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1.
Medicine (Baltimore) ; 100(14): e25450, 2021 Apr 09.
Artículo en Inglés | MEDLINE | ID: mdl-33832151

RESUMEN

BACKGROUND: This meta-analysis aimed to compare the efficiency of fascia iliaca compartment block (FICB) and femoral nerve block (FNB) for pain management in knee and hip surgeries. METHODS: We searched four electronic databases (Pubmed, Embase, Cochrane library database, Web of Science) from inception to January 2019. Only randomized controlled trials (RCTs) were included. Two review authors independently extracted data for each included study. Primary outcomes were visual analogue scale at 12 hours, 24 hours, 48 hours, total morphine consumption, the length of hospital stay and the occurrence of nausea and vomiting. Standardized mean difference (SMD) or risk ratio (RR) and 95% confidence intervals (CIs) were calculated for continuous outcomes and discontinuous outcomes respectively. We used the Cochrane Risk of Bias tool to assess risk of bias. Stata 12.0 was used for meta-analysis. RESULTS: Finally, 7 RCTs involving 508 patients (FICB = 254, FNB = 254) were included in this meta-analysis. Compared with FNB group, FICB has no benefit for visual analogue scale at 12 hours (SMD = 0.02, 95% CI, -0.15 to 0.19; P = .820), 24 hours (SMD = -0.02, 95% CI, -0.22 to 0.18; P = .806), and 48 hours (SMD = -0.02, 95% CI, -0.22 to 0.19; P = .872). No significant differences were found regarding total morphine consumption (SMD = -0.07, 95% CI, -0.29 to 0.15; P = .533). What's more, there was no significant difference between the length of hospital stay and the occurrence of nausea and vomiting (P > .05). CONCLUSION: FICB has equivalent pain control and morphine-sparing efficacy when compared with FNB. More high-quality RCTs are needed to identify the optimal drugs and volume of local infiltration protocols.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Artroplastia de Reemplazo de Rodilla , Bloqueo Nervioso/métodos , Dolor Postoperatorio/prevención & control , Analgésicos Opioides/uso terapéutico , Fascia/inervación , Nervio Femoral , Humanos , Morfina/uso terapéutico , Dimensión del Dolor , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/tratamiento farmacológico , Resultado del Tratamiento
2.
Georgian Med News ; (311): 36-40, 2021 Feb.
Artículo en Ruso | MEDLINE | ID: mdl-33814387

RESUMEN

Acute postoperative pain is still an urgent problem in surgery. Today there are many drugs for pain relief, but at the same time, the adequacy of postoperative analgesia for the subjective assessments of patients does not exceed 50%. Therefore, taking into account the pathophysiology of acute pain syndrome, it is necessary to inject an anesthetic directly near the operating field, which can be achieved by long-term conduction anesthesia. So, in the area of the head and neck, there are several techniques (G. Brown, J. Bershet, V. M. Uvarov, J. S. Vaisblat, V. A. Dubov and V. D. Dunaevsky, P. Yu. Stolyarenko), but all of them have a metric definition of the point at the near and do not take into account the individual anatomical characteristics of patients, as well as anastomoses of the nerves. Therefore, the goal of our work was to create an optimal complex of conductive postoperative pain relief taking into account the pathophysiology of acute pain and the characteristics of postoperative defects in patients with pathology of the maxillofacial region. We have proposed a combination of three blockades: central anesthesia at the foramen ovale, angular glossopharyngeal nerve block and superficial cervical plexus block with prolonged catheterization. This technique of anesthesia allows you to carry out dressings painlessly and in full. It also significantly improves the ability to swallow, even with a probe. It has a positive effect on the state of moisture in the oral cavity.


