Perspectives of pain specialists, patients, and family members on long-term opioid use for chronic non-cancer pain: a qualitative study.

BACKGROUND: Opioids are currently prescribed for chronic non-cancer pain (CNCP), and some patients use opioids continuously for long-term treatment. Stakeholders' awareness about long-term opioid therapy is essential for improving the safety and effectiveness of pain treatment. The purpose of this study is to explore the perspectives of pain specialists, patients, and family caregivers about long-term opioid use in CNCP management. METHODS: This study was a qualitative study and adhered to the COREQ guidelines. Pain specialists (n = 12), patients (n = 14), and family members (n = 9) were recruited to the study by purposive sampling at the Pain Clinic of Ramathibodi Hospital. Semi-structured interviews were recorded, verbatim transcribed, conceptually coded, and analyzed using Atlas.ti 8.0. RESULTS: All groups of participants described opioids as non-first-line drugs for pain management. Opioids should be prescribed only for severe pain, when non-opioid pharmacotherapy and non-pharmacological therapies are not effective. Patients reported that the benefits of opioids were for pain relief, while physicians and most family members highlighted that opioid use should improve functional outcomes. Physicians and family members expressed concerns about opioid-related side effects, harm, and adverse events, while patients did not. Patients confirmed that they would continue using opioids for pain management under supervision. However, physicians stated that they would taper off or discontinue opioid therapy if patients' pain relief or functional improvement was not achieved. Both patients and family members were willing to consider non-pharmacological therapies if potential benefits existed. Patient education, doctor-patient/family relationships, and opioid prescription policies were proposed to enhance CNCP management. CONCLUSION: Long-term opioid therapy for CNCP may be beneficial in patients who have established realistic treatment goals (for both pain relief and functional improvement) with their physicians. Regular monitoring and evaluation of the risks and benefits, adverse events, and drug-related aberrant behaviors are necessary. Integrated multimodal multidisciplinary therapies and family member collaborations are also important for improving CNCP management.

Anesthetic Techniques and Incidence of Complications in Fetoscopic Surgery.

BACKGROUND: Nowadays, fetoscopic surgery has been accepted to be a procedure to correct numerous congenital anomalies. This operation can be successfully done under general, regional or local anesthesia with sedation. Incidence of complications from anesthesia in fetoscopic surgery has not been reported in Thailand. OBJECTIVE: To describe anesthetic techniques and incidence of complications in fetoscopic surgery. MATERIAL AND METHOD: Data of 152 pregnant women undergoing fetoscopic surgery in a single university hospital was retrospectively chart reviewed from June 2005 to November 2015. Patient characteristics, choices of anesthesia, medication used, intraoperative data and complications were collected. RESULTS: During the study period, spinal anesthesia was the most popular technique used in fetoscopic surgery (71%). Other anesthetic techniques used were general anesthesia with endotracheal tube (GA) (20.5%), epidural anesthesia (1.3%), combined spinal and epidural anesthesia (0.7%), failed spinal anesthesia converting to GA (2.6%) and local anesthesia with sedation (3.9%). Most frequent anesthetic-related complication was maternal hypotension which occurs in 115 out of 152 patients (75.6%). All of 5 cases (3.3%) of postoperative pulmonary edema received SA. Fetal death after operation was 25 in 152 records (16.4%). None of patients received GA experienced desaturation, pulmonary aspiration, failed intubation or pulmonary edema. CONCLUSION: Spinal anesthesia (SA) is the most frequent technique used for fetoscopy, and hypotension is the most common complication. Since pulmonary edema was also found, judicious perioperative fluid management should be implemented to prevent postoperative pulmonary edema.