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1.
Georgian Med News ; (287): 13-19, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30958281

RESUMO

Anesthesia of curettage of uterine cavity (CUC) at postoperative period causes additional expenses. Preventive intraoperative anesthesia makes it possible to reduce these expenses and provide significant positive economic effect on state budget. The objective of this research is determination of influence of different methods of anesthesia of CUC on cash value of anesthetic maintenance of CUC and the possibility of saving of budgetary funds. 128 women took part in the research. They underwent the procedure of CUC. Anesthetic maintenance was performed using different medicamental combinations and their dosages. Mathematical calculation of the cost of each CUC stage was done considering the cost of consumables, medical preparations and value of labor of medical staff. In the course of this research, it was proven that a combination of additional use of dexketoprofen (at the stage of premedication of CUC) and performing preventive intraoperative applicational anesthesia with bupivacaine solution can save 130 452,26UAH of wage fund per year and general budget savings within the confines of a state can each 9 954 617,67UAH per year.


Assuntos
Serviço Hospitalar de Anestesia/economia , Anestesia/economia , Bupivacaína/economia , Curetagem/métodos , Útero/cirurgia , Serviço Hospitalar de Anestesia/organização & administração , Bupivacaína/administração & dosagem , Redução de Custos , Curetagem/economia , Feminino , Humanos , Período Pós-Operatório
2.
Plast Reconstr Surg ; 143(4): 1269-1274, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30730499

RESUMO

BACKGROUND: Postsurgical pain management is critical to patient satisfaction and value. Several studies have evaluated liposomal bupivacaine in postoperative pain management protocols; however, its economic feasibility remains undefined. This study analyzes the economic impact of liposomal bupivacaine using a national claims database to assess postoperative clinical and financial outcomes in plastic and reconstructive procedures. METHODS: The Vizient Clinical Data Base/Resource Manager electronic database was reviewed for plastic surgery procedures (i.e., abdominoplasty, abdominal wall reconstruction, mastectomy with immediate tissue expander placement, mastectomy with direct-to-implant reconstruction, autologous breast reconstruction, and augmentation mammaplasty) at participating hospitals from July 1, 2016, to July 1, 2017. The main outcome measures were the length of stay; 7-, 14-, and 30-day readmission rates; and direct and total costs observed. RESULTS: During the study period, 958 total cases met inclusion criteria. Liposomal bupivacaine was used in 239 cases (25 percent). Compared with cases that did not use liposomal bupivacaine, liposomal bupivacaine cases had a decreased length of stay (9.2 days versus 5.8 days), decreased cost (total cost, $39,531 versus $28,021; direct cost, $23,960 versus $17,561), and lower 30-day readmission rates (4 percent versus 0 percent). The 14- and 7-day readmission rates were similar between the two groups. CONCLUSIONS: The use of liposomal bupivacaine may contribute to a reduction in length of stay, hospital costs, and 30-day readmission rates for abdominal and breast reconstructive procedures, which could contribute to a favorable economic profile from a system view. Focusing on the measurement and improvement of value in the context of whole, definable, patient processes will be important as we transition to value-based payments.


Assuntos
Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Procedimentos Cirúrgicos Reconstrutivos/economia , Parede Abdominal/cirurgia , Abdominoplastia/economia , Abdominoplastia/estatística & dados numéricos , Anestésicos Locais/economia , Bupivacaína/economia , Custos e Análise de Custo , Feminino , Humanos , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Lipossomos , Mamoplastia/economia , Readmissão do Paciente/economia , Readmissão do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos
3.
J Clin Anesth ; 53: 56-63, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30326379

RESUMO

STUDY OBJECTIVE: Intravenous patient-controlled opioid analgesia (IVPCA), epidural analgesia and transversus abdominis plane (TAP) infiltrations are frequently used postoperative pain management modalities. The aim of this study was to conduct a cost-effectiveness analysis comparing the use of epidural, IVPCA, and TAP infiltrations with liposomal bupivacaine for analgesia in the first 72 h postoperatively in patients undergoing major lower abdominal surgery. DESIGN: Retrospective cost effectiveness analysis. SETTING: Operating room. PATIENTS: We obtained data on major lower-abdominal surgeries performed under general anesthesia on adult patients between January 2012 and July 2014. INTERVENTIONS: A cost-effectiveness analysis was comparing the use of epidural, IVPCA, and TAP infiltrations with liposomal bupivacaine for analgesia in the first 72 h postoperatively. MEASUREMENTS: A decision analytic model was used to estimate the health outcomes for patients undergoing major lower abdominal surgery. The primary outcome was time-weighted pain from 0 to 72 h after surgery, as measured by numerical rating scale pain scores. The analysis was conducted from the perspective of the hospital as the party responsible for most costs related to surgery. MAIN RESULTS: From the base case analysis, IVPCA was the optimal strategy regarding cost and effect. TAP with LB, however, was only narrowly dominated, while epidural was clearly dominated. From the sensitivity analysis at willingness-to-pay (WTP) of $150, IV PCA and TAP infiltration were each the optimal strategy for approximately 50% of the iterations. At WTP of $10,000, epidural was only the optimal strategy in 10% of the iterations. CONCLUSIONS: This is the first study in the literature to compare the cost-effectiveness of epidural, IVPCA, and TAP infiltrations with LB. Within reasonable WTP values, there is little differentiation in cost-effectiveness between IVPCA and TAP infiltration with LB. Epidural does not become a cost-effective strategy even at much higher WTP values.