Asunto(s)
Analgesia , Neoplasias de Cabeza y Cuello , Bloqueo Nervioso , Anestésicos Locales , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Dolor Postoperatorio/tratamiento farmacológico
3.
J Surg Orthop Adv ; 30(1): 2-6, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33851905

RESUMEN

The objective of this study was to investigate the effect of standardized preoperative opioid counseling on postoperative opioid consumption for patients undergoing outpatient lower extremity orthopaedic surgery. Participating patients undergoing elective outpatient lower extremity orthopaedic surgery were randomized to either receive preoperative opioid counseling or not receive counseling (control group). Counseling was delivered via a five-minute pre-recorded standardized video preoperatively. Postoperatively, patients in both groups were queried for their postoperative pain experience, opioid consumption, non-opioid medication consumption, and any adverse effects related to their pain management experience. A total of 107 patients were studied, with 45 in the counseling group and 62 in the control group. Patients that received preoperative opioid counseling consumed on average 6.5 opioid pills postoperatively; the control group consumed 12.4 opioid pills (p = 0.008). Preoperative opioid counseling resulted in a statistically significant reduction in postoperative opioid consumption after outpatient lower extremity orthopaedic surgery. (Journal of Surgical Orthopaedic Advances 30(1):002-006, 2021).


Asunto(s)
Analgésicos Opioides , Procedimientos Ortopédicos , Analgésicos Opioides/uso terapéutico , Consejo , Humanos , Extremidad Inferior/cirugía , Pacientes Ambulatorios , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/prevención & control , Estudios Prospectivos
4.
J Opioid Manag ; 17(2): 101-107, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33890273

RESUMEN

OBJECTIVE: This study sought to determine the rate at which nonopioid analgesics were utilized in postoperative pain management plans after pediatric ambulatory surgery in patients who were also prescribed postoperative opioids. DESIGN: Retrospective cohort analysis. PARTICIPANTS: Patients ≤ 21 years old who were prescribed opioid medications after undergoing ambulatory surgery at a tertiary-care medical center. METHODS: Postoperative day 1 (POD1) opioid prescription and use survey data along with electronic medical record data were extracted and analyzed for patients meeting inclusion criteria between April 2017 and December 2017. MAIN OUTCOME MEASURE: Recommendation to take nonopioid analgesics after discharge. RESULTS: A total of 849 (63.2 percent) patients responded to the survey and 275 (32.4 percent) of these cases were prescribed postoperative opioids. Of the 273 cases included in this study, 137 (50.2 percent) received recommendations to take at least one nonopioid analgesic as well, and 164 (60.1 percent) reported using their prescribed opioids on POD1. Opioid use did not vary significantly with nonopioid analgesic recommendations. There was significant variability in opioid and nonopioid analgesic prescribing and recommendation patterns across surgical subspecialties. CONCLUSIONS: There was limited use of nonopioid analgesics in postoperative pain management plans after pediatric ambulatory surgery. This leaves many patients with only opioid-based agents as the first-line medication for postoperative pain management. These findings highlight an opportunity to educate prescribers and patients on the importance of step-wise multimodal analgesic plans.


Asunto(s)
Analgésicos no Narcóticos , Adulto , Procedimientos Quirúrgicos Ambulatorios , Analgésicos no Narcóticos/uso terapéutico , Analgésicos Opioides/efectos adversos , Niño , Humanos , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/tratamiento farmacológico , Pautas de la Práctica en Medicina , Estudios Retrospectivos , Adulto Joven
5.
J Opioid Manag ; 17(2): 155-167, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33890279

RESUMEN

OBJECTIVE: Prescription opioid misuse represents a social and economic challenge in the United States. We evaluated Schedule II opioid prescribing practices by primary care providers (PCPs), orthopedic and general surgeons, and pain management specialists. DESIGN: Prospective evaluation of prescribing practices of PCPs, orthopedic and general surgeons, and pain management specialists over 5 years (October 1, 2014-September 30, 2019) in an outpatient setting. METHODS: An analysis of Schedule II opioid prescribing following the implementation of federal and state guidelines and evidence-based standards at our institution. RESULTS: There were significantly more PCPs, orthopedic and general surgeons, and pain management specialists with a significantly increased number who prescribed Schedule II opioids, whereas there was a simultaneous significant decline in the average number of Schedule II opioid prescriptions per provider, Schedule II opioid pills prescribed per provider, and Schedule II opioid pills prescribed per patient by providers. The average number of Schedule II opioid prescriptions with a quantity >90 and Opana/Oxycontin prescriptions per PCP, orthopedic surgeon, and pain management specialist significantly decreased. The total morphine milligram equivalent (MME)/day of Schedule II opioids ordered by PCPs, orthopedic and general surgeons, and pain management specialists significantly declined. The ages of the providers remained consistent throughout the study. CONCLUSIONS: This study reports the implementation of federal and state regulations and institutional evidence-based guidelines into primary care and medical specialty practices to reduce the number of Schedule II opioids prescribed. Further research is warranted to determine alternative therapies to Schedule II opioids that may alleviate a patient's pain without initiating or exacerbating a potentially lethal opioid addiction.


