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multimodal analgesia

J Ch Fan
INTRODUCTION: Data from a local report revealed the superior outcome of regional anaesthesia and analgesia compared with general anaesthesia and intravenous patient-controlled analgesia in total knee arthroplasty. This retrospective study aimed to assess the efficacy of intra-operative periarticular multimodal injection in improving postoperative pain and reducing morphine consumption with patient-controlled analgesia after total knee arthroplasty in patients with knee osteoarthritis...
March 14, 2018: Hong Kong Medical Journal, Xianggang Yi Xue za Zhi
J He, X Q Zheng, C H Luo, Z X Huang, W Y He, H B Wang, C X Yang
Objective: To evaluate the efficacy of ultrasound guided quadratus lumborum block combined with non-steroidal anti-inflammatory drugs for postoperative analgesia in patients undergoing total hip arthroplasty. Methods: From January to June 2017, sixty American Society of Anesthesiologists (ASA) physical status Ⅰ to Ⅲ patients, aged 55-75 yr, scheduled for total hip arthroplasty, were randomly divided into control group(group N) and quadratus lumborum block (group R). Ultrasound guided quadratus lumborum block was implemented on the affected side at the end of operation...
February 27, 2018: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Robert M Van Haren, Reza J Mehran, Arlene M Correa, Mara B Antonoff, Carla M Baker, Ta Charra Woodard, Wayne L Hofstetter, Gabriel E Mena, Jack A Roth, Boris Sepesi, Stephen G Swisher, Ara A Vaporciyan, Garrett L Walsh, David C Rice
BACKGROUND: Enhanced recovery after surgery (ERAS) pathways aim to improve postoperative recovery through evidence-based practices including early ambulation, multimodal opioid-sparing analgesia, and reduction of surgical stress. The purpose of this study was to evaluate outcomes following implementation of ERAS in patients undergoing resection for pulmonary malignancy. METHODS: A retrospective review compared outcomes for patients undergoing pulmonary resection for primary lung cancer...
March 9, 2018: Annals of Thoracic Surgery
Don C Beringer
No abstract text is available yet for this article.
January 2018: Clinical Orthopaedics and related Research
Stephen Yu, John Dundon, Olga Solovyova, Joseph Bosco, Richard Iorio
BACKGROUND: TKA pain management protocols vary widely with no current consensus on a standardized pain management regimen. Multimodal TKA pain management protocols aim to address pain control, facilitate functional recovery, and maintain patient satisfaction. QUESTIONS/PURPOSES: (1) Did changes to our pain management protocol, specifically adding liposomal bupivacaine, eliminating patient-controlled analgesia (PCA), and discontinuing femoral nerve blocks (FNBs), affect narcotic consumption after TKA? (2) Did these changes to our pain management protocols affect patient-reported pain scores? (3) Does the use of an immediate postoperative PCA affect rapid rehabilitation and functional recovery? (4) How did changes to our pain management regimen affect discharge disposition and pain-related Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores? METHODS: We retrospectively analyzed an institutional arthroplasty database between September 2013 and September 2015 containing 1808 patients who underwent primary TKA...
January 2018: Clinical Orthopaedics and related Research
Jacob M Drew, Jonathan Neilio, Lisa Kunze
Perioperative care of the total knee arthroplasty (TKA) patient has evolved considerably over the past decade. Among the changes driving this evolution toward shorter hospitalization and accelerated rehabilitation have been regional anesthesia, peripheral nerve blockade, and multimodal analgesia protocols. These complementary techniques are increasingly supported by scientific evidence, though considerable uncertainty persists regarding the optimal combination of strategies. Continued refinement of technique and critical evaluation is trending toward greater characterization of the comparative effectiveness of myriad options...
March 7, 2018: Journal of Knee Surgery
Rikke Vibeke Nielsen
Increasing evidence indicate that pain is insufficiently treated following surgical procedures. It is essential that pain treatment is effective with a minimum of side effects in order to promote postoperative rehabilitation. Multimodal analgesia is most likely an important strategy in reducing postoperative pain. Combinations of different analgesics with different mechanisms of action may have an additive analgesic effect with fewer side effects compared to using a single drug. However, there is still a pronounced lack of documentation for the effect and side effects of these multimodal analgesic regimes...
