The Importance of Optimizing Acute Pain in the Orthopedic Trauma Patient

Jones, Jerry W.; Southerland, Warren A; Catalani, Blas

doi:10.1016/j.ocl.2017.06.003

Cited by 30 publications

(23 citation statements)

References 147 publications

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“…Judgement of quality of postoperative recovery has changed from single physiological variables to a broader assessment of patient outcome, for example, ability to drink, eat and mobilise . To achieve this, adequate and safe treatment of acute postoperative pain is important . Despite increased attention, postoperative pain is still undertreated .…”

Section: Introductionmentioning

confidence: 99%

Postoperative quality and safety using Efficacy Safety Score (ESS) and a wireless patient monitoring system at the ward: A randomised controlled study

Skraastad

Borchgrevink

Nilsen

et al. 2019

Acta Anaesthesiol Scand

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Background Postoperative pain, side‐effects and time to mobilisation are indicators for the quality of postoperative recovery. The aim of this randomised controlled study was to investigate if efficacy safety score (ESS) combined with a wireless patient monitoring system would improve these clinical outcomes for patients at a general surgical ward. Methods The trial included 195 patients randomised to a standard care group (SC‐Group) or intervention group (INT‐Group) receiving continuous wireless monitoring of vital signs combined with ESS during the first 24 postoperative hours. The primary outcome was time to mobilisation. Secondary outcomes were average pain, doses of postoperative opioids, unscheduled interventions, side‐effects, patient satisfaction and length of hospital stay (LOS). Results Mean time to postoperative mobilisation was 10.1 hours for patients in the INT‐Group compared to 14.2 hours in the SC‐Group; this corresponds to an adjusted hazard ratio of 1.54 (95% confidence interval 1.04‐2.28). INT‐Group patients received a higher dose of oral morphine equivalents; 26 mg vs 15 mg, P < .001; reported lower intensity of pain on a 0‐10 scale; 2.1 vs 3.3, P < .001; and had higher patient satisfaction on a 5‐point scale; 4.9 vs 4.3, P < .001. The LOS was similar between the groups; 71 hours in INT‐Group vs 77 hours in SC‐Group, P = .58. No serious side‐effects were registered in INT‐Group, whereas two were registered in SC‐Group. Conclusions Introducing ESS as a decision tool combined with a wireless monitoring system resulted in less pain, increased satisfaction and more rapid mobilisation for patients in this study. Trial Registration: http://clinicaltrials.gov Identifier: NCT03438578.

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Section: Introductionmentioning

confidence: 99%

Postoperative quality and safety using Efficacy Safety Score (ESS) and a wireless patient monitoring system at the ward: A randomised controlled study

Skraastad

Borchgrevink

Nilsen

et al. 2019

Acta Anaesthesiol Scand

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“…Optimization of postoperative pain management in elderly patients is essential for fast-track surgery and patient-related outcomes [ 1 , 2 ]. Several medication regimens have been proposed to optimize postoperative pain recovery [ 3 , 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Creatinine-Based Renal Function Estimates and Dosage of Postoperative Pain Management for Elderly Acute Hip Fracture Patients

et al. 2018

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Many analgesics and their metabolites are renally excreted. The widely used Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)-estimated glomerular filtration rate (eGFR) equations are not developed for use in the elderly, while the recent Berlin Initiative Study (BIS), Full Age Spectrum (FAS), and Lund-Malmö revised (LMR) equations are. This observational study investigated differences between creatinine-based eGFR equations and how the choice of equation influences dosage of analgesics in elderly (≥70 years) patients admitted with acute hip fracture. eGFR was calculated by the CKD-EPI, BIS, Cockcroft-Gault (CG), FAS, LMR, and Modification of Diet in Renal Disease (MDRD) equations. Standard daily dose for postoperative pain medications ibuprofen, morphine and gabapentin was simulated for each equation according to dosage recommendations in Renbase®. For 118 patients, mean eGFR from the CKD-EPI, BIS, CG, FAS, LMR, and MDRD equations was 67.3 mL/min/1.73 m2, 59.1 mL/min/1.73 m2, 56.9 mL/min/1.73 m2, 60.3 mL/min/1.73 m2, 58.9 mL/min/1.73 m2, and 79.1 mL/min/1.73 m2, respectively (p < 0.0001). Mean difference to CKD-EPI was −10.4 mL/min/1.73 m2 to 11.8 mL/min/1.73 m2. Choice of eGFR equation significantly influenced the recommended dose (p < 0.0001). Shifting to BIS, FAS, or LMR equations led to a lower recommended dose in 20% to 31% of patients. Choice of eGFR equation significantly influenced dosing of ibuprofen, morphine, and gabapentin.

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“…The hemodynamic values were within the normal physiological range at all time intervals in the patients of all the three groups. The mean ± SD (range) of RSS at 15 minutes was 2.07 ± 0.59 (1-5) in the control group, 1.93 ± 0.37 (1)(2)(3) in the block Dex group and 2.23 ± 0.50 (1-3) in the systemic Dex group (P = 0.01), but all patients were arousable on command and no patient was deeply sedated. During the rest of the time points RSS failed to show a statistical difference.…”

Section: Resultsmentioning

confidence: 92%

“…Pain related to trauma surgery is frequently severe, but remains undertreated [1,2]. Opioids and non-steroidal antiinflammatory drugs have been recently questioned due to undesirable adverse effects in a multi-trauma patient having neurologic and respiratory impairment [2,3].…”

Section: Introductionmentioning

confidence: 99%

Role of dexmedetomidine as adjuvant in postoperative sciatic popliteal and adductor canal analgesia in trauma patients: a randomized controlled trial

et al. 2020

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Background: The effect of dexmedetomidine as an adjuvant in the adductor canal block (ACB) and sciatic popliteal block (SPB) on the postoperative tramadol-sparing effect following spinal anesthesia has not been evaluated. Methods: In this randomized, placebo-controlled study, ninety patients undergoing below knee trauma surgery were randomized to either the control group, using ropivacaine in the ACB + SPB; the block Dex group, using dexmedetomidine + ropivacaine in the ACB + SPB; or the systemic Dex group, using ropivacaine in the ACB + SPB + intravenous dexmedetomidine. The primary outcome was a comparison of postoperative cumulative tramadol patient-controlled analgesia (PCA) consumption at 48 hours. Secondary outcomes included time to first PCA bolus, pain score, neurological assessment, sedation score, and adverse effects at 0, 5, 10, 15, and 60 minutes, as well as 4, 6, 12, 18, 24, 30, 36, 42, and 48 hours after the block. Results: The mean ± standard deviation of cumulative tramadol consumption at 48 hours was 64.83 ± 51.17 mg in the control group and 41.33 ± 38.57 mg in the block Dex group (P = 0.008), using Mann-Whitney U-test. Time to first tramadol PCA bolus was earlier in the control group versus the block Dex group (P = 0.04). Other secondary outcomes were comparable. Conclusions: Postoperative tramadol consumption was reduced at 48 hours in patients receiving perineural or systemic dexmedetomidine with ACB and SPB in below knee trauma surgery.

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The Importance of Optimizing Acute Pain in the Orthopedic Trauma Patient

Cited by 30 publications

References 147 publications

Postoperative quality and safety using Efficacy Safety Score (ESS) and a wireless patient monitoring system at the ward: A randomised controlled study

Postoperative quality and safety using Efficacy Safety Score (ESS) and a wireless patient monitoring system at the ward: A randomised controlled study

Creatinine-Based Renal Function Estimates and Dosage of Postoperative Pain Management for Elderly Acute Hip Fracture Patients

Role of dexmedetomidine as adjuvant in postoperative sciatic popliteal and adductor canal analgesia in trauma patients: a randomized controlled trial

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