Asunto(s)
Analgésicos Opioides , Cirujanos , Analgésicos Opioides/uso terapéutico , Sustancias Controladas , Prescripciones de Medicamentos , Humanos , Dolor/tratamiento farmacológico , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/tratamiento farmacológico , Pautas de la Práctica en Medicina , Atención Primaria de Salud , Estudios Prospectivos , Especialización , Estados Unidos
6.
J Opioid Manag ; 17(2): 169-179, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33890280

RESUMEN

OBJECTIVE: To date, the majority of studies have focused on the adverse effect of opioid overutilization on outcomes, risk factors for overutilization and dependence, and the development of procedure-specific guidelines. We present the results of a multiphased approach to reducing opioid prescribing. DESIGN: A retrospective pre-post study of opioid prescriptions across 386,393 patient encounters was conducted. The preintervention cohort included patient encounters from November 2016 to March 2017, and the post-intervention cohort included encounters from April 2017 to October 2019. SETTING: Single-institution orthopedic practice. PATIENTS, PARTICIPANTS: 386,393 patient encounters. INTERVENTION: Multiple prescribing reduction interventions were implemented from April 2017 to July 2018. MAIN OUTCOME MEASURE: Average morphine milligram equivalent (MME) per patient encounter. RESULTS: Implementation of the interventions resulted in an average reduction of 15.2 MME per encounter (54.5 percent) compared to the preimplementation cohort (pre: avg. MME = 27.9, SD 113.6; post: avg. MME = 12.7, SD 66.1; p < 0.001). The number of pills per opioid prescription was reduced by 13.4 (29.5 percent) (pre: avg. pill count = 45.5, S.D. 25.1; post: avg. pill count = 32.1, SD 21.1; p < 0.001), and the percent of patients receiving opioids was reduced from 8.3 percent to 5.8 percent (p < 0.001). Prescribing compliance was evaluated for 7,664 surgical encounters, with 98.2 percent of prescriptions meeting stated guidelines; 5.5 percent of these encounters required second prescriptions. CONCLUSIONS: The use of a multiphase approach effectively reduced the opioid prescribing patterns of a large orthopedic practice and was successful across subspecialties. This approach provides a template that other institutions may use to reduce opioid overprescribing in orthopedic practices.


Asunto(s)
Analgésicos Opioides , Ortopedia , Analgésicos Opioides/efectos adversos , Prescripciones de Medicamentos , Humanos , Dolor Postoperatorio/tratamiento farmacológico , Pautas de la Práctica en Medicina , Estudios Retrospectivos
8.
Artículo en Inglés | MEDLINE | ID: mdl-33800559

RESUMEN

BACKGROUND: Severe postoperative pain is a significant problem after cesarean sections. METHODS: This study was a randomized, controlled trial of 105 patients conducted in two hospitals. All patients were anesthetized spinally for elective cesarean section. Each participant was randomly allocated to one of three study groups: the quadratus lumborum block (QLB) group, the transversus abdominis plane block (TAPB) group, or the control (CON) group. The primary outcome of this study determined acute pain intensity on the visual analog scale (VAS). The secondary outcomes determined morphine consumption and chronic pain evaluation according to the Neuropathic Pain Symptom Inventory (NPSI) after hospital discharge. RESULTS: At rest, the pain intensity was significantly higher in the CON group than in the QLB and TAPB groups at hours two and eight. Upon activity, the pain in the control subjects was more severe than in the QLB and TAPB groups in three and two of five measurements, respectively. Moreover, morphine consumption was significantly lower in the QLB (9 (5-10)) and TAPB (10 (6-14)) groups than in the CON (16 (11-19)) group. Persistent postoperative pain was significantly lower in the QLB group than in the CON group at months one and six following hospital discharge. CONCLUSIONS: Both the QLB and TAPB can improve pain management after cesarean delivery. Moreover, the QLB might reduce the severity of persistent postoperative pain months after cesarean section.