March 2018: Danish Medical Journal
Helle Molter Duriaud, Niels Kroman, Henrik Kehlet
INTRODUCTION: Improvement in perioperative care programmes has facilitated post-operative recovery and use of short-term or outpatient procedures. The aim of this study was to assess the feasibility and safety of an outpatient breast cancer programme in patients referred to a large breast cancer unit. METHODS: After an introduction period involving 554 consecutive patients, all patients operated from 1 November 2015 to 30 June 2016 (a total 483 patients) were treated with multimodal oral analgesia, preoperative high-dose glucocorticoids and no routine use of drains...
March 2018: Danish Medical Journal
Dimitra Tziona, Marianna Papaioannou, Argyro Mela, Styliani Potamianou, Alexandros Makris
PURPOSE: Total knee arthroplasty (TKA) is associated with moderate to severe postoperative pain. This study evaluates the technique of local infiltration analgesia (LIA), by comparing it to saline injections in addition to a standardized multimodal regimen including an adductor canal block. METHODS: Between September 2015 and March 2016, forty patients aged 18 years and older, ASA I-III, undergoing primary unilateral cemented TKA under spinal anesthesia were randomized to receive either LIA (LIA group) or normal saline (sham LIA group)...
March 5, 2018: Journal of Anesthesia
Karima Karam Khan, Robyna Irshad Khan
BACKGROUND: Pain after laparoscopic cholecystectomy is mild to moderate in intensity. Several modalities are employed for achieving safe and effective postoperative analgesia, the benefits of which adds to the early recovery of the patients. As a part of multimodal analgesia, various approaches of Transversus abdominis plane (TAP) block has been used for management of parietal and incisional components of pain after laparoscopic cholecystectomy. This study was designed to compare the analgesic efficacy of two different approaches of ultrasound guided TAP block, i...
January 2018: Journal of Ayub Medical College, Abbottabad: JAMC
Stavros G Memtsoudis, Jashvant Poeran, Nicole Zubizarreta, Crispiana Cozowicz, Eva E Mörwald, Edward R Mariano, Madhu Mazumdar
BACKGROUND: Multimodal analgesia is increasingly considered routine practice in joint arthroplasties, but supportive large-scale data are scarce. The authors aimed to determine how the number and type of analgesic modes is associated with reduced opioid prescription, complications, and resource utilization. METHODS: Total hip/knee arthroplasties (N = 512,393 and N = 1,028,069, respectively) from the Premier Perspective database (2006 to 2016) were included. Analgesic modes considered were opioids, peripheral nerve blocks, acetaminophen, steroids, gabapentin/pregabalin, nonsteroidal antiinflammatory drugs, cyclooxygenase-2 inhibitors, or ketamine...
March 2, 2018: Anesthesiology
G Soto, M Naranjo González, F Calero
Systemic lidocaine used in continuous infusion during the peri-operative period has analgesic, anti-hyperalgesic, as well as anti-inflammatory properties. This makes it capable of reducing the use of opioids and inhalational anaesthetics, and the early return of bowel function, and patient hospital stay. The aim of this narrative review was to highlight the pharmacology and indications for clinical application, along with new and interesting research areas. The clinical applications of peri-operative lidocaine infusion have been reviewed in several recent systematic reviews and meta-analyses in patients undergoing open and laparoscopic abdominal procedures, ambulatory procedures, and other types of surgery...
February 26, 2018: Revista Española de Anestesiología y Reanimación
Deepa Kattail, Alexandra Macmillan, Leila Musavi, Rachel Pedreira, Muhammad Faateh, Regina Cho, Joseph Lopez, Amir H Dorafshar
BACKGROUND: Postoperative pain following open craniosynostosis repair has not been studied extensively and is sometimes thought to be inconsequential. The purpose of this study was to assess postoperative pain in this pediatric population. METHODS: We performed a retrospective chart review of patients (n = 54) undergoing primary open craniosynostosis repair from 2010 to 2016. Demographics, length of stay (LOS), pain scores, emesis events, and perioperative analgesics were reviewed...
February 27, 2018: Journal of Craniofacial Surgery
Katarzyna Popiolek-Barczyk, Dorota Łażewska, Gniewomir Latacz, Agnieszka Olejarz, Wioletta Makuch, Holger Stark, Katarzyna Kieć-Kononowicz, Joanna Mika
BACKGROUND AND PURPOSE: The histaminergic system is a promising target for the development of new analgesics, since expression of histamine H3 R and H4 R receptors has been reported in regions related to nociceptive transmission. The aim of our study was to determine the analgesic effects of new H3 R and H4 R antagonists in naive and neuropathic (CCI, chronic constriction injury) male and female mice. EXPERIMENTAL APPROACH: We investigated the effects of newly synthesized H3 R (E-162; 1-(5-(naphthalen-1-yloxy)pentyl)piperidine) and H4 R (TR-7; 4-(4-chlorophenyl)-6-(4-methylpiperazin-1-yl)-1,3,5-triazin-2-amine) antagonists on mechanical (von Frey) and thermal (cold plate, tail flick) stimuli in naive and CCI-exposed (7 days after injury) animals...