Assuntos
Analgesia Epidural/economia , Analgesia Controlada pelo Paciente/economia , Analgésicos Opioides/economia , Bupivacaína/economia , Bloqueio Nervoso/economia , Dor Pós-Operatória/terapia , Músculos Abdominais/inervação , Adulto , Idoso , Analgesia Epidural/métodos , Analgesia Controlada pelo Paciente/métodos , Analgésicos Opioides/administração & dosagem , Bupivacaína/administração & dosagem , Análise Custo-Benefício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Econômicos , Bloqueio Nervoso/métodos , Manejo da Dor/economia , Manejo da Dor/métodos , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Estudos Retrospectivos , Resultado do Tratamento
4.
J Shoulder Elbow Surg ; 27(12): 2257-2261, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30340926

RESUMO

BACKGROUND: Postoperative pain control, short-term and long-term narcotic consumption, complication rates, and costs of indwelling interscalene catheter (ISC) were compared with a liposomal bupivacaine (LBC) mixture in patients undergoing primary total elbow arthroplasty. METHODS: Forty-four consecutive patients were identified, the first 28 with an ISC and the later 16 with intraoperative LBC injection that also included ketorolac and 0.5% bupivacaine. Medical records were reviewed for visual analog scale scores for pain, oral morphine equivalent (OME) use, complications, and facility charges. RESULTS: Average visual analog scale scores at 24 hours, 2 weeks, 6 weeks, and 12 weeks were not significantly different. Mean OME use was significantly greater in the LBC group at 24 hours but less at 12 weeks, although this difference was not statistically significant. Twelve anesthetic-related complications occurred in the ISC group (1 major and 11 minor); 10 patients (36%) had at least 1 complication. The major complication was respiratory failure requiring emergent tracheostomy. Minor complications included leaking pump/catheters, catheters inadvertently pulled out early, global hand paresthesias, forearm paresthesias, and pain at the catheter site. There were no anesthetic-related complications in the LBC group. The average charge for the LBC mixture was $327.10; charges for ISC, including equipment and anesthesia fees, were $1472.42. CONCLUSIONS: An LBC mixture provides similar pain relief with fewer complications at a lower cost than indwelling ISC after total elbow arthroplasty. Although the OME use in the LBC group was almost double that of the ISC group at 24 hours, there was no difference at later time points.


Assuntos
Analgésicos não Entorpecentes/administração & dosagem , Anestésicos Locais/administração & dosagem , Artroplastia de Substituição do Cotovelo , Bupivacaína/administração & dosagem , Cetorolaco/administração & dosagem , Idoso , Analgésicos não Entorpecentes/efeitos adversos , Analgésicos não Entorpecentes/economia , Analgésicos Opioides/uso terapêutico , Anestésicos Locais/efeitos adversos , Anestésicos Locais/economia , Bupivacaína/efeitos adversos , Bupivacaína/economia , Cateteres de Demora , Combinação de Medicamentos , Uso de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Injeções , Cetorolaco/efeitos adversos , Cetorolaco/economia , Masculino , Morfina/uso terapêutico , Dor Pós-Operatória/prevenção & controle , Estudos Retrospectivos , Escala Visual Analógica
5.
Plast Reconstr Surg ; 141(6): 1327-1330, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29750760

RESUMO

Effective postsurgical analgesia is a critical aspect of patient recovery. The goal of this prospective, randomized, controlled, blinded study was to examine the effect that liposomal bupivacaine delivered by means of a transversus abdominis plane block has on pain control in women undergoing unilateral deep inferior epigastric perforator flap reconstruction. Institutional review board approval was granted for this prospective study. Patients were eligible if they were undergoing unilateral, delayed deep inferior epigastric perforator flap reconstruction. Patients were randomized to one of three groups: liposomal bupivacaine transversus abdominis plane block, or bupivacaine pain pump. Charts were reviewed for demographics, length of stay, and postoperative narcotic use. There were eight patients in the liposomal bupivacaine and bupivacaine transversus abdominis plane block groups and five patients in the pain pump group. A retrospective cohort of six patients who did not receive any intervention was included. Patients who received a liposomal bupivacaine transversus abdominis plane block used statistically significantly less intravenous and total postoperative narcotics in milligrams and milligrams per kilogram per day compared with all other cohorts. They were able to get out of bed at an earlier time point. Overall hospital costs were similar among the groups. This is the first study to investigate liposomal bupivacaine delivered as a transversus abdominis plane block in a prospective, randomized, blinded study in women undergoing unilateral, delayed, abdominally based autologous breast reconstruction. The authors were able to demonstrate a significant reduction in intravenous and total narcotic use when a liposomal bupivacaine transversus abdominis plane block was used. Future studies are needed to prospectively investigate the effect that liposomal bupivacaine would have on immediate and bilateral reconstructions.


Assuntos
Anestésicos Locais/administração & dosagem , Neoplasias da Mama/cirurgia , Bupivacaína/administração & dosagem , Mamoplastia/métodos , Dor Pós-Operatória/prevenção & controle , Retalho Perfurante , Músculos Abdominais/inervação , Anestésicos Locais/economia , Bupivacaína/análogos & derivados , Bupivacaína/economia , Custos de Medicamentos , Feminino , Humanos , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Lipossomos , Pessoa de Meia-Idade , Entorpecentes/administração & dosagem , Bloqueio Nervoso/métodos , Medição da Dor , Dor Pós-Operatória/economia , Cuidados Pós-Operatórios/métodos , Náusea e Vômito Pós-Operatórios/induzido quimicamente , Estudos Prospectivos
6.
Am J Surg ; 214(1): 53-58, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28624028

RESUMO

BACKGROUND: Our objective was to assess clinical and financial outcomes with long-acting liposomal bupicavaine (LB) in laparoscopic colorectal surgery. METHODS: Patients that received local infiltration with LB were strictly matched to a control group, and compared for postoperative pain, opioid use, length of stay (LOS), hospital costs, and complication, readmission, and reoperation rates. RESULTS: A total of 70 patients were evaluated in each cohort. Operative times and conversion rates were similar. LB patients had lower post-anesthesia care unit pain scores (P = .001) and used less opioids through postoperative day 3 (day 0 P < .01; day 1 P = .03; day 2 P = .02; day 3 P < .01). Daily pain scores were comparable. LB had shorter LOS (mean 2.96 vs 3.93 days; P = .003) and trended toward lower readmission, complication, and reoperation rates. Total costs/patient were $746 less with LB, a savings of $52,200 across the cohort. CONCLUSIONS: Using local wound infiltration with LB, opioid use, LOS, and costs were improved after laparoscopic colorectal surgery. The additional medication cost was overshadowed by the overall cost benefits. Incorporating LB into a multimodal pain regiment had a benefit on patient outcomes and health care utilization.


Assuntos
Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Colo/cirurgia , Laparoscopia , Dor Pós-Operatória/prevenção & controle , Reto/cirurgia , Analgésicos Opioides/uso terapêutico , Anestésicos Locais/economia , Bupivacaína/economia , Estudos de Casos e Controles , Preparações de Ação Retardada/economia , Uso de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Lipossomos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias , Reoperação/estatística & dados numéricos , Texas
7.
J Arthroplasty ; 32(11): 3557-3562, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28390888

RESUMO

BACKGROUND: The efficacy and costs of indwelling interscalene catheter (ISC) and liposomal bupivacaine (LBC), with and without adjunctive medications, in patients with primary shoulder arthroplasty are a source of current debate. METHODS: In 214 arthroplasties, 156 patients had ISC and 58 had LBC injections that were mixed with morphine, ketorolac, and 0.5% bupivacaine with epinephrine. Charts were reviewed for visual analog scale pain scores, oral morphine equivalent (OME) usage, major complications, and costs. RESULTS: Visual analog scale scores were not significantly different at 24 hours or at 2, 6, and 12 weeks. Average OME consumption at 24 hours was significantly more with LBC, but was not significantly different at 12 weeks. Relative risk of a major complication was nearly 4 times higher with ISC than with LBC. The average cost for the LBC mixture was $289.04, and for ISC, including equipment and anesthesia fees, was $1559.42. CONCLUSION: The intraoperative LBC mixture provided equivalent pain relief with significantly fewer major complications and at markedly lower cost than ISC. LBC required almost twice as much OME to attain the same level of pain relief at 24 hours, but there was no significant difference in the cumulative amount of outpatient narcotic use.


Assuntos
Anestésicos Locais/administração & dosagem , Artroplastia do Ombro/efeitos adversos , Bupivacaína/administração & dosagem , Cateteres de Demora/efeitos adversos , Dor Pós-Operatória/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Analgésicos/administração & dosagem , Anestésicos Locais/economia , Bupivacaína/economia , Cateterismo , Cateteres de Demora/economia , Epinefrina/administração & dosagem , Feminino , Humanos , Cetorolaco/administração & dosagem , Tempo de Internação , Lipossomos , Masculino , Pessoa de Meia-Idade , Morfina/administração & dosagem , Manejo da Dor , Medição da Dor , Dor Pós-Operatória/etiologia , Estudos Retrospectivos , Ombro
8.
JAMA Surg ; 152(1): 90-95, 2017 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-27732710

