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1.
Vet Clin North Am Small Anim Pract ; 49(6): 981-991, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31581985

RESUMO

Surgery is the mainstay of therapy for canine and human solid cancers. Alarmingly, evidence suggests that the process of surgery may exacerbate metastasis and accelerate the kinetics of cancer progression. Understanding the mechanisms by which cancer progression is accelerated as a result of surgery may provide pharmacologic interventions. This review discusses surgery-induced cancer progression. It focuses on immunomodulatory properties of anesthesia and opioids and evidence that studies evaluating the role of opioids in tumor progression are indicated. It concludes by discussing why companion animals with spontaneously arising cancer are an ideal model for clinical trials to investigate this phenomenon.


Assuntos
Analgésicos Opioides/uso terapêutico , Doenças do Cão/tratamento farmacológico , Manejo da Dor/veterinária , Dor/veterinária , Animais , Progressão da Doença , Cães , Metástase Neoplásica , Neoplasias/complicações , Neoplasias/tratamento farmacológico , Neoplasias/cirurgia , Neoplasias/veterinária , Dor/tratamento farmacológico , Manejo da Dor/métodos , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/veterinária
2.
Am Surg ; 85(9): 956-960, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638506

RESUMO

Postoperative pain managed with opioids has contributed to the opioid crisis through overprescribing practices. We assessed opioid-prescribing habits and their use by patients undergoing surgery for cutaneous malignancies. An Institutional Review Board-approved retrospective analysis was conducted for patients who underwent skin cancer resection between January 2018 and June 2018. Data were collected from the electronic medical record, and opioid-related data were collected from patient interviews and state registries. There were 120 study participants (42 females and 78 males) with a median age of 67 years (range, 21-94 years). All received preincision local anesthetic: 64 had liposomal bupivacaine (LB) (53%) and 56 had non-LB bupivacaine (47%). Most participants (n = 88) used 0 opioids (73%), including 43 LB-anesthetic (67%) and 45 non-LB-anesthetic (80%). No significance was seen between those with a diagnosis of chronic pain, narcotic tolerance, an area of resection, and nodal sampling groups in opioid use. Four patients (3%) requested a refill. Of 105 prescriptions written for opioids, 99 had leftover opioids for an overprescribing rate of 94 per cent. This study suggests pain after skin cancer surgery is manageable with very limited opioid requirements. Our results support prescribing no more than five opioid tablets for postoperative pain control in patients undergoing resection for skin malignancies.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Analgésicos Opioides/uso terapêutico , Prescrição Inadequada/estatística & dados numéricos , Dor Pós-Operatória/tratamento farmacológico , Neoplasias Cutâneas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Feminino , Humanos , Lipossomos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Estudos Retrospectivos , Sudeste dos Estados Unidos , Adulto Jovem
3.
Am Surg ; 85(9): 1013-1016, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638516

RESUMO

Transversus abdominis plane (TAP) blocks are a safe and effective way to provide immediate postoperative pain relief in surgical patients, and have been shown to decrease narcotic requirements. Concerns about complications of narcotics, increase in hospital length of stay (LOS), and health-care costs make this of particular interest. We compared standard bupivacaine TAP blocks with those carried out using liposomal bupivacaine to evaluate postoperative outcomes. Fifty patients undergoing elective laparoscopic colectomy received laparoscopic liposomal bupivacaine TAP blocks using 80 cc of local anesthetic, and data were collected prospectively during hospitalization. Data collected included amount of narcotic medication used during hospitalization, number of days to ambulation, number of days to bowel function, and LOS. These patients were compared with the last 50 patients recruited to the control/bupivacaine TAP block arm of the study. The same data parameters were collected and all patients were on an enhanced recovery protocol, which included scheduled acetaminophen, ibuprofen, and gabapentin by mouth, as well as clear liquid diet starting on postoperative day zero. Statistical analysis was performed using Student's t test and Fisher's exact test; P < 0.05 was considered statistically significant. Patients treated with liposomal bupivacaine needed less narcotics (5.06 vs 18.75 mg, P = 0.0002), had earlier bowel function (1.7 vs 2.4 days, P = 0.0002), and shorter LOS (2.7 vs 3.4 days, P = 0.0146). Patients undergoing laparoscopic colon resections seem to require fewer narcotics and have better patient outcomes with liposomal bupivacaine TAP blocks. Based on our data, liposomal bupivacaine seems to be superior to bupivacaine for TAP blocks.