Asunto(s)
Dolor Crónico , Bloqueo Nervioso , Músculos Abdominales , Cesárea/efectos adversos , Dolor Crónico/terapia , Femenino , Humanos , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/prevención & control , Embarazo
9.
Medicine (Baltimore) ; 100(17): e25560, 2021 Apr 30.
Artículo en Inglés | MEDLINE | ID: mdl-33907103

RESUMEN

ABSTRACT: The aim of this study was to assess the efficacy of combined opioids by comparing four regimens of patient-controlled epidural analgesia (PCEA) after cesarean section.Parturient patients who underwent elective or emergent cesarean section under combined spinal and epidural anesthesia from April 2013 to March 2016 were retrospectively analyzed. Based on PCEA, they were assigned to one of 4 groups: local anesthetic alone (LA), epidural single morphine administration during surgery followed by local anesthetic alone (M), local anesthetic combined with fentanyl 10 µg/h (F10), or local anesthetic combined with fentanyl 20 µg/h (F20). The primary outcome was the number of PCEA boluses used. Secondary outcomes included the use of rescue analgesia, postoperative nausea and vomiting, and postoperative pruritus.A total of 250 parturients were analyzed. Whereas the number of PCEA boluses in the LA group was significantly higher than in the other combined opioid groups on the day of surgery and postoperative day 1 (LA: 3 [1-6] and 7 [4-9] vs M: 2 [0-4] and 4 [0-7] vs F10: 1 [0-4] and 3 [0-6] vs F20: 1 [0-3] and 2 [0-8], P = .012 and 0.010, respectively), within the combined opioid groups, the number was not significantly different. Significantly fewer patients in the F20 group required rescue analgesia on postoperative day 1 and 2 (25 and 55%) than those in the M (66 and 81%) and F10 (62 and 66%) groups (P < .001 and P = .007, respectively). Postoperative nausea and vomiting and pruritus were significantly higher in the M group (P < .008 and P = .024, respectively).The results of the present study suggest that local anesthetic alone after a single administration of morphine, or local anesthetic combined with fentanyl 10 µg/h would generally be adequate for PCEA, whereas local anesthetic combined with fentanyl 20 µg/h would be suitable for conventional epidural analgesia.


Asunto(s)
Analgesia Epidural/métodos , Analgesia Obstétrica/métodos , Analgesia Controlada por el Paciente/métodos , Manejo del Dolor/métodos , Dolor Postoperatorio/tratamiento farmacológico , Adulto , Analgésicos Opioides/administración & dosificación , Anestésicos Locales/administración & dosificación , Cesárea/efectos adversos , Quimioterapia Combinada , Femenino , Fentanilo/administración & dosificación , Humanos , Morfina/administración & dosificación , Dimensión del Dolor , Dolor Postoperatorio/etiología , Embarazo , Estudios Retrospectivos , Autoadministración , Resultado del Tratamiento
10.
Clin Oral Investig ; 25(5): 2511-2536, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33839939