RESUMO

Importance: Liposomal bupivacaine is a novel extended-duration anesthetic that has recently been used for local infiltration in total knee arthroplasty (TKA). Athough liposomal bupivacaine is widely used, it is unknown if the benefits justify the cost in the veteran population at our institution. Objective: To evaluate a change in practice: the effect of local infiltration of liposomal bupivacaine on perioperative outcomes in patients undergoing primary TKA. Design, Setting, and Participants: A retrospective cohort study was conducted among patients who underwent primary TKA at a Veterans Affairs Medical Center before (March 3, 2013-March 2, 2014) and after (March 3, 2014-March 2, 2015) the implementation of liposomal bupivacaine for local infiltration in TKA. Intervention: Drug utilization evaluation of liposomal bupivacaine for local infiltration in TKA. Main Outcomes and Measures: Use of opioids after discharge from the postanesthesia care unit. Results: Among 199 patients, those who received liposomal bupivacaine after primary TKA (mean [SD] age, 65.3 [6.9] years; 93 males and 5 females) had a reduced median opioid use in the first 24 hours after surgery compared with those who did not receive liposomal bupivacaine (mean [SD] age, 64.9 [8.4] years; 95 males and 6 females; [intravenous morphine equivalents, 12.50 vs 22.50 mg; P = .001]). The use of patient-controlled analgesia was also reduced among patients who received liposomal bupivacaine vs those who did not (49 vs 91; P < .001). A reduction in the use of antiemetics was observed in the first 24 hours after surgery (13 vs 34; P = .001) and in the postanesthesia care unit among those who received liposomal bupivacaine vs those who did not (4 vs 20; P = .001). The number of patients in the postanesthesia care unit with no pain was improved among those who received liposomal bupivacaine vs those who did not (44 vs 19; P < .001). Although median (interquartile range) pain scores in the postanesthesia care unit were improved among patients who received liposomal bupivacaine vs those who did not (4.0 [0.0-6.6] vs 5.5 [3.0-7.5]; P = .001), patients who received liposomal bupivacaine had greater median (interquartile range) pain scores 48 hours (5.5 [4.0-7.0] vs 5.0 [3.0-6.0]; P = .01), 72 hours (5.0 [4.0-6.0] vs 4.0 [2.0-6.0]; P = .002), and 96 hours (5.0 [3.0-6.5] vs 4.0 [1.0-5.0]; P = .003) after surgery than those who did not receive liposomal bupivacaine. There was no difference in the median length of stay between the 2 groups. Institutional cost savings was estimated at $27 000 per year. Conclusions and Relevance: Local infiltration of liposomal bupivacaine reduces use of opioids in the first 24 hours after primary TKA. Similarly, reduction in antiemetic use and improved postoperative pain are also seen in the first 24 hours after surgery but are limited to this time frame. Furthermore, a positive institutional cost savings was observed.


Assuntos
Analgésicos Opioides/administração & dosagem , Anestesia Local/métodos , Anestésicos Locais/administração & dosagem , Artroplastia do Joelho , Bupivacaína/administração & dosagem , Idoso , Analgesia Controlada pelo Paciente , Analgésicos Opioides/economia , Anestésicos Locais/economia , Antieméticos/uso terapêutico , Bupivacaína/economia , Redução de Custos , Feminino , Humanos , Análise de Séries Temporais Interrompida , Lipossomos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico , Período Pós-Operatório , Estudos Retrospectivos
9.
Obstet Gynecol ; 128(5): 1009-1017, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27741199

RESUMO

OBJECTIVE: To investigate opioid use and pain scores associated with incisional injection of liposomal bupivacaine compared with bupivacaine hydrochloride after laparotomy for gynecologic malignancies. METHODS: A retrospective cohort study was conducted to compare abdominal incision infiltration with liposomal bupivacaine with bupivacaine hydrochloride after modification of a pre-existing enhanced recovery pathway. Patients undergoing staging laparotomy or complex cytoreductive surgery under the updated pathway were compared with patients treated under the original pathway (historic controls). Endpoints included cumulative opioid use (primary outcome) in oral morphine equivalents and cumulative pain score. RESULTS: In the complex cytoreductive cohort, median oral morphine equivalents were lower in the liposomal bupivacaine group through 24 hours (30 compared with 53.5 mg, P=.002), 48 hours (37.5 compared with 82.5 mg, P=.005), and the length of stay (62 compared with 100.5 mg, P=.006). Fewer liposomal bupivacaine patients required intravenous rescue opioids (28.9% compared with 55.6%, P<.001) or patient-controlled analgesia (4.1% compared with 33.3%, P<.001). Cumulative pain score was no different between groups through 48 hours (161 compared with 158, P=.69). Postoperative nausea and ileus were less frequent in patients receiving liposomal bupivacaine. Median hospital stay was 5 days in both groups. In the staging laparotomy cohort, cumulative opioids and cumulative pain score were no different between groups (through 48 hours: 162 compared with 161, P=.62; 38 compared with 38, P=.68, respectively). Intravenous rescue opioids (15.3% compared with 28.6%, P=.05) and patient-controlled analgesia (1.4% compared with 8.3%, P=.05) were used less frequently in the liposomal bupivacaine group. Median hospital stay was 4 days in both groups. Despite the higher cost of liposomal bupivacaine, total pharmacy costs did not differ between groups. CONCLUSION: Abdominal incision infiltration with liposomal bupivacaine was associated with less opioid and patient-controlled analgesia use with no change in pain scores compared with bupivacaine hydrochloride after complex cytoreductive surgery for gynecologic malignancies. Improvements were also seen in patients undergoing staging laparotomy.