Assuntos
Músculos Abdominais/inervação , Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Colectomia/efeitos adversos , Laparoscopia/efeitos adversos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/tratamento farmacológico , Analgésicos Opioides/uso terapêutico , Feminino , Humanos , Tempo de Internação , Lipossomos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos
4.
Am Surg ; 85(10): 1155-1158, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657314

RESUMO

The utility of opioid-sparing multimodal analgesia protocols (OSMMAPs) in opioid-tolerant (OT) patients is unknown. We sought to determine the impact of a standardized OSMMAP in OT versus opioid-naïve (ON) patients after major colorectal surgery. Consecutive patients undergoing surgery before (January 2015-March 2017) and after OSMMAP implementation (April 2017-March 2018) were identified from a single-institution prospective colorectal surgery registry. OT was defined by the presence of an opioid on the preadmission medication record. Opioid use (measured in oral morphine equivalents (OMEs)) and surgical outcomes were compared between OT and ON patients pre- and post-OSMMAP. The study cohort of 201 patients included 59 OT patients (25 pre- and 34 post-OSMMAP) and 142 ON controls (34 pre- and 108 post-OSMMAP). The median age was 47.5 years (IQR 32), and 50% were male. 185 patients (92%) had a laparoscopic/robotic resection and 16 (8%) open. There were statistically significant reductions in OME required post-OSMMAP on each postoperative day (days 1 to 4) and cumulative OME for both OT and ON patients. The reduction in opioid requirements was significantly larger in OT than ON patients. We present the first study highlighting a larger opioid usage reduction in OT than in ON patients after OSMMAP implementation.


Assuntos
Analgésicos Opioides/uso terapêutico , Procedimentos Cirúrgicos do Sistema Digestório , Tolerância a Medicamentos , Morfina/uso terapêutico , Manejo da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico , Adulto , Analgésicos não Entorpecentes/administração & dosagem , Analgésicos não Entorpecentes/uso terapêutico , Analgésicos Opioides/administração & dosagem , Estudos de Casos e Controles , Protocolos Clínicos , Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Feminino , Fentanila/administração & dosagem , Fentanila/uso terapêutico , Humanos , Laparoscopia/estatística & dados numéricos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Morfina/administração & dosagem , Avaliação de Resultados (Cuidados de Saúde) , Medicação Pré-Anestésica/efeitos adversos , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Resultado do Tratamento
5.
Am Surg ; 85(10): 1198-1203, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657324

RESUMO

Overdose of opioids is the number one cause of accidental death in the United States, and surgeons are overprescribing these medications. The aim of this study was to assess the feasibility of implementing postoperative opioid prescribing guidelines for general surgery procedures at a public hospital, where patients have lower socioeconomic status, public insurance, and limited access to care. We implemented a quality improvement project, which included in-service training for surgical staff and distribution of standardized guidelines. An infographic for patients was created to facilitate education on postoperative pain management. Pre- and postintervention opioid prescriptions and emergency room visits were compared for patients undergoing common general surgery procedures (inguinal hernia repair, appendectomy, and laparoscopic cholecystectomy). The median number of narcotic pills prescribed significantly decreased from 30 (n = 64) to 15 (n = 63) after the intervention (P < 0.0001). Morphine milligram equivalents decreased from a median [range] of 150 [20,600] to 90 [5,300] (P < 0.0001). The percentage of patients with postoperative pain-related emergency department visits remained low (1.6%). Standardization of postoperative opioid prescription practices was successfully implemented at a public hospital without an increase in the number of emergency room visits for pain.