RESUMEN

PURPOSE: To evaluate the clinical efficacy of various analgesic medications in mitigating orofacial pain following dental implant surgery. MATERIALS AND METHODS: A systematic search was conducted to identify randomized controlled clinical trials (RCTs). The primary outcomes examined were post-operative pain (POP) and consumption of rescue analgesics following implant placement; secondary outcomes included adverse effects, post-operative inflammation, infection, swelling, bleeding, patient satisfaction, and quality of life. Random effects meta-analysis was conducted for risk ratios of dichotomous data. RESULTS: Nine RCTs fulfilled the eligibility criteria. Individual studies and meta-analysis of two studies indicated that nonsteroidal anti-inflammatory drugs (NSAIDs) significantly reduced POP and consumption of rescue analgesics after dental implant placement compared to placebo. Transdermal administration of NSAIDs may be superior to the oral route as it was similarly effective for POP control and resulted in fewer side effects. Glucocorticoids administered as primary analgesics or NSAID adjuvants resulted in comparable pain sensation compared to NSAIDs alone. Caffeine-containing analgesics were reported as acceptable and effective for the treatment of POP and swelling when compared to codeine adjuvants. With regard to analgesic dosing schedules, pain modulation may be most critical during the first 72 h following dental implant placement. Risk of bias assessment indicated an overall low risk of bias across the included trials. CONCLUSION: Within the limitations of this review, POP following implant surgery may be effectively treated with the short-term use of analgesic medications. However, given the heterogeneity in the available RCTs, there is insufficient evidence to recommend an analgesic regimen following dental implant surgery. CLINICAL RELEVANCE: Short-term use of analgesic medications may be sufficient for post-operative pain management in dental implant surgery. Ultimately, the clinician's analgesic prescription should be directed by a patient's medical history, in order to increase the success of pain management in a short period of time and decrease potential adverse effects. TRIAL REGISTRATION: CRD42018099324.


Asunto(s)
Implantes Dentales , Analgésicos/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Humanos , Dolor Postoperatorio/tratamiento farmacológico , Ensayos Clínicos Controlados Aleatorios como Asunto
11.
J Opioid Manag ; 17(2): 145-154, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33890278

RESUMEN

OBJECTIVES: Recently, opioid abuse and related overdoses have increased warranting the need for research directed against the opioid epidemic. Previous studies identified that patients on opioid therapy may become zinc deficient and that zinc, in a murine model, may antagonistically affect the opioid receptor.13 Further understanding the relationship between opioid use and zinc deficiency may mitigate the opioid epidemic. METHODS: A retrospective study was conducted to identify zinc (Zn2+) deficiencies among post-operative total hip arthroplasty (THA) patients. On post-operative day one, patients had routine blood tests, including Zn2+ plasma levels. Patients were considered Zn2+-deficient if their Zn2+ plasma was < 56 µg/dL (Reference: 56-134 µg/dL). Upon discharge from the hospital, the patients' inpatient opioid medication consumption per day was determined by dividing total morphine milligram equivalents (MMEs) by length of stay. A Student's t-test was performed to compare the total MMEs for Zn2+-deficient patients versus Zn2+-normal patients. A univariate analysis followed by multiple linear regression was performed to identify demographic or surgical predictors of MMEs/day. RESULTS: For Zn2+-deficient patients, the total MMEs/day was 33.62 ( ± 27.06), as compared to Zn2+-normal patients who consumed 16.22 ( ±16.01) MMEs/day (p = 0.031). The univariate analysis and multiple linear regression showed that patients' Zn2+ status had a significant contribution toward predicting MMEs/day, with p = 0.022 and p = 0.04, re-spectively. CONCLUSION: The results of this study suggest that Zn2+ deficiency may potentiate opioid consumption. Thus, Zn2+ sup-plementation may be a simple approach to reducing opioid addiction and dependence.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Trastornos Relacionados con Opioides , Analgésicos Opioides/efectos adversos , Artroplastia de Reemplazo de Cadera/efectos adversos , Humanos , Trastornos Relacionados con Opioides/diagnóstico , Trastornos Relacionados con Opioides/tratamiento farmacológico , Trastornos Relacionados con Opioides/epidemiología , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/tratamiento farmacológico , Estudios Retrospectivos , Zinc
12.
Orthop Clin North Am ; 52(2): 103-110, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33752831

RESUMEN

Orthopedic surgeries are associated with the prescription of more narcotics than any other surgical specialty, particularly for total knee replacement (TKR) surgery. The authors examined controlled substance prescriptions following TKR surgery in a sample of 560 TKR patients. Results indicated that of all the 5164 prescriptions documented on the controlled substance monitoring database, 64% were for opioid medications. More than half of the patients received controlled substances from both the surgery site provider and a nonsurgery site provider in the year following surgery. The authors recommend that providers consider the possibility of outside prescribing when prescribing opioid analgesic.


