on the management of chronic pain, the use of opioids in surgical patients presents a particularly challenging problem requiring clinicians to balance two competing interests: managing acute pain in the immediate postoperative period and minimizing the risks of persistent opioid use following the surgery. Finding ways to minimize this risk is particularly salient in light of a growing literature suggesting that post-surgical patients are at increased risk for chronic opioid use. The perioperative care team, including surgeons and anesthesiologists, is poised to develop clinical and systems-based interventions aimed at providing pain relief in the immediate postoperative period while also reducing the risks of opioid use longer term. In this paper, we discuss the consequences of chronic opioid use following surgery, and present an analysis of the extent to which surgery has been associated with chronic opioid use. We follow with a discussion of the risk factors that are associated with chronic opioid use after surgery, and proceed with an analysis of the extent to which opioid sparing perioperative interventions (e.g., nerve blockade) have been shown to reduce the risk of chronic opioid use following surgery. We then conclude with a discussion of future research directions.

show abstract

“…2 A combination of preoperative and multimodal analgesia can significantly decrease acute pain. 3 Recent research in spinal, obstetric, and cardiac surgery has shown the unique potential of intravenous methadone, which, in addition to its long halflife, has mu opiate as well as N-methyl-D-aspartate receptor (NMDA) effects on pain. [4][5][6][7][8] No published studies to date have used methadone delivered via the oral route.…”

Section: Introductionmentioning

confidence: 99%

Preoperative oral methadone for postoperative pain in patients undergoing cardiac surgery: A randomized double-blind placebo-controlled pilot

Bolton

Chomicki

McKay

et al. 2019

Canadian Journal of Pain

View full text Add to dashboard Cite

Background: Inadequately controlled sternotomy pain after cardiac surgery can lead to delayed recovery and patient suffering. Preoperative intravenous methadone is effective for reducing both postoperative pain and opioid consumption. Despite ease of administration, the effects of preoperative oral methadone are not well described in the literature. Aims: This pilot study investigated the effect of preoperative oral methadone on pain scores, analgesia requirements, and opioid-induced side effects. Methods: A randomized double-blind placebo-controlled model was used with sampling of patients undergoing sternotomy for isolated coronary artery bypass graft (CABG) surgery (ClinicalTrials.gov registration no. NCT02774499). Participants were randomized to receive oral methadone (0.3 mg/kg) or oral placebo prior to entering the operating room. The primary outcome was pain scores on a 0-10 Verbal Rating Scale. Secondary outcomes included morphine requirements using patient-controlled analgesia (PCA), time to extubation, level of sedation, and side effects such as nausea, vomiting, pruritus, hypoventilation, and hypoxia over a 72-h monitoring time. Results: Twenty-one patients completed the study. Oral methadone did not reduce pain scores in the methadone group (P = 0.08). However, postoperative morphine requirement during the first 24 h was reduced by a mean of 23 mg in the methadone group (mean difference, −23; 99% confidence interval [CI], 37-13 mg; P < 0.005). No reduction in pain scores or PCA morphine was observed beyond 24 h postoperatively. There was no difference in incidence of opioid-related side effects between groups throughout the postoperative period. Conclusions: Though preoperative oral methadone did not reduce pain scores, morphine requirements were reduced in the first 24 h post-CABG. RÉSUMÉ Contexte: Lorsqu'elle est mal contrôlée, la douleur secondaire à une sternotomie après une chirurgie cardiaque peut retarder le rétablissement du patient et lui occasionner de la souffrance. Laméthadone intraveineuse préopératoire est efficace pour réduire à la fois la douleur postopératoire et la consommation d'opiacés. Malgré que laméthadone orale soit facile à administrer, ses effets ne sont pas bien décrits dans la littérature. But: Cette étude pilote portait sur l'effet de laméthadone orale préopératoire sur les scores de douleur, les besoins en analgésie et les effets secondaires induits par les opioïdes. Méthodes: Un modèle randomisé à double insu contrôlé par placebo aété utilisé auprès d'un échantillon de patients subissant une sternotomie pour un pontage aortocoronarien unique (PAC) (NCT02774499). Les participants ont été randomisés pour recevoir de laméthadone orale (0,3mg/kg) ou un placebo oral avant d'entrer dans la salle d'opération. Le résultat principal était les scores de douleur obtenus sur une échelle d'évaluation verbale de 0 à 10. Les résultats secondaires comprenaient les besoins en morphine par le truchement d'une analgésie contrôlée par le patient (ACP), le temps écoulé avant l'extubation, le...

show abstract

Preventive analgesia for postoperative pain control: a broader concept

Cited by 90 publications

References 49 publications

Preemptive use of oral gabapentin or pregabalin for acute postoperative pain following lower limb orthopaedic surgery under spinal anaesthesia

Preemptive use of oral gabapentin or pregabalin for acute postoperative pain following lower limb orthopaedic surgery under spinal anaesthesia

Chronic Opioid Use After Surgery: Implications for Perioperative Management in the Face of the Opioid Epidemic

Preoperative oral methadone for postoperative pain in patients undergoing cardiac surgery: A randomized double-blind placebo-controlled pilot

Contact Info

Product

Resources

About