Assuntos
Analgésicos Opioides/uso terapêutico , Manejo da Dor/normas , Dor Pós-Operatória/tratamento farmacológico , Melhoria de Qualidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Apendicectomia/efeitos adversos , Colecistectomia Laparoscópica/efeitos adversos , Prescrições de Medicamentos/normas , Serviço Hospitalar de Emergência/estatística & dados numéricos , Estudos de Viabilidade , Feminino , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Herniorrafia/efeitos adversos , Hospitais Públicos , Humanos , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Guias de Prática Clínica como Assunto , Adulto Jovem
6.
Niger J Clin Pract ; 22(10): 1313-1318, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31607717

RESUMO

Low-level laser therapy (LLLT) is considered as a recent technique in the dental field. Nowadays, it is used by many clinicians in dentistry. The stimulation of the healing process and pain relief are among its most popular uses. The purpose of this paper is to discuss and review the latest extra-oral applications of LLLT in the dental field. An electronic search of English scientific papers from 2000 to 2018 was accomplished using PubMed and Google Scholar search engines. The following key words were used extra-oral, applications, LLLT, and dental field. This review demonstrates the marked effectiveness of LLLT in the management of many conditions and how it could improve the quality of life of many patients. However, LLLT is still considered a recent alternative and requires more understanding of its mechanism of action by conducting more high-quality randomized clinical trials with larger sample sizes and longer follow-up periods.


Assuntos
Odontologia , Terapia com Luz de Baixa Intensidade/métodos , Manejo da Dor/psicologia , Qualidade de Vida , Cicatrização , Humanos
7.
Schmerz ; 33(5): 471-474, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31571060

RESUMO

The treatment of any causal, procedure-specific and/or concomitant acute pain is an essential quality feature in any surgical subspecialty. An interdisciplinary and interprofessional pain therapy aims for an immediate improvement of the patients' quality of life, a reduction of the risk of postoperative morbidity and mortality in the medium term, prevention of any pain chronification in the long run as well as a reduction of hospitalization and sick leave. The "Agreement of the Professional Association of German Anesthesiologists and the Professional Association of German Surgeons for the Organization of Postoperative Pain Therapy" exists since 1992. In view of the continuously developing scientific evidence, updated guideline recommendations and interprofessionally designed treatment pathways, these agreements have been adapted to the current requirements and structural conditions of the German healthcare system. Thus, both aforementioned professional associations promote an up to date version of an "Agreement for the Organization of Pain Therapy for Surgical Patients", a precise recommendation and a manual for the acting partners in order to realize the abovementioned goals.


Assuntos
Anestesiologistas , Manejo da Dor , Dor Pós-Operatória , Cirurgiões , Alemanha , Humanos , Manejo da Dor/normas , Dor Pós-Operatória/tratamento farmacológico , Qualidade de Vida , Sociedades
8.
Medicine (Baltimore) ; 98(39): e17328, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574868

RESUMO

INTRODUCTION: Gastric leiomyosarcoma (LMS) is a rare malignancy with minimal therapeutic options and has poor prognosis once metastasis develops. PATIENT CONCERNS: A case of gastric LMS with multiple metastases, pain, and progressive anemia 13 months after the initial diagnosis in a 43-year-old woman. DIAGNOSIS: Gastric LMS with liver metastases and multiple retroperitoneal lymphatic metastases. INTERVENTIONS: Minimally invasive therapies of repeated tetrahydropalmatine and oxaliplatin-based transarterial chemoembolization and high-intensity focused ultrasound treatment were performed. OUTCOMES: The treatments resulted in significant pain relief (numerical rating scale from 8-2 points) after the initial treatment, improvement in performance status and quality of life, and a progression-free survival of 4 months after treatment. CONCLUSION: This combined modality palliative treatment approach was well tolerated with noticeable pain relief.


Assuntos
Quimioembolização Terapêutica/métodos , Tratamento por Ondas de Choque Extracorpóreas/métodos , Leiomiossarcoma/patologia , Manejo da Dor/métodos , Dor , Qualidade de Vida , Neoplasias Gástricas/patologia , Adulto , Terapia Combinada/métodos , Feminino , Humanos , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/fisiopatologia , Neoplasias Hepáticas/secundário , Imagem Multimodal/métodos , Estadiamento de Neoplasias , Dor/diagnóstico , Dor/etiologia , Dor/psicologia , Medição da Dor/métodos , Cuidados Paliativos/métodos , Intervalo Livre de Progressão , Resultado do Tratamento
9.
Medicine (Baltimore) ; 98(39): e17358, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574881