Assuntos
Analgésicos Opioides/administração & dosagem , Bupivacaína/administração & dosagem , Neoplasias dos Genitais Femininos/cirurgia , Laparotomia , Administração Oral , Analgesia Controlada pelo Paciente , Bupivacaína/economia , Estudos de Coortes , Feminino , Humanos , Injeções/métodos , Tempo de Internação , Lipossomos , Pessoa de Meia-Idade , Morfina/administração & dosagem , Estadiamento de Neoplasias , Dor , Complicações Pós-Operatórias , Estudos Retrospectivos , Ferida Cirúrgica
11.
Am J Health Syst Pharm ; 73(9): e247-54, 2016 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-27099332

RESUMO

PURPOSE: Results of a cost-benefit analysis of intraoperative use of liposomal bupivacaine for postsurgical pain management in patients undergoing total knee arthroplasty (TKA) are presented. METHODS: In a retrospective single-site study, clinical and cost outcomes were compared in a group of 134 consecutive patients who received liposomal bupivacaine (by local infiltration) during TKA and a propensity score-matched historical cohort of 134 patients undergoing TKA who received usual care (continuous femoral nerve blockade with conventional bupivacaine delivered via elastomeric pump). RESULTS: Postsurgical pain scores and opioid use were similar in the two study groups; the mean total amount of nonsteroidal antiinflammatory drugs administered was lower in the liposomal bupivacaine group. Patients who received liposomal bupivacaine typically ambulated earlier than those who received usual care (22% and 3%, respectively, walked on the day of surgery; p < 0.05) and were more likely to be discharged within two days (50% versus 19%, p < 0.001); on average, liposomal bupivacaine- treated patients walked farther on the day of surgery (6.0 m versus 3.1 m, p < 0.001) and the day after surgery (63.7 m versus 25.5 m, p < 0.001) and had a shorter length of stay (LOS) (3.1 days versus 3.6 days, p < 0.03). The mean adjusted total direct hospital cost per patient was significantly lower with liposomal bupivacaine use versus usual care ($8758 versus $9213, p = 0.033). CONCLUSION: In patients undergoing TKA, intraoperative administration of liposomal bupivacaine for management of postsurgical pain was found to offer advantages over usual care, including decreased time to ambulation and reduced hospital LOS.


Assuntos
Anestésicos Locais/economia , Artroplastia do Joelho/economia , Bupivacaína/economia , Análise Custo-Benefício/métodos , Manejo da Dor/economia , Dor Pós-Operatória/economia , Idoso , Anestésicos Locais/administração & dosagem , Artroplastia do Joelho/efeitos adversos , Bupivacaína/administração & dosagem , Feminino , Humanos , Lipossomos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Dor Pós-Operatória/prevenção & controle , Estudos Retrospectivos
12.
Clin Drug Investig ; 35(9): 575-82, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26305021

RESUMO

BACKGROUND AND OBJECTIVE: Effective treatment of postoperative pain contributes to decreasing the rate of complications as well as the total cost of the operated patients. The aim of this study was to analyze the costs and the efficiency of use of continuous infusion of levobupivacaine 0.5 % with the help of an infusion pump in modified radical mastectomy. METHODS: A cost calculation of the analgesic procedures (continuous infusion of levobupivacaine 0.5 % [levobupivacaine group (LG)] or saline [saline group (SG)] (2 ml/h 48 h) has been carried out based on the data of a previous clinical trial (double-blind randomized study) of patients who underwent modified radical mastectomy surgery. The measure of the effectiveness was the point reduction of pain derived from the verbal numeric rating scale (VNRS). The usual incremental cost-effectiveness ratio (ICER) was performed. RESULTS: Considering only the intravenous analgesia, overall costs were lower in LG, as less analgesia was used (EUR14.06 ± 7.89 vs. 27.47 ± 14.79; p < 0.001). In this study the costs of the infusion pump were not calculated as it was used by both groups and they offset each other. However, if the infusion pump costs were included, costs would be higher in the LG, (EUR91.89 ± 7.89 vs. 27.47 ± 14.79; p < 0.001) and then the ICER was -8.51, meaning that for every extra point of decrease in the pain verbal numerical rating score over the 2-day period, the cost increased by EUR8.51. CONCLUSION: Infiltration of local anesthetics is an effective technique for controlling postoperative pain and the associated added costs are relatively low in relation to the total cost of mastectomy, therefore providing patients with a higher quality of care in the prevention of pain. CLINICAL TRIALS REGISTRATION: clinicaltrials.gov: reference number NCT01389934. http://clinicaltrials.gov/show/NCT01389934


Assuntos
Anestésicos Locais/administração & dosagem , Bupivacaína/análogos & derivados , Mastectomia Radical Modificada/métodos , Dor Pós-Operatória/tratamento farmacológico , Anestésicos Locais/economia , Bupivacaína/administração & dosagem , Bupivacaína/economia , Análise Custo-Benefício , Método Duplo-Cego , Feminino , Humanos , Levobupivacaína , Dor Pós-Operatória/economia , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
13.
J Arthroplasty ; 30(9 Suppl): 64-7, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26117072