February 27, 2018: British Journal of Pharmacology
Allana Munro, Ana Sjaus, Ronald B George
PURPOSE OF REVIEW: High-quality analgesia has been linked to improved patient satisfaction as well as improved short-term and long-term postoperative outcomes. Acute surgical pain is a modifiable risk factor for development of chronic postoperative pain, which is reported by up to 26% of gynecologic surgical patients. In other surgical populations, multimodal analgesia has shown improved pain control and decreased reliance on opioids. This review examines recent evidence for various analgesic modalities applied specifically to the gynecologic surgical population...
February 22, 2018: Current Opinion in Anaesthesiology
P G Genov, V H Timerbaev, A A Grin, O Yu Rebrova
DESIGN: 129 patients scheduled for elective lumbar discectomy in 2010-2013 were enrolled in prospective study. Group K (n=20) underwent general anaesthesia and postoperative analgesia on-demand. Group PMA+SA (n=23) got subarachnoid block and preventive multimodal analgesia (PMA) including ketoprofen, paracetamol and nalbuphine. At PMA group (n=21) general anaesthesia and PMA were used; at PMA+I (n=21) also bupivacaine wound infiltration was administrated; at PlvL4+S (n=20) - depo-corticosteroid was applied locally on affected spinal nerve root; at PMA+IS (n=24) wound infiltration and local corticosteroids were combined...
September 2017: Anesteziologiia i Reanimatologiia
Richard L Purcell, Kyle E Nappo, Daniel W Griffin, Michael McCabe, Terrence Anderson, Michael Kent
PURPOSE: A newer formulation of bupivacaine, encapsulated within carrier molecules, has garnered attention for its role in providing extended post-operative analgesia. The purpose was to evaluate the addition of liposomal bupivacaine to fascia iliaca blockade during hip arthroscopy. METHODS: Retrospective cohort study of patients undergoing hip arthroscopy with a pre-operative fascia iliaca blockade with either liposomal bupivacaine (Group 1; 266mg + 20 cc 0...
February 16, 2018: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Federico Piccioni, Riccardo Ragazzi
Enhanced recovery after surgery (ERAS) programs are developed to prevent factors that delay postoperative recovery as well as issues that cause complications. The development of video-assist thoracoscopic surgery (VATS) techniques favors the fast recovery after thoracic procedures. ERAS strategies are based on multidisciplinary approach in which the anesthetist plays an important role from the preoperative to the postoperative phase with several goals. After preoperative evaluation and medical optimization, the anesthetist must ensure a tailored anesthetic plan aiming to a fast recovery and adequate pain relief to reduce the response to the surgical stress...
2018: Journal of visualized surgery
Jan-Willem Potters, Markus Klimek
This review summarizes the added value of local anesthetics in patients undergoing craniotomy for brain tumor resection, which is a procedure that is carried out frequently in neurosurgical practice. The procedure can be carried out under general anesthesia, sedation with local anesthesia or under local anesthesia only. Literature shows a large variation in the postoperative pain intensity ranging from no postoperative analgesia requirement in two-thirds of the patients up to a rate of 96% of the patients suffering from severe postoperative pain...
2018: Local and Regional Anesthesia
Jonathan W Cheah, David C Sing, Erik N Hansen, Pedram Aleshi, Thomas P Vail
BACKGROUND: Intrathecal morphine (ITM) combined with bupivacaine spinal anesthesia can improve postoperative pain, but has potential side effects of postoperative nausea/vomiting (PONV) and pruritus. With the use of multimodal analgesia and regional anesthetic techniques, postoperative pain control has improved significantly to a point where ITM may be avoided in total joint arthroplasty (TJA). METHODS: We performed a retrospective study of primary TJA patients who underwent a standardized multimodal recovery pathway and received bupivacaine neuraxial anesthesia with ITM vs bupivacaine neuraxial anesthesia alone (control)...
January 31, 2018: Journal of Arthroplasty
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