RESUMO

OBJECTIVES: Previous studies comparing adductor canal block (ACB) with femoral nerve block (FNB) are inconclusive with regard to patient-controlled analgesia (PCA) induced by opioids. Moreover, some postoperative pain severity results differ between previous randomized controlled trials (RCTs). The primary aim of the current study was to compare total intravenous morphine consumption administered via PCA during the first postoperative day in continuous FNB and ACB groups after total knee arthroplasty (TKA). Secondary aims included evaluation of postoperative pain via a visual analog scale, degree of knee extension, quadriceps muscle strength, and ability to sit, stand upright, and walk. METHODS: The study was a RCT. Inclusion criteria were presence of gonarthrosis, age >18 and <75 years, and scheduled for TKA under single-shot spinal anesthesia. RESULTS: A number of morphine uses was lower in the FNB group than in the ACB group (14, range 12-15 vs 20, range 18-22; P = .0001), and they perceived less severe pain at the 8th (P = .00003) and 24th hours. However, ACB was significantly superior with regard to most of the other parameters pertaining to mobility, including muscle strength at the 8th and 24th hours, degree of knee extension at the 8th hour, sitting at the 8th hour, standing upright at the 24th hour, and walking at the 24th and 48th hours. DISCUSSION: FNB was associated with the perception of less severe pain after TKAs. However, ACB was associated with earlier mobility rehabilitation.


Assuntos
Artroplastia do Joelho/efeitos adversos , Nervo Femoral/efeitos dos fármacos , Bloqueio Nervoso/métodos , Manejo da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Feminino , Humanos , Masculino , Morfina/uso terapêutico , Força Muscular/efeitos dos fármacos , Medição da Dor , Dor Pós-Operatória/etiologia , Músculo Quadríceps , Amplitude de Movimento Articular/efeitos dos fármacos , Recuperação de Função Fisiológica/efeitos dos fármacos , Resultado do Tratamento
10.
Medicine (Baltimore) ; 98(40): e17133, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577705

RESUMO

BACKGROUND: This study aimed to investigate the efficacy and safety between early preoperative administration and postoperative administration of oral meloxicam in patients underwent arthroscopic knee surgery (AKS). METHODS: Totally 296 patients with the intention to undergo AKS were recruited and randomly allocated as 1:1 ratio into early preoperative analgesia (EPA) group and postoperative analgesia (POA) group. Pain visual analog scale (VAS) score and severity (at rest and at flexion), patient global assessment (PGA) score, the consumption of rescue analgesia (pethidine), and adverse events were evaluated during the perioperation. And knee range of motion (ROM), International Knee Documentation Committee (IKDC) score, and Lysholm score were assessed at baseline and at 3 months after AKS. RESULTS: Both pain VAS score and severity (at rest and at flexion) were decreased at 4, 8, and 12 hours, but similar at -24, -2, 24, 36, and 48 hours after AKS in EPA group compared with POA group. Besides, PGA score was lower at 4, 8, 12, and 24 hours, but similar at -24, -2, 36, and 48 hours after AKS in EPA group compared with POA group. As to the consumption of pethidine in perioperative period, it was decreased in EPA group compared with POA group. No difference was observed in knee ROM, IKDC score, Lysholm score, and adverse effects between EPA group and POA group. CONCLUSION: Early preoperative administration of meloxicam was a superior approach in pain control compared with postoperative administration in treating patients underwent AKS.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Artroscopia/efeitos adversos , Articulação do Joelho/cirurgia , Meloxicam/uso terapêutico , Manejo da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico , Adulto , Anti-Inflamatórios não Esteroides/administração & dosagem , Feminino , Humanos , Masculino , Meloxicam/administração & dosagem , Pessoa de Meia-Idade , Medição da Dor , Período Pós-Operatório , Período Pré-Operatório , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Fatores de Tempo
11.
Clin Exp Rheumatol ; 37 Suppl 120(5): 112-117, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31621559

