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? 2022Purpose: Perioperative glucocorticoids have been effectively used as a pain management regimen for reducing pain after hand surgery. We hypothesize that a methylprednisolone taper (MPT) course following surgery will reduce p...
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? 2022Purpose: Perioperative glucocorticoids have been effectively used as a pain management regimen for reducing pain after hand surgery. We hypothesize that a methylprednisolone taper (MPT) course following surgery will reduce pain and opioid consumption in the early postoperative period. Methods: This study was a randomized controlled trial of patients undergoing surgical fixation for distal radius fracture. Before surgery, patients were randomly assigned to receive preoperative dexamethasone only or preoperative dexamethasone followed by a 6-day oral MPT. Patient pain and opioid consumption data were collected for 7 days after surgery using a patient-reported pain journal. Results: Our study consisted of 56 patients enrolled from November 2018 to March 2020. Twenty-eight patients each were assigned to the control and treatment groups. Demographic characteristics such as age, body mass index, the dominant side affected, smoking status, diabetes status, and current narcotic use were similar between the control and treatment groups. With a noticeable, significant reduction starting on postoperative day 2, patients who received an MPT course consumed substantially less opioids during the first 7 days (7.8 ± 7.2 pills compared with 15.5 ± 11.5 pills, a 50% reduction). These patients also consumed significantly fewer oral morphine equivalents than the control group (81.2 vs 41.2). A significant difference in the pain visual analog scale scores between the 2 groups was noted starting on postoperative day 2, with 48% of the treatment group reporting no pain by postoperative day 6. No adverse events, including infection or complications of wound or bone healing, were seen in either group. Conclusions: There was an early improvement in pain and reduction in early opioid consumption with a 6-day MPT following surgical fixation for distal radius fracture. With no increased risk of adverse events in our sample, MPT may be a safe and effective way to reduce postoperative pain. Type of study/level of evidence: Therapeutic II.
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Background: There are few studies outlining an adoptable enhanced recovery pathway after mastectomy and reconstruction. This study analyzed a constructed and employed multimodal pain control regimen and the data extrapolated demon...
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Background: There are few studies outlining an adoptable enhanced recovery pathway after mastectomy and reconstruction. This study analyzed a constructed and employed multimodal pain control regimen and the data extrapolated demonstrates how it may influence narcotic use and length of stay in the hospital. Methods: A retrospective electronic medical record review from 2016 to 2016 under the care of two surgeons from a community hospital included 47 patients. Results: After implementation of the regimen, average length of stay in the hospital decreased by nearly 10 hours with about 1/3 of the patients having a completely narcotic free hospitalization. Conclusion: By employing these techniques, adequate pain control is possible, patient satisfaction would increase and length of hospital stay would decrease. Encouraging results of this study propose a regimen that could easily and affordably be adopted amongst other hospitals and surgeons across multiple specialties.
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Background: One of the most undesirable results after total knee arthroplasty (TKA) is severe immediate postoperative pain, resulting in patient dissatisfaction. We aimed to evaluate nefopam's analgesic efficacy after primary TKA ...
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Background: One of the most undesirable results after total knee arthroplasty (TKA) is severe immediate postoperative pain, resulting in patient dissatisfaction. We aimed to evaluate nefopam's analgesic efficacy after primary TKA along with related outcomes, including morphine consumption and adverse events. Methods: We conducted a double-blind, randomized controlled trial of patients undergoing unilateral primary TKA, comparing 24 hours of 80 mg of continuous intravenous nefopam to placebo infusion. A 10 0-mm Visual Analog Scale (VAS) for pain-at-rest and in-motion <48 hours was the primary outcome measure. Secondary outcomes were morphine and antiemetic consumption, adverse events, and func-tional outcomes: time-to-walk, timed up-and-go test, postoperative knee range of motion at 24 and 48 hours, time-to-discharge, and patient satisfaction scores. Results: Patients in the nefopam group had significantly lower VAS at rest 6 hours postop (20.3 +/- 27.3 vs 35 +/- 24.3, P = .01). Other timepoints and in-motion VAS did not significantly differ. Total morphine consumption (0-48 hours) was 37% less, significantly lower, in the nefopam group (5.3 +/- 4.5 vs 8.4 +/- 7.5 mg, P = .03). Antiemetic consumption was also 61% lower in the nefopam group but not statistically significant (0.8 +/- 2.3 vs 2.0 +/- 3.8 mg, P = .08). There were no variations in adverse events, functional outcomes, and satisfaction scores between groups. Conclusion: Continuous nefopam administration as part of multimodal analgesia for 24 hours post-TKA produced a significant analgesic effect but only within the first 6 hours. However, there was a notable reduction in morphine use 48 hours postop. Nefopam isa useful agent for contemporary pain control after TKA. Level of Evidence: Therapeutic Level I. (c) 2022 Elsevier Inc. All rights reserved.
