Although there is a scarcity of evidence pertaining to the management of postoperative pain medication in the ambulatory setting, some findings suggest an approach similar to that used for the treatment of acute pain.
Variation exists in opioid prescribing practices among clinicians in single-hospital systems, which prompts concern about the potential for opioid overprescribing.
Women who undergo vaginal delivery in the United States may frequently be prescribed opioid medications for pain within 1 week of hospital discharge, often dispensed at high doses and in significant quantities.
Preoperative opioid use was reported by approximately 23% of patients undergoing surgery, with age, tobacco use, depression, poor life satisfaction, and medical comorbidities identified as independent factors associated with pre-interventional opioid use.
Postpartum Pain Management Recommendations From the American College of Obstetricians and Gynecologists
A committee from the American College of Obstetricians and Gynecologists formulated several recommendations for safely managing pain and fatigue in women during the early postpartum period.
Higher PainDETECT Scores, Neuropathic Pain Preoperatively May Increase Risk for Chronic Pain Post-TKR
Individuals with knee osteoarthritis who have indicators of high vs low/no levels of neuropathic pain may be at elevated risk for chronic pain after total knee replacement surgery.
Labor epidural analgesia may be associated with reduced likelihood of breastfeeding at 6 weeks.
The Company indicated that they will work towards an New Drug Application submission for the treatment in the second half of 2018.
For patients undergoing invasive procedures, opioid-related adverse drug events are common and are associated with worse clinical and cost outcomes.
The use of opioid-free analgesia to manage postsurgical pain is still limited, particularly in some patient groups that may be at a higher risk for opioid-related adverse drug events.
Administration of clonidine — intrathecally or intravenously — may not supplement spinal anesthesia-associated analgesia after cesarean delivery.
With the distinct qualities that come from post-surgical procedures in the realm of pediatrics, conclusions are still being considered.
Liposomal bupivacaine use in patients undergoing total knee arthroplasty is not associated with clinically meaningful reductions in inpatient opioid use, resource utilization, or opioid-related complications.
Perioperative lidocaine infusions may reduce the likelihood of developing chronic postsurgical pain.
Calcium phosphate cement loaded with bupivacaine vs ropivacaine may accelerate functional recovery after bone reconstruction surgery and maintain bone-filling properties.
Regional anesthesia is associated with a lower opioid consumption in both knee and hip replacement surgeries, compared to general anesthesia.
A once-daily intravenous injection of meloxicam may safely and effectively relieve moderate to severe bunionectomy-associated pain.
Adverse events associated with opioids administered for the management of postsurgical and postendoscopy pain may be associated with worse cost and patient outcomes.
In this multicenter, double-blind, placebo-controlled trial, patients (N=409) were randomized 1:1:1 to a postoperative regimen of IV tramadol 50mg, IV tramadol 25mg, or placebo administered over 15 minutes at hours 0, 2, 4, and once every 4 hours thereafter (up to 13 doses).
The management of postsurgical pain with patient-controlled analgesia pumps may be safe, as indicated by a low rate of device-related error.
The researchers found that the median prescription size was 350 mg oral morphine equivalents and median patient use was 225 mg oral morphine equivalents following open hiatal hernia repair.
Acetaminophen in combination with ibuprofen or oxycodone, as well as diclofenac, and flurbiprofen may offer more effective analgesia for acute postoperative dental pain in adults.
Researchers conducted a prospective survey of patients to investigate postoperative opioid use.
An elastic net algorithm was used to create a predictive model of postoperative pain in the first 24 hours after surgery using a randomly selected training cohort.
Opioids and sedatives may represent independent and additive predictors of cardiopulmonary and respiratory arrest in both medical and surgical patients.
The use of high doses of opioids — particularly long-acting opioids — during surgery may increase the risk for 30-day readmission.
Administration of hyaluronidase and corticosteroid methylprednisolone acetate to the epidural space during epiduroscopy for failed back surgery-related radicular pain may improve back pain and disability at 1 year.
Postoperative pain management that combines a reduction of opioids with the use of intravenous acetaminophen may shorten hospital length of stay, reduce the rate of complications related to opioids, and lower related costs.
Additionally, statistical significance vs placebo was also achieved in total postsurgical opioid consumption through 48 hours (P<0.0001); opioid-free subjects through 48 hours (P<0.01); and time to first opioid rescue through 48 hours (P<0.0001).
Multimodal analgesia after hip or knee arthroplasty may be associated with fewer complications and reduced opioid prescriptions and hospital length of stay, compared with unimodal analgesia.
Fewer respiratory, GI issues; reductions also seen in opioid prescriptions and hospital length of stay
Clinical Pain Advisor Articles
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- Medical Cannabis Legalization Associated With Reduced Schedule III Opioid Prescriptions
- Electroacupuncture May Help Reduce Opioid Use in Chronic Musculoskeletal Pain
- Neuropathic Pain Medications
- Higher Buprenorphine Dose May Not Increase Severity of Neonatal Abstinence Syndrome
- Terms Used for Addiction May Be Associated With Explicit, Implicit Bias
- Ketamine Infusions May Be Effective for Refractory Headache
- Physical, Psychosocial Activity May Be Protective Against Development of Chronic Pain in Older Adults
- Opioid Use Disorder Prevalence at Delivery on the Rise in the US, According to CDC
- Suprazygomatic Sphenopalatine Ganglion Block May Quickly Relieve Status Migrainosus Pain
- Pharmacologically Induced Headache Accompanied by Dilated Cephalic Vessels
- IV Lidocaine May Be Safe, Efficacious for Pediatric Status Migraine
- Gray Matter Changes in Migraine Associated With Clinical Characteristics