RESUMO

Most patients with knee and hip osteoarthritis (OA) should be treated in primary care by non-surgical treatments. Building on substantial evidence from randomised trials, exercise therapy and education, typically delivered by physical therapists, are core first line treatments universally recommended in treatment guidelines for OA alongside weight loss, if needed. Exercise therapy provides at least as effective pain relief as pharmacological pain medications, without serious adverse effects; furthermore, the treatment effect from exercise therapy is similar, irrespective of baseline pain intensity and radiographic OA severity. Exercise therapy should be individualised to the preferences and needs of the individual patient, but at least 12 supervised sessions, 2 sessions per week, are required initially to obtain sufficient clinical benefit. Structured patient education concerning OA and its treatment options, including self-management, is important to retain motivation and adherence to an exercise programme and thereby maintain the effects over the long-term. If treatment effects from exercise therapy and patient education are insufficient, the physical therapist can deliver supplementary interventions that include knee orthoses and manual treatment.


Assuntos
Terapia por Exercício , Osteoartrite do Quadril , Osteoartrite do Joelho , Humanos , Articulação do Joelho , Manejo da Dor
12.
Clin Exp Rheumatol ; 37 Suppl 120(5): 124-129, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31621576

RESUMO

Osteoarthritis (OA) is a debilitative, painful condition with significant global burden. Pharmacological options have limited analgesic efficacy and their side-effects often restrict their use. Novel pharmacological options are needed to relieve patient symptoms and their consequent disease impact. A variety of pharmacological options have been investigated in treating OA, including existing therapies previously used for treating other arthritides (such as colchicine and hydroxychloroquine) and new therapies targeting pain (including monoclonal antibodies to nerve growth factor and intra-articular trans-capsaicin). Extended-release triamcinolone may offer more persisting analgesic effects compared to immediate-release preparations. While most studies have been unsuccessful, pharmacological therapies targeting peripheral nociceptive pathways appear promising.


Assuntos
Osteoartrite , Dor/tratamento farmacológico , Analgésicos/uso terapêutico , Humanos , Osteoartrite/tratamento farmacológico , Manejo da Dor , Medição da Dor
13.
J Opioid Manag ; 15(4): 267-271, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31637678

RESUMO

OBJECTIVE: Assess relationships between patient health literacy and formal education and use of opioids during and following an emergency department (ED) visit. DESIGN: Prospective, cross-sectional study. SETTING: Academic ED. PARTICIPANTS: Adults aged ≥ 60 years presenting to the ED with musculoskeletal pain. MAIN OUTCOME MEASURES: Opioid use during and after an ED visit. RESULTS: In a sample of 136 patients, patients with low health literacy were more likely to receive an opioid in the ED than patients with high health literacy (70 percent vs 52 percent; 18 percent difference, 95% confidence interval [CI]: -1 percent, 35 percent), receive an opioid prescription (63 percent vs 44 percent; 19 percent difference, 95% CI: 1 percent, 37 percent), and take opioids during the week following the ED visit (48 percent vs 29 percent; 18 percent difference, 95% CI: 0 percent, 36 percent). CONCLUSIONS: A greater proportion of older adults receiving ED care for musculoskeletal pain with low health literacy receive and use opioids during and following an ED visit.


Assuntos
Analgésicos Opioides/uso terapêutico , Serviço Hospitalar de Emergência , Alfabetização em Saúde , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Manejo da Dor , Estudos Prospectivos
14.
J Opioid Manag ; 15(4): 272-274, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31637679

RESUMO

OBJECTIVE: To determine the utility of the screener and opioid assessment for patients with pain-revised (SOAPP-R) for patients with cancer-related pain. DESIGN: The authors performed a retrospective analysis of cancer patients screened with the SOAPP-R. Opiate abuse was determined using a combination of urine drug screens and analysis of patients' electronic medical records. SETTING/PATIENTS: Patients who were seen at a palliative care clinic presenting with pain or needing an opioid prescription at an academic medical center with any type of cancer were screened using the SOAPP-R (N = 69). OUTCOME MEASURES: Aberrant opioid-related behavior was determined using a combination of provider notes and urine drug screens. RESULTS: A positive SOAPP-R score (⩾18) was observed in 27 participants (39.1 percent). The sensitivity and specificity of the SOAPP-R in the study population was 0.75 and 0.80, respectively. CONCLUSIONS: The SOAPP-R, in its current form, may have value in screening patients with cancer for substance abuse. Incorporation of the screening tool in palliative and oncology settings may help reduce opioid abuse in cancer patients.