Asunto(s)
Analgésicos Opioides/administración & dosificación , Artroplastia de Reemplazo de Rodilla , Dolor Postoperatorio/tratamiento farmacológico , Pautas de la Práctica en Medicina/estadística & datos numéricos , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estados Unidos
13.
Orthop Clin North Am ; 52(2): 149-155, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33752836

RESUMEN

The field of hand surgery continues to evolve in new and exciting directions. Advances in diagnosis and management for common complaints and complex injuries allow higher-level care, while still being cognizant of the cost of health care delivery. Indications and protocols for past paradigm shifts, such as volar locked plating for distal radial fractures, continue to be honed, and the outcomes seen for modern flexor tendon repairs are impressive. Open questions remain, but promising results for scaphoid nonunion surgery and peripheral nerve reconstruction with processed allograft will continue to shed light on these unsolved problems.


Asunto(s)
Traumatismos de la Mano/cirugía , Procedimientos Ortopédicos/métodos , Traumatismos de la Muñeca/cirugía , Analgésicos Opioides/administración & dosificación , Evaluación de la Discapacidad , Humanos , Dolor Postoperatorio/tratamiento farmacológico
14.
J Opioid Manag ; 17(1): 63-67, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33735428

RESUMEN

OBJECTIVE: We examined changes in opioid prescriptions after outpatient laparoscopic cholecystectomy (LC) before and after (1) an educational intervention for surgical residents and (2) subsequent changes in state regulations for handling these prescriptions. DESIGN: A single-institution retrospective review evaluated opioids prescribed on discharge in morphine milligram equivalents (MMEs) over three periods: Period 1, prior to educational intervention (October 1, 2017 to January 31, 2018); Period 2, after intervention and before regulation changes occurred (February 1, 2018 to May 31, 2018); and Period 3, after changes in regulations went into effect (June 1, 2018 to September 30, 2018). SETTING: A large urban teaching hospital in Detroit, Michigan. PATIENTS: All adults receiving outpatient LC during one of the study periods. Patients with a history of regular opioid use prior to surgery were excluded. There were 49 patients in Period 1, 57 in Period 2, and 51 in Period 3. INTERVENTIONS: All general surgery residents participated in an education session focusing on problems related to opioid addiction, prescribing trends, and multimodal pain control options in February 2018. MAIN OUTCOME MEASURE: Mean MME per patient was compared between time periods. RESULTS: Average MME was reduced from 87.11 in Period 1 to 65.96 in Period 2 to 51.80 in Period 3. Analysis of variance showed MME differed significantly among the periods. Scheffe post hoc t-tests showed MME prescribed during Periods 2 and 3 were each significantly lower than Period 1, whereas Periods 2 and 3 did not differ significantly. CONCLUSIONS: MME prescribed after outpatient LC significantly decreased after the educational intervention and remained low after state mandate went into effect.


Asunto(s)
Analgésicos Opioides , Internado y Residencia , Adulto , Analgésicos Opioides/efectos adversos , Hospitales de Enseñanza , Humanos , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/tratamiento farmacológico , Pautas de la Práctica en Medicina , Estudios Retrospectivos
16.
Nat Commun ; 12(1): 1367, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33649338

RESUMEN

Effective control of pain management has the potential to significantly decrease the need for prescription opioids following a surgical procedure. While extended release products for pain management are available commercially, the implementation of a device that safely and reliably provides extended analgesia and is sufficiently flexible to facilitate a diverse array of release profiles would serve to advance patient comfort, quality of care and compliance following surgical procedures. Herein, we review current polymeric systems that could be utilized in new, controlled post-operative pain management devices and highlight where opportunities for improvement exist.