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Purpose of review The purpose of this review is to summarize the most recent evidence-based interventions for perioperative pain management in minimally invasive gynecologic surgery. Recent findings With particular emphasis on pre...
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Purpose of review The purpose of this review is to summarize the most recent evidence-based interventions for perioperative pain management in minimally invasive gynecologic surgery. Recent findings With particular emphasis on preemptive interventions in recent studies, we found preoperative counseling, nutrition, exercise, psychological interventions, and a combination of acetaminophen, celecoxib, and gabapentin are highly important and effective measures to reduce postoperative pain and opioid demand. Intraoperative local anesthetics may help at incision sites, as a paracervical block, and a transversus abdominus plane block. Postoperatively, an effort should be made to utilize non-narcotic interventions such as abdominal binders, ice packs, simethicone, bowel regimens, gabapentin, and scheduled NSAIDs and acetaminophen. When prescribing narcotics, providers should be aware of recommended amounts of opioids required per procedure so as to avoid overprescribing. Our findings emphasize the evolving importance of preemptive interventions, including prehabilitation and pharmacologic agents, to improve postoperative pain after minimally invasive gynecologic surgery. Additionally, a multimodal approach to nonnarcotic intraoperative and postoperative interventions decreases narcotic requirement and improves opioid stewardship.
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Percutaneous nephrolithotomy (PCNL) is the gold-standard treatment for large and complex renal stones. Though associated with higher stone-free rates compared to other minimally invasive stone procedures, this comes at the expense...
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Percutaneous nephrolithotomy (PCNL) is the gold-standard treatment for large and complex renal stones. Though associated with higher stone-free rates compared to other minimally invasive stone procedures, this comes at the expense of increased morbidity including postoperative pain and discomfort. We describe our enhanced recovery after surgery (ERAS) protocol for PCNL with emphasis on the use of erector spinae plane blocks to improve patient satisfaction and reduce postoperative opioid use and bother.
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Background: The opioid epidemic is a public health crisis impacting the practice of surgeons performing primary total hip arthroplasty (THA). Seeking to evaluate changes in prescribers' practices, we asked the following questions:...
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Background: The opioid epidemic is a public health crisis impacting the practice of surgeons performing primary total hip arthroplasty (THA). Seeking to evaluate changes in prescribers' practices, we asked the following questions: (1) Have the initial discharge opioids following THA changed and (2) Have initial total oral morphine milligram equivalents (OME) prescribed following THA decreased since 2014?
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Total knee arthroplasty (TKA) is one of the most commonly performed procedures in the United States. Poorly controlled pain and opioid side effects are associated with worse outcomes. As the prescription opioid epidemic progresses...
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Total knee arthroplasty (TKA) is one of the most commonly performed procedures in the United States. Poorly controlled pain and opioid side effects are associated with worse outcomes. As the prescription opioid epidemic progresses, strategies to provide adequate analgesia while minimizing opioid use are rapidly being developed. Recent efforts have focused on multimodal pain regimens, which combine several opioid and non-opioid classes of analgesic medications and interventions. In this review, we summarize the current best evidence for major components of MPRs as applied to TKA and provide a description of our practice and MPR for use in our practice.
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BACKGROUND: Surgeons contribute to the opioid epidemic by overprescribing opioids for postoperative pain. Excess, unused opioids may be diverted for misuse/abuse.
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