Assuntos
Analgésicos Opioides , Neoplasias/complicações , Transtornos Relacionados ao Uso de Opioides , Dor/tratamento farmacológico , Inquéritos e Questionários/normas , Analgésicos Opioides/uso terapêutico , Humanos , Programas de Rastreamento/métodos , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Dor/etiologia , Manejo da Dor , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco , Sensibilidade e Especificidade
15.
J Opioid Manag ; 15(4): 333-341, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31637685

RESUMO

BACKGROUND: The use of opioid analgesics in the United States has increased nearly fourfold since 1999 resulting in a similar increase in opioid-related overdose deaths. Although the Centers for Disease Control published guidelines for prescribing chronic opioids, there is a lack of guidance for prescribing postoperative opioids. OBJECTIVE: To offer an evidence-based approach to prescribing opioids for post-operative pain management in the orthopedic setting. METHODS: A narrative review was performed of studies evaluating and quantifying opioid use in orthopedic patients in the postoperative setting, as well as studies analyzing patient satisfaction and perception with regards to opioid use. RESULTS: Studies show that postoperative pain may not be the largest contributing factor to developing an opioid use disorder, but rather patient factors such as tobacco and substance use disorder, mental health disorders, anxiety, mood disorders, pre-existing chronic pain, and recent opioid use may play a role. The review also found that most patients do not utilize significant portions of prescribed opioids and most do not require a refill. This trend leaves patients with thousands of unused pills, which are either retained, shared, or diverted. Although there is no guideline for prescribing opioids postoperatively, data suggest that clinicians can prescribe smaller dosages and fewer quantities of opioids initially. There are also non-opioid strategies that can be employed to reduce opioid consumption. CONCLUSION: There is a need for more high quality research to be conducted to standardize postoperative opioid prescribing patterns and create best practice guidelines to guide clinicians. Orthopedic practices should consider creating institutional guidelines to reduce the amount of opioids prescribed.


Assuntos
Analgésicos Opioides , Prescrições de Medicamentos/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides , Padrões de Prática Médica , Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/uso terapêutico , Humanos , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Procedimentos Ortopédicos , Manejo da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Padrões de Prática Médica/estatística & dados numéricos , Estados Unidos
16.
J Opioid Manag ; 15(4): 345-348, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31637687

RESUMO

Opioid tapering may be necessary for patients on long-term opioids. Here, the authors presented a patient who had uncontrolled chronic musculoskeletal pain while on chronic methadone. Upon methadone tapering, the patient had been taking methadone for longer than six years and had severe methadone-related adverse effects. Using multidisciplinary interventions of patient education and counseling, physical interventions, and nonopioid medications, patient's methadone was discontinued after longer than one year tapering with relatively good pain control. The tapering process highlights the importance of pain management during opioid tapering using multidisciplinary interventions to prevent and treat opioid withdrawal and pain relapses.


Assuntos
Analgésicos Opioides/efeitos adversos , Metadona , Manejo da Dor/métodos , Síndrome de Abstinência a Substâncias , Humanos , Metadona/uso terapêutico , Entorpecentes , Síndrome de Abstinência a Substâncias/prevenção & controle
17.
Medicine (Baltimore) ; 98(42): e17545, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626118