Asunto(s)
Sistemas de Liberación de Medicamentos , Manejo del Dolor , Dolor Postoperatorio/tratamiento farmacológico , Polímeros/química , Analgésicos/administración & dosificación , Analgésicos/uso terapéutico , Animales , Humanos , Control Social Formal
18.
BMC Oral Health ; 21(1): 91, 2021 03 02.
Artículo en Inglés | MEDLINE | ID: mdl-33653320

RESUMEN

BACKGROUND: Serratiopeptidase has been clinically used in controlling surgical and non-surgical inflammatory conditions. This study was conducted to assess the therapeutic effect of Serratiopeptidase in patients undergoing surgical removal of impacted mandibular third molar. METHODS: This randomized clinical trial investigated the efficacy of Serratiopeptidase and Paracetamol after surgical removal of impacted third molar for 5 days (n = 67) as compared with an equivalent dose of placebo and Paracetamol (n = 66). Outcome measures were reported pain, trismus and swelling using Laskin method. All outcome measures were recorded on days 0, 1, 2, 4, and 5 post-surgeries. RESULTS: In this clinical trail 133 patients (mean age 23 years, 54% female) completed the study. Baseline characteristics were comparable across treatment groups. Serratiopeptidase significantly improved trismus compared with control on the 4th day (27.30 ± 7.3 mm and 32.06 ± 7.7 mm, respectively (P < 0.001) Swelling markedly improved, The distance from the lower edge of the earlobe to the midpoint of the symphysis for cases vs control were 111.49 ± 8.1 mm and 115.39 ± 9.9 mm, respectively (P < 0.001). Reported pain, showed no statistical significance difference. CONCLUSION: Serratiopeptidase resulted in better inflammation improvement than placebo over 5 days. Further studies are warranted to assess longer-term and clinical outcomes, as well as safety. CLINICAL RELEVANCE: Serratiopeptidase administered postoperatively helps in improving trismus and swelling after removal of impacted lower third molars. Trial registration The study was registered in ClinicalTrial.gov under the number NCT02493179. Registered 1st of June 2015, https://clinicaltrials.gov/ct2/results?cond=serratiopeptidase .


Asunto(s)
Tercer Molar , Diente Impactado , Adulto , Método Doble Ciego , Edema/etiología , Edema/prevención & control , Femenino , Humanos , Masculino , Tercer Molar/cirugía , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/prevención & control , Péptido Hidrolasas , Extracción Dental/efectos adversos , Diente Impactado/cirugía , Resultado del Tratamiento , Trismo/etiología , Trismo/prevención & control , Adulto Joven
19.
BMC Geriatr ; 21(1): 189, 2021 03 18.
Artículo en Inglés | MEDLINE | ID: mdl-33736611

RESUMEN

BACKGROUND: Prescription opioids are commonly used for postoperative pain relief in older adults, but have the potential for misuse. Both opioid side effects and uncontrolled pain have detrimental impacts. Frailty syndrome (reduced reserve in response to stressors), pain, and chronic opioid consumption are all complex phenomena that impair function, nutrition, psychologic well-being, and increase mortality, but links among these conditions in the acute postoperative setting have not been described. This study seeks to understand the relationship between frailty and patterns of postoperative opioid consumption in older adults. METHODS: Patients ≥ 65 years undergoing elective surgery with a planned hospital stay of at least one postoperative day were recruited for this cohort study at pre-anesthesia clinic visits. Preoperatively, frailty was assessed by Edmonton Frailty and Clinical Frailty Scales, pain was assessed by Visual Analog and Pain Catastrophizing Scales, and opioid consumption was recorded. On the day of surgery and subsequent hospitalization days, average pain ratings and total opioid consumption were recorded daily. Seven days after hospital discharge, patients were interviewed using uniform questionnaires to measure opioid prescription use and pain rating. RESULTS: One hundred seventeen patients (age 73.0 (IQR 67.0, 77.0), 64 % male), were evaluated preoperatively and 90 completed one-week post discharge follow-up. Preoperatively, patients with frailty were more likely than patients without frailty to use opioids (46.2 % vs. 20.9 %, p = 0.01). Doses of opioids prescribed at hospital discharge and the prescribed morphine milligram equivalents (MME) at discharge did not differ between groups. Seven days after discharge, the cumulative MME used were similar between cohorts. However, patients with frailty used a larger fraction of opioids prescribed to them (96.7 % (31.3, 100.0) vs. 25.0 % (0.0, 83.3), p = 0.007) and were more likely (OR 3.7, 95 % CI 1.13-12.13) to use 50 % and greater of opioids prescribed to them. Patients with frailty had higher pain scores before surgery and seven days after discharge compared to patients without frailty. CONCLUSIONS: Patterns of postoperative opioid use after discharge were different between patients with and without frailty. Patients with frailty tended to use almost all the opioids prescribed while patients without frailty tended to use almost none of the opioids prescribed.


Asunto(s)
Analgésicos Opioides , Fragilidad , Cuidados Posteriores , Anciano , Analgésicos Opioides/efectos adversos , Estudios de Cohortes , Femenino , Anciano Frágil , Fragilidad/diagnóstico , Fragilidad/epidemiología , Humanos , Masculino , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/tratamiento farmacológico , Alta del Paciente , Pautas de la Práctica en Medicina
20.
Medicine (Baltimore) ; 100(7): e24721, 2021 Feb 19.
Artículo en Inglés | MEDLINE | ID: mdl-33607813

RESUMEN

BACKGROUNDS: The main objective of this study was to compare the pain control efficacy of local administration of Lidocaine with or without the nonsteroidal anti-inflammatory drug, Ketorolac, and local conventional Lidocaine injection in core needle biopsy of the musculoskeletal tumor. METHODS: The current study was a randomized, double-blind controlled clinical trial that included 128 patients with suspected musculoskeletal tumors. Patients were randomly assigned to either the Ketorolac plus Lidocaine (n = 64) or Lidocaine group (n = 64). The Ketorolac - Lidocaine combination syringe contained 30 mg Ketorolac and 2% Lidocaine - adrenaline dosage, and the Lidocaine syringe contained 2% Lidocaine - adrenaline dosage. The level of pain after core needle biopsy was evaluated for each patient at 1, 6, 12, 24, 48, and >48 hours by a Visual Analog Scale (VAS). The mean VAS changes over time were compared between the Ketorolac plus Lidocaine and Lidocaine groups using a linear mixed model. RESULTS: baseline information including mean age of patients in Lidocaine group (51.5 ±â€Š19.4 years) and in Lidocaine - Ketorolac combination group (50.1 ±â€Š18 years), diagnosis (malignant, benign, metastatic, infection), tumor location (upper and lower extremities, back), VAS score 1-hour post-operation (mild and moderate pain) were noted. The VAS score ratings were significantly lower in Lidocaine - Ketorolac combination group when compared to the Lidocaine group during the 1 to 24 hours post-operation time period. CONCLUSION: Patients receiving Lidocaine - Ketorolac combination dosage had significantly lower VAS scores, and these results confirm that local injection of Lidocaine - Ketorolac combination had a superior pain-controlling effect during the first 24 hours after the biopsy procedure in comparison to Lidocaine injection alone, as measured by VAS score scale.


Asunto(s)
Biopsia con Aguja Gruesa/efectos adversos , Ketorolaco/administración & dosificación , Lidocaína/administración & dosificación , Manejo del Dolor/métodos , Adulto , Anciano , Anestésicos Locales/administración & dosificación , Anestésicos Locales/uso terapéutico , Antiinflamatorios no Esteroideos/administración & dosificación , Antiinflamatorios no Esteroideos/uso terapéutico , Método Doble Ciego , Quimioterapia Combinada/métodos , Femenino , Humanos , Ketorolaco/uso terapéutico , Lidocaína/uso terapéutico , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Dimensión del Dolor/estadística & datos numéricos , Dimensión del Dolor/tendencias , Dolor Postoperatorio/tratamiento farmacológico , Neoplasias de los Tejidos Blandos/patología
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