RESUMO

Liposomal bupivacaine periarticular injection (PAI) offers sustained bupivacaine release after TKA, but few prospective independent studies exist. In this prospective, blinded study, liposomal bupivacaine was randomized against bupivacaine and incorporated into a comprehensive multimodal pain management protocol. 111 primary TKAs were randomized to receive PAI: 58 patients received 266 mg (20cc) liposomal bupivacaine mixed with 75 mg (30cc) 0.25% bupivacaine, and 53 patients received 150 mg (60cc) 0.25% bupivacaine. Visual analog pain scores and narcotic use were determined. No pain score differences occurred between study and control patients: Day 1: 4.5/4.6 (P=0.73); Day 2: 4.4/4.8 (P=0.27); or Day 3: 3.5/3.7 (P=0.58). Narcotic use was similar during hospitalization, 51.8/54.2 (P=0.34). The study medication costs $285, and the control medication costs $2.80. This finding does not justify the routine use of liposomal bupivacaine.


Assuntos
Anestésicos Locais/administração & dosagem , Artroplastia do Joelho , Bupivacaína/administração & dosagem , Lipossomos/administração & dosagem , Manejo da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Bupivacaína/economia , Preparações de Ação Retardada/administração & dosagem , Feminino , Humanos , Injeções Intra-Articulares/economia , Lipossomos/economia , Masculino , Pessoa de Meia-Idade , Manejo da Dor/economia , Medição da Dor , Estudos Prospectivos , Método Simples-Cego
14.
Anaesthesist ; 62(4): 271-7, 2013 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-23535895

RESUMO

BACKGROUND: Hyperbaric prilocaine 2 % has been available for spinal anesthesia in Germany for 2 years and is characterized by a short duration of action, a lack of postspinal urine retention and a reduction of transient neurological syndromes. However, desirable pharmacological properties are contrasted by higher pharmacological costs compared to hyperbaric bupivacaine 0.5 %. MATERIALS AND METHODS: This paper deals with a sensitivity analysis for the use of hyperbaric prilocaine 2 % versus hyperbaric bupivacaine 0.5 % in Germany and investigates the financial break-even point up to which time a shorter patient stay in the recovery area compensates for the higher costs for the use of prilocaine 2 % for ambulatory spinal aaesthesia. A sensitivity analysis is an instrument of investment appraisal. It is a model to reduce a complex system with numerous variables to a straightforward calculation by assuming a framework requirement and systematically changing only one or two variables. In this paper additional costs for spinal anesthesia have been neglected, only the time a nurse spends with the patient in the recovery area and the costs for each vial of drug have been taken into account. RESULTS: For the assumption of 75 min time until leaving the recovery area and being discharged after spinal anesthesia with hyperbaric prilocaine 2 % versus 150 min (recovery of motor competence) or 405 min (voiding) with hyperbaric bupivacaine 0.5 % the calculation shows a cost benefit for hyperbaric prilocaine 2 % of EUR 11.64 or EUR 64.76 compared to hyperbaric bupivacaine 0.5 % and EUR 13.32 or EUR 66.44 compared to isobaric bupivacaine 0.5 %. Under the assumption that all patients who have received spinal anesthesia with hyperbaric bupivacaine 0.5 % can be discharged from the recovery area after 150 min, the use of hyperbaric prilocaine 2 % remains more economical as long as the patient is discharged from the recovery area within 130 min. If 405 min recovery time is assumed for hyperbaric bupivacaine 0.5 % the costs compared with hyperbaric prilocaine 2 % will be compensated after 300 min. To be more economical compared to patients with hyperbaric prilocaine 2 % those who received hyperbaric bupivacaine 0.5 % must be discharged from the recovery area within at least 100 min. However, a time of less than 160 min for discharge from the recovery area is not published anywhere in the literature. In summary, the use of hyperbaric prilocaine 2 % for 60 min operation time is cheaper than the use of bupivacaine 0.5 % as long as patients do not stay in the recovery area for longer than 120 min and are discharged from the recovery area. CONCLUSIONS: For German framework conditions the use of hyperbaric prilocaine 2 % can provide an economical advantage compared to the use of hyperbaric bupivacaine 0.5 % if staff assignment can be flexible.


Assuntos
Raquianestesia , Anestésicos Locais , Prilocaína , Procedimentos Cirúrgicos Ambulatórios , Período de Recuperação da Anestesia , Raquianestesia/efeitos adversos , Raquianestesia/economia , Anestésicos Locais/efeitos adversos , Anestésicos Locais/economia , Bupivacaína/efeitos adversos , Bupivacaína/economia , Análise Custo-Benefício , Custos de Medicamentos , Alemanha , Humanos , Modelos Econômicos , Enfermagem/estatística & dados numéricos , Pacientes Ambulatoriais , Prilocaína/efeitos adversos , Prilocaína/economia
15.
BMC Musculoskelet Disord ; 12: 53, 2011 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-21352559

RESUMO

BACKGROUND: For the majority of patients with osteoarthritis (OA), joint replacement is a successful intervention for relieving chronic joint pain. However, between 10-30% of patients continue to experience chronic pain after joint replacement. Evidence suggests that a risk factor for chronic pain after joint replacement is the severity of acute post-operative pain. The aim of this randomised controlled trial (RCT) is to determine if intra-operative local anaesthetic wound infiltration additional to a standard anaesthesia regimen can reduce the severity of joint pain at 12-months after total knee replacement (TKR) and total hip replacement (THR) for OA. METHODS: 300 TKR patients and 300 THR patients are being recruited into this single-centre double-blind RCT. Participants are recruited before surgery and randomised to either the standard care group or the intervention group. Participants and outcome assessors are blind to treatment allocation throughout the study. The intervention consists of an intra-operative local anaesthetic wound infiltration, consisting of 60 mls of 0.25% bupivacaine with 1 in 200,000 adrenaline. Participants are assessed on the first 5 days post-operative, and then at 3-months, 6-months and 12-months. The primary outcome is the WOMAC Pain Scale, a validated measure of joint pain at 12-months. Secondary outcomes include pain severity during the in-patient stay, post-operative nausea and vomiting, satisfaction with pain relief, length of hospital stay, joint pain and disability, pain sensitivity, complications and cost-effectiveness. A nested qualitative study within the RCT will examine the acceptability and feasibility of the intervention for both patients and healthcare professionals. DISCUSSION: Large-scale RCTs assessing the effectiveness of a surgical intervention are uncommon, particularly in orthopaedics. The results from this trial will inform evidence-based recommendations for both short-term and long-term pain management after lower limb joint replacement. If a local anaesthetic wound infiltration is found to be an effective and cost-effective intervention, implementation into clinical practice could improve long-term pain outcomes for patients undergoing lower limb joint replacement. TRIAL REGISTRATION: Current Controlled Trials ISRCTN96095682.


Assuntos
Anestésicos Locais/uso terapêutico , Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Cuidados Intraoperatórios , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Anestésicos Locais/economia , Bupivacaína/economia , Bupivacaína/uso terapêutico , Doença Crônica , Análise Custo-Benefício , Método Duplo-Cego , Seguimentos , Humanos , Estudos Longitudinais , Dor Pós-Operatória/epidemiologia , Satisfação do Paciente , Prevalência , Índice de Gravidade de Doença , Resultado do Tratamento
16.
Acta Chir Belg ; 111(6): 360-3, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-22299320

RESUMO

BACKGROUND: Pre-incisional infiltration of anaesthetic is proven to reduce postoperative pain in breast cancer surgery. However, studies of post-incisional infiltration for modified radical mastectomy are rare. The purpose of this study was to investigate whether post-incisional infiltration with bupivacaine provides improved postoperative pain relief and a cost-effective benefit. METHODS: This is a retrospective study. Between January 2006 and May 2008, 139 patients who received modified radical mastectomy were recruited to participate in the study. Patients receiving local infiltration received bupivacaine (0.5% bupivacaine, 5 ml diluted to 10 ml with distilled water) injected into the dermis surrounding the incision after wound suture. Pain intensity was evaluated using a Visual Analogue Scale (VAS) score and measurement of the required doses of meperidine and acetaminophen. The pain score was recorded every eight hours for three days. RESULTS: All patients were female. Seventy-two patients received local infiltration with bupivacaine after wound suture and 67 patients did not. There were no significant differences between the two patient groups in age, body weight and height, length of general anaesthesia and operative time. Hospital stay was significantly shorter for patients receiving local infiltration of bupivacaine. The VAS score was higher up to 16 hours post-surgery for patients who did not receive local infiltration. Meperidine and acetaminophen consumption was less for patients who received local infiltration (P = 0.010). CONCLUSION: Post-incisional wound infiltration with bupivacaine can relieve pain during the first 16 hours after surgery and shorten hospital stay, and it provides a cost-effective benefit.


Assuntos
Anestésicos Locais/administração & dosagem , Neoplasias da Mama/cirurgia , Bupivacaína/administração & dosagem , Mastectomia Radical Modificada , Dor Pós-Operatória/tratamento farmacológico , Acetaminofen/administração & dosagem , Adulto , Idoso , Analgésicos não Entorpecentes/administração & dosagem , Analgésicos Opioides/administração & dosagem , Anestésicos Locais/economia , Bupivacaína/economia , Análise Custo-Benefício , Feminino , Humanos , Injeções Intralesionais , Tempo de Internação/economia , Mastectomia Radical Modificada/métodos , Meperidina/administração & dosagem , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/economia , Dor Pós-Operatória/etiologia , Estudos Retrospectivos , Taiwan , Resultado do Tratamento
17.
Anesth Analg ; 111(2): 482-7, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20529986

RESUMO

Neuraxial analgesia is frequently administered to women in labor. For many years, bupivacaine has been used because of its long duration of action, lack of excessive motor block, and minimal fetal and neonatal effects. However, bupivacaine is one of the most cardiotoxic local anesthetics in current use and motor block is still a problem. Many local anesthetics such as bupivacaine exist in 2 forms, levorotatory and dextrorotatory. Ropivacaine, an amide local anesthetic produced in the pure levorotatory form addresses some of the concerns related to bupivacaine. In this article, we present the literature comparing ropivacaine and bupivacaine to determine whether there is an advantage to using one of these local anesthetics for labor analgesia. We found that there is no advantage to the routine use of ropivacaine for labor analgesia.


Assuntos
Amidas/administração & dosagem , Analgesia Epidural/métodos , Analgesia Obstétrica/métodos , Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Dor do Parto/tratamento farmacológico , Amidas/efeitos adversos , Amidas/economia , Analgesia Epidural/efeitos adversos , Analgesia Epidural/economia , Analgesia Obstétrica/efeitos adversos , Analgesia Obstétrica/economia , Anestésicos Locais/efeitos adversos , Anestésicos Locais/economia , Animais , Bupivacaína/efeitos adversos , Bupivacaína/economia , Qualidade de Produtos para o Consumidor , Análise Custo-Benefício , Relação Dose-Resposta a Droga , Custos de Medicamentos , Medicina Baseada em Evidências , Feminino , Humanos , Atividade Motora/efeitos dos fármacos , Gravidez , Medição de Risco , Ropivacaina , Resultado do Tratamento
18.
Arch Ital Urol Androl ; 81(1): 13-6, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19499752

RESUMO

INTRODUCTION: The management of Prostate cancer (PC), since PSA testing has been introduced in the clinical practice, has been significantly spoiled by a "leading-time bias" effect. As a consequence, this has brought to a dramatic diagnosis anticipation at the 4th-5th decade of life in sexually active and otherwise asymptomatic men. Standard options as radical prostatectomy or EBRT are hampered by a significant negative impact on patient's QoL. More recently several alternative minimally-invasive ablative treatment modalities have been proposed with promising results. Among these, TR-HIFU (Trans-Rectal High Intensity Focused Ultrasound) is playing a growing role in the treatment of localized low-intermediate risk PC, although long-term oncologic outcome are still awaited. In order to achieve an optimal result, a specific TR-HIFU's requirement is given by an unchanging target throughout the whole procedure. Therefore, the ideal anaesthesia should be either minimally-invasive and allow to get a motionless target up to 3-4 hours. A retrospective evaluation of efficacy and safety of a spinal anaesthesia in this patient's setting was done. MATERIAL AND METHODS: 107 patients with localized prostate cancer treated in our institution from October 2004 to December 2007 with TR-HIFU procedure received a subarachnoidal anaesthesia with combined administration of 0.5% normobaric racemic bupivacaine (15 to 17.5 mg) and sufentanil 5 microg. RESULTS: This technique allowed covering the whole TR-HIFU procedure (analgesia and motor blockade up to 4-5 hours). It was well tolerated by patients who only rarely required additional sedative or analgesics. A low anaesthesia-related side effects rate, as arterial hypotension, nausea and vomiting, and no severe side effects of intrathecal opioids, as deep sedation, bradycardia, myosis, bradypnea and oxygen desaturation, occurred. Intraoperative employment of sedatives and postoperative need of analgesics was low. CONCLUSIONS: Using a low-dose intrathecal sufentanil an effective spinal block either on the sensitive and motor pathways was provided. Patients' tolerance to the procedure was good and the side-effect rate low. No adverse reactions to intrathecal sufentanil 5 microg were observed. In our experience TR-HIFU can be performed with neuraxial block in most of the cases and it's associated to a favorable cost-benefit rate.


Assuntos
Raquianestesia/economia , Raquianestesia/métodos , Anestésicos Locais/economia , Bupivacaína/economia , Neoplasias da Próstata/terapia , Sufentanil/economia , Ultrassom Focalizado Transretal de Alta Intensidade , Adjuvantes Anestésicos/economia , Idoso , Análise Custo-Benefício , Quimioterapia Combinada , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Estudos Retrospectivos , Espaço Subaracnóideo , Resultado do Tratamento , Ultrassom Focalizado Transretal de Alta Intensidade/instrumentação
20.
Rev. cuba. farm ; 40(1)ene.-abr. 2006. tab, graf
Artigo em Espanhol | LILACS | ID: lil-446773

RESUMO

Se realizó un estudio económico prospectivo de costo-efectividad con datos primarios de efectividad obtenidos de un ensayo clínico aleatorizado, donde se comparan 2 anestésicos vía espinal: lidocaína al 5 por ciento y bupivacaína al 0,5 por ciento. La efectividad se evaluó como la probabilidad de aparición de síntomas neurológicos transitorios, reacción adversa propia de este grupo de medicamentos. Se formaron aleatoriamente 2 grupos de pacientes que requerían cirugías por debajo del ombligo con una duración no mayor de 120 min, con la aplicación de cada una de las opciones de anestesia estudiada a cada grupo, 109 pacientes en el grupo de lidocaína y 97 en el grupo de bupivacaína. Un especialista en Neurología evaluó a ciegas la condición neurológica posquirúrgica de cada paciente antes y 24 h después de la intervención. Se calcularon los costos de cada alternativa, que incluyeron los ocasionados por la toxicidad neurológica, y se determinaron las relaciones costo-efectividad y los costos incrementales. El grupo de bupivacaína resultó la alternativa con mejor relación costo-efectividad


Assuntos
Anestésicos Locais/economia , Raquianestesia , Bupivacaína/economia , Análise Custo-Eficiência , Lidocaína/economia
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