RESUMO

BACKGROUND: Controversy still exists regarding the efficiency and safety of ilioinguinal/iliohypogastric nerve (II/IH) block versus transversus abdominis plane (TAP) block for pain management after inguinal hernia repair. The purpose of the current meta-analysis was to perform a relatively credible and comprehensive assessment to compare the efficiency and safety of II/IH versus TAP for pain management after inguinal hernia repair. METHODS: The PUBMED, CENTRAL, and EMBASE were systematically searched. Studies comparing II/IH versus TAP for pain management in adult patients undergoing inguinal herniorrhaphy were included. The results of this study are synthesized and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. RESULTS: Six studies with 632 patients were included in this study. No statistically significant difference was observed between the II/IH and TAP groups in postoperative opioid use, the time to first request for rescue analgesia, the incidence of postoperative nausea and vomiting (PONV), incidence of complication related with nerve blocks and patient satisfaction. The TAP group had a significantly higher pain score at 6 and 8 hours postoperatively (6 hours: mean difference [MD] = 0.94, 95% confidence interval [CI] 0.67-1.22, I = 0%, P < .01; 8 hours: MD = 1.02, 95% CI 0.3-1.74, I = 59%, P < .01). However, no statistically significant difference was observed at 1, 2, 4, 12, 24, 48 hours, and 6 months postoperatively. CONCLUSIONS: In general, this meta-analysis revealed that both approaches have similar postoperative opioid consumption and no significant difference in postoperative complication and patient satisfaction. The II/IH block provides excellent analgesic effects at 6 and 8 hours after inguinal herniorrhaphy in compared with the TAP block. However, more high-quality randomized controlled trials with long-term follow-up are still required to make the conclusion.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/efeitos adversos , Bloqueio Nervoso/métodos , Neuralgia/tratamento farmacológico , Dor Pós-Operatória/tratamento farmacológico , Músculos Abdominais/inervação , Adulto , Idoso , Analgésicos Opioides/uso terapêutico , Feminino , Herniorrafia/métodos , Humanos , Plexo Hipogástrico , Masculino , Pessoa de Meia-Idade , Neuralgia/etiologia , Manejo da Dor/métodos , Dor Pós-Operatória/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
18.
Vet Clin North Am Small Anim Pract ; 49(6): 1143-1156, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31473030

RESUMO

Physical agent modalities can be effective in the perioperative period for controlling pain and inflammation. This article presents research-based evidence to support the use of these modalities in pain management and to reduce the use of pain medications, including opioids. The mechanism of action, applications, contraindications, and adverse effects of cryotherapy, pulsed electromagnetic field therapy, transcutaneous electrical nerve stimulation, and laser therapy are reviewed. Incorporation of 1 or more of these therapies in anesthesia pain management protocols can improve outcomes and reduce potential drug side effects.


Assuntos
Manejo da Dor/veterinária , Dor/veterinária , Assistência Perioperatória/veterinária , Animais de Estimação , Animais , Dor/tratamento farmacológico , Manejo da Dor/métodos , Assistência Perioperatória/métodos
19.
Vet Clin North Am Small Anim Pract ; 49(6): 1127-1141, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31474414

RESUMO

Adjuvant analgesics (ie, gabapentin, tramadol, and ketamine) are commonly used in small animal practice. Most of these drugs are prescribed for outpatients, when pain is refractory to classic analgesics (ie, local anesthetics, opioids, and nonsteroidal antiinflammatory drugs [NSAIDs]), or when contraindications exist to the administration of other analgesics, including NSAIDs. This article reviews the mechanisms of action, clinical use, potential adverse effects, and current evidence of adjuvant analgesics in the treatment of acute pain in companion animals. These drugs should be considered as alternatives aimed at reducing or replacing opioids.


Assuntos
Analgésicos/uso terapêutico , Manejo da Dor/veterinária , Dor/veterinária , Animais , Anti-Inflamatórios não Esteroides/uso terapêutico , Dor/tratamento farmacológico , Manejo da Dor/métodos
20.
Vet Clin North Am Small Anim Pract ; 49(6): 1063-1083, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31492541

RESUMO

The incorporation of nerve stimulation and ultrasound guidance to veterinary regional anesthesia allows accurate performance of techniques to block the thoracic limb and the thorax. When performed correctly, regional anesthesia can either constitute an alternative to the use of opioids and other systemic analgesics, or have a significant opioid-sparing effect. This article provides an overview of some techniques described using objective methods of nerve location, which can be used to provide perioperative locoregional anesthesia and analgesia to the thoracic limb and thorax. The approaches described may be used to decrease the perioperative use of opioids in small animals.


Assuntos
Anestesia Local/veterinária , Membro Anterior/inervação , Bloqueio Nervoso/veterinária , Manejo da Dor/veterinária , Tórax/inervação , Anestesia Local/métodos , Animais
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