State of the art opioid-sparing strategies for post-operative pain in adult surgical patients

Gabriel, Rodney A.; Swisher, Matthew W; Sztain, Jacklynn F.; Furnish, Timothy; Ilfeld, Brian M.; Said, Engy T.

doi:10.1080/14656566.2019.1583743

Cited by 92 publications

(71 citation statements)

References 154 publications

(105 reference statements)

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“…In their current review, i.e. 'state of the art opioid-sparing strategies for post-operative pain in adult surgical patients', Gabriel and co-workers emphasized both the excellent analgesic potential of RA and its 'opiate-sparing' effects (16). Table 1 shows observational data of a large German hospital (17,18) with a variety of regional catheters, demonstrating that the majority of relevant postoperative pain conditions are treatable in this way.…”

Section: Alternatives For Sufficient Postoperative Pain Therapymentioning

confidence: 99%

Regional Catheters for Postoperative Pain Control: Review and Observational Data

Suksompong

Bormann

2020

Anesth Pain Med

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Context: Perioperative analgesia is an essential but frequently underrated component of medical care. The purpose of this work is to describe the actual situation of surgical patients focusing on effective pain control by discarding prejudice against 'aggressive' measures. Evidence Acquisition: This is a narrative review about continuous regional pain therapy with catheters in the postoperative period. Included are the most-relevant literature as well as own experiences. Results: As evidenced by an abundance of studies, continuous regional/neuraxial blocks are the most effective approach for relief of severe postoperative pain. Catheters have to be placed in adequate anatomical positions and meticulously maintained as long as they remain in situ. Peripheral catheters in interscalene, femoral, and sciatic positions are effective in patients with surgery of upper and lower limbs. Epidural catheters are effective in abdominal and thoracic surgery, birth pain, and artery occlusive disease, whereas paravertebral analgesia may be beneficial in patients with unilateral approach of the truncus. However, failure rates are high, especially for epidural catheter analgesia. Unfortunately, many reports lack a comprehensive description of catheter application, management, failure rates and complications and thus cannot be compared with each other. Conclusions: Effective control of postoperative pain is possible by the application of regional/neuraxial catheters, measures requiring dedication, skill, effort, and funds. Standard operating procedures contribute to minimizing complications and adverse side effects. Nevertheless, these methods are still not widely accepted by therapists, although more than 50% of postoperative patients suffer from 'moderate, severe or worst' pain.

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Section: Alternatives For Sufficient Postoperative Pain Therapymentioning

confidence: 99%

Regional Catheters for Postoperative Pain Control: Review and Observational Data

Suksompong

Bormann

2020

Anesth Pain Med

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“…As such, controlled-release local anesthetic formulations have also been developed [257][258][259]. Liposomal bupivacaine has not demonstrated clinically meaningful benefits to postoperative pain control or opioid reduction when compared to conventional local anesthetics in local wound infiltration, periarticular injection, or peripheral nerve blockade [249,[260][261][262][263][264][265][266][267][268][269][270][271][272][273][274][275]. Potential benefits and cost-effectiveness of extended-release local anesthetic formulations are likely to vary significantly depending on injection technique, site, and type of surgical procedure, so institutions should consider surgery-and patient-specific use of these agents.…”

Section: Regional and Local Anesthesiamentioning

confidence: 99%

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

et al. 2021

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Surgical procedures are key drivers of pain development and opioid utilization globally. Various organizations have generated guidance on postoperative pain management, enhanced recovery strategies, multimodal analgesic and anesthetic techniques, and postoperative opioid prescribing. Still, comprehensive integration of these recommendations into standard practice at the institutional level remains elusive, and persistent postoperative pain and opioid use pose significant societal burdens. The multitude of guidance publications, many different healthcare providers involved in executing them, evolution of surgical technique, and complexities of perioperative care transitions all represent challenges to process improvement. This review seeks to summarize and integrate key recommendations into a “roadmap” for institutional adoption of perioperative analgesic and opioid optimization strategies. We present a brief review of applicable statistics and definitions as impetus for prioritizing both analgesia and opioid exposure in surgical quality improvement. We then review recommended modalities at each phase of perioperative care. We showcase the value of interprofessional collaboration in implementing and sustaining perioperative performance measures related to pain management and analgesic exposure, including those from the patient perspective. Surgery centers across the globe should adopt an integrated, collaborative approach to the twin goals of optimal pain management and opioid stewardship across the care continuum.

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“…It is also used intravenously for its antiarrhythmic effect. Current studies reported that intravenous infusion of lidocaine showed analgesic effects and without serious adverse reaction in a variety of chronic pain,13,14 including PHN 15,16. Consecutive 3 mg/kg lidocaine infusion (once a week for 4 consecutive weeks) provided effective short-term pain relief in a cohort of neuropathic pain (PHN or CRPS) 17.…”

Section: Introductionmentioning

confidence: 99%

<p>Intravenous infusion of lidocaine enhances the efficacy of conventional treatment of postherpetic neuralgia</p>

Tan¹,

Ma²,

Yuan³

et al. 2019

JPR

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BackgroundPostherpetic neuralgia (PHN) is one kind of severe neuropathic pain which currently cannot be effectively cured. Recent researches suggest that intravenous infusion of lidocaine has a therapeutic effect on neuropathic pain such as PHN; however, the optimal dose and frequency of lidocaine infusion and the effectiveness and safety of this treatment in PHN patients still needs more clinical research. The aim of this study was to evaluate the therapeutic effects of daily intravenous lidocaine infusion on the outcome of the routine treatment of PHN.MethodsSixty PHN patients were randomly divided into two groups: 1) control group (Control), treated with conventional therapies, such as antiepileptic pills, analgesics, neurotrophic medicines, paravertebral spinal nerve block and physiotherapy; 2) lidocaine group (Lido) received daily infusion of lidocaine (4 mg/kg) besides the conventional treatments. If the pain is not controlled sufficiently, additional tramadol is given and the average consumption of tramadol is calculated. Pain intensity was assessed before and after each infusion, and the number of breakthrough pain in the last 24 hrs were recorded. The incidence of adverse reactions related to intravenous lidocaine infusion was recorded.ResultsFor five consecutive days, numeric rating scale (NRS) scores were significantly decreased after 1 hr of intravenous infusion of lidocaine. Compared with Control, the NRS scores and the frequency of breakthrough pain in the Lido were significantly reduced. In addition, the extra tramadol consumption in the Lido was significantly lower than that in the Control, and the average hospital stay of patients in Lido was decreased. However, anxiety and depression scores showed no difference between Lido and Control.ConclusionDaily intravenous lidocaine (4 mg/kg for 5 days) enhanced the outcome of PHN treatment, reduced the amount of analgesic medicine and shortened the length of hospital stay with no obvious adverse side effects.

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State of the art opioid-sparing strategies for post-operative pain in adult surgical patients

Cited by 92 publications

References 154 publications

Regional Catheters for Postoperative Pain Control: Review and Observational Data

Regional Catheters for Postoperative Pain Control: Review and Observational Data

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

<p>Intravenous infusion of lidocaine enhances the efficacy of conventional treatment of postherpetic neuralgia</p>

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