scholarly journals Creatinine-Based Renal Function Estimates and Dosage of Postoperative Pain Management for Elderly Acute Hip Fracture Patients

2018 ◽  
Vol 11 (3) ◽  
pp. 88 ◽  
Author(s):  
Morten Houlind ◽  
Kristian Petersen ◽  
Henrik Palm ◽  
Lillian Jørgensen ◽  
Mia Aakjær ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Postoperative Pain ◽  
Estimated Glomerular Filtration Rate ◽  
Postoperative Pain Management ◽  
The Elderly ◽  
Recommended Dose ◽  
Disease Epidemiology ◽  
Pain Medications ◽  
Daily Dose ◽  
Egfr Equation

Many analgesics and their metabolites are renally excreted. The widely used Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)-estimated glomerular filtration rate (eGFR) equations are not developed for use in the elderly, while the recent Berlin Initiative Study (BIS), Full Age Spectrum (FAS), and Lund-Malmö revised (LMR) equations are. This observational study investigated differences between creatinine-based eGFR equations and how the choice of equation influences dosage of analgesics in elderly (≥70 years) patients admitted with acute hip fracture. eGFR was calculated by the CKD-EPI, BIS, Cockcroft-Gault (CG), FAS, LMR, and Modification of Diet in Renal Disease (MDRD) equations. Standard daily dose for postoperative pain medications ibuprofen, morphine and gabapentin was simulated for each equation according to dosage recommendations in Renbase®. For 118 patients, mean eGFR from the CKD-EPI, BIS, CG, FAS, LMR, and MDRD equations was 67.3 mL/min/1.73 m2, 59.1 mL/min/1.73 m2, 56.9 mL/min/1.73 m2, 60.3 mL/min/1.73 m2, 58.9 mL/min/1.73 m2, and 79.1 mL/min/1.73 m2, respectively (p < 0.0001). Mean difference to CKD-EPI was −10.4 mL/min/1.73 m2 to 11.8 mL/min/1.73 m2. Choice of eGFR equation significantly influenced the recommended dose (p < 0.0001). Shifting to BIS, FAS, or LMR equations led to a lower recommended dose in 20% to 31% of patients. Choice of eGFR equation significantly influenced dosing of ibuprofen, morphine, and gabapentin.

scholarly journals Our first Experience of Continuous Fascia Iliaca Compartment Block for Post Operative Analgesia in a Case of Fracture Femur in TU Teaching Hospital

2018 ◽  
Vol 16 (2) ◽  
pp. 248-250
Author(s):  
Bigen Man Shakya ◽  
Ninadini Shrestha
Keyword(s):  
Case Report ◽  
Pain Management ◽  
Postoperative Pain ◽  
Teaching Hospital ◽  
Postoperative Pain Management ◽  
The Elderly ◽  
Pain Medication ◽  
Fracture Femur ◽  
Fascia Iliaca Compartment Block

The postoperative pain management in the elderly is challenging due to comorbidities and change in physiology due to age itself. This limit the use of medication which include pain medication also. The fascia iliaca compartment block has been described in the literature for fracture of femur. It has even been safely used by non anaesthesiologist also. To our knowledge, we did not find any case report of continuous fascia iliaca compartment block published in Nepal. This is our first experience of successful continous fasicia iliaca compartment block in case of 89 year old lady with multiple co morbidities in whom traditional pain medication might be difficult to use. We encourage to practice this block which is both safe and easy to perform with good results.

scholarly journals What Can Breast and Plastic Surgeons Do to Help Fight the Opioid Crisis: The Interpectoral Block for Pain Control Following Aesthetic and Reconstructive Breast Surgery

2020 ◽  
Vol 2 (1) ◽  
Author(s):  
Michael Scheflan ◽  
Tanir M Allweis
Keyword(s):  
Postoperative Pain ◽  
Pain Control ◽  
Ultrasound Guidance ◽  
Breast Surgery ◽  
Standard Of Care ◽  
Postoperative Pain Management ◽  
Effective Technique ◽  
Regional Analgesia ◽  
Pain Medications ◽  
Opioid Administration

Abstract With the heightened awareness of the dangers of opioid administration, the importance of providing effective non-opioid postoperative pain management is evident. Regional analgesia for breast surgery has been described, but it is unclear how widely it is utilized. The authors describe a simple block performed during ablative, aesthetic, and reconstructive breast surgery to improve postoperative pain control and significantly decrease the need for postoperative pain medications. The interpectoral (PECS I) block covers the lateral and medial pectoral nerves and can be administered by the anesthesiologist under ultrasound guidance after induction of general anesthesia, or by the surgeon under direct vision, using a blunt cannula, at the time of surgery. The authors have been practicing this technique in every patient undergoing aesthetic, ablative, and reconstructive breast surgery in the last 4 years. In approximately 350 patients, none received opioids after discharge, which was either same day or the following day. The authors provide a brief review of the literature and a detailed description of the technique along with a video demonstrating the procedures. Intraoperative pectoral block is a simple and effective technique for decreasing postoperative pain and analgesic requirements and could be widely adopted as a standard of care in breast surgery.

Barriers to Postoperative Pain Management in Hip Fracture Patients with Dementia as Evaluated by Nursing Staff

2014 ◽  
Vol 15 (1) ◽  
pp. 208-219 ◽  
Author(s):  
Maija Rantala ◽  
Päivi Kankkunen ◽  
Tarja Kvist ◽  
Sirpa Hartikainen
Keyword(s):  
Hip Fracture ◽  
Pain Management ◽  
Postoperative Pain ◽  
Nursing Staff ◽  
Postoperative Pain Management

Postoperative Pain Management Surgery

2018 ◽  
Author(s):  
Abhishek Parmar
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Perioperative Period ◽  
Postoperative Pain Management ◽  
Multimodal Analgesia ◽  
Anesthetic Techniques ◽  
Clinical Approach ◽  
Acute Setting ◽  
Pain Medications

Optimal pain management in the perioperative period is essential to improving patient quality of life, preventing postoperative complications, and ensuring improved surgical outcomes.1 This review discusses the optimal clinical approach to pain management in the acute setting, centering on the concept of multimodal analgesia. Various opioid and nonopioid medications available for treating acute pain are discussed, with a focus on the “pain ladder,” adverse effects of pain medications, