Impact of modified-release opioid use on clinical outcomes following total hip and knee arthroplasty: a propensity score-matched cohort study.

Modified-release opioids are often prescribed for the management of moderate to severe acute pain following total hip and knee arthroplasty, despite recommendations against their use due to increasing concerns regarding harm. The primary objective of this multicentre study was to examine the impact of modified-release opioid use on the incidence of opioid-related adverse events compared with immediate-release opioid use, among adult inpatients following total hip or knee arthroplasty. Data for total hip and knee arthroplasty inpatients receiving an opioid analgesic for postoperative analgesia during hospitalisation were collected from electronic medical records of three tertiary metropolitan hospitals in Australia. The primary outcome was the incidence of opioid-related adverse events during hospital admission. Patients who received modified with or without immediate-release opioids were matched to those receiving immediate-release opioids only (1:1) using nearest neighbour propensity score matching with patient and clinical characteristics as covariates. This included total opioid dose received. In the matched cohorts, patients given modified-release opioids (n = 347) experienced a higher incidence of opioid-related adverse events overall, compared with those given immediate-release opioids only (20.5%, 71/347 vs. 12.7%, 44/347; difference in proportions 7.8% [95%CI 2.3-13.3%]). Modified-release opioid use was associated with an increased risk of harm when used for acute pain during hospitalisation after total hip or knee arthroplasty.

Patient characteristics and quality of life among a sample of Australian chronic pain clinic attendees.

BACKGROUND: Multidisciplinary chronic pain management programs have proliferated widely in recent decades. The clinical characteristics of patients attending these clinics are becoming the subject of increased research. Recent European data suggests that patients attending these clinics report very low quality of life. AIMS: The present study profiles an Australian population in terms of demographics, clinical characteristics and quality of life, as measured by the Short Form 36 Quality of Life Questionnaire (SF-36). METHODS: Data were collected prospectively from consecutive patients presenting to a multidisciplinary chronic pain clinic at a major Sydney metropolitan teaching-hospital. Cross-sectional analysis of demographic and clinical characteristics and quality of life were then undertaken. RESULTS: Descriptive analysis of demographics and clinical characteristics suggest a patient population group reporting significant pain severity and reduced quality of life. The comparison of SF-36 domain scores between clinic patients and Australian norm values indicates a greatly reduced score on all SF-36 domains for clinic patients. Pain clinic patients reported the most profound effect upon quality of life in the role physical, physical function and social function domains of the SF-36. Stepwise multiple regression indicated impaired coping ability and depressive disability as the most significant correlates of low quality of life. CONCLUSION: Patients who attend chronic pain clinics are likely to report low quality of life with an inability to cope. These findings suggest that future intervention research should explore the impacts of behavioural and self-management interventions. Psychological distress and ability to cope could be used as indices of improvement.

Management of postoperative epidural analgesia: a survey of Australian practice.

A sample of Australian hospitals was surveyed about their practice preferences in relation to the management of epidural analgesia for postoperative pain. Results indicated substantial variation in practice preference across institutions with respect to observation protocols, epidural analgesia duration, catheter removal where anticoagulant therapy is concurrent and management of catheter problems. Further research appears necessary to develop optimal epidural analgesia management practice.

Use of breath-activated Patient Controlled Analgesia for acute pain management in a patient with quadriplegia.

We report the use of breath-activated Patient Controlled Analgesia (PCA) for the provision of analgesia in a quadriplegic patient with traumatic neck injury. This provided good pain relief, decreased opioid complications, improved perceptions of self-control, smoothed recovery and enhanced patient, family as well as staff satisfaction. The setup and principles of its use in a patient with high anxiety and unable to use conventionally activated PCA are illustrated.

Femoral nerve blockade in the multidisciplinary management of intractable localized pain due to metastatic tumor: a case report.

This report describes the management of a 39-year-old man with intractable metastatic femoral bone pain managed by femoral nerve blockade, first via a percutaneously tunneled catheter and later via an implanted Port-A-Cath system. Analgesia was maintained by repeated injections of bupivacaine. The multitherapeutic approach utilizing surgical fixation, radiotherapy, opioid analgesics and adjuvants, transcutaneous electrical nerve stimulation, physiotherapy, and neural blockade to the management is emphasized.

Blood-stained pleural effusion complicating interpleural analgesia.

A case of blood-stained pleural effusion complicating interpleural analgesia for a difficult nephrectomy is reported. We describe our technique of placement of the interpleural catheter. Interpleural infusion of 0.25% bupivacaine at 7 mls/h provided excellent postoperative analgesia. However, a left pleural effusion was demonstrated from chest X-ray films taken from the third day post-operatively. Persistent low grade fever and a large pleural effusion necessitated drainage which resulted in improvement in symptoms. Possible aetiologies of the effusion are discussed, although the exact cause was uncertain. Observation for a developing pleural effusion and other complications should form part of the postoperative observation and if one does develop, the necessary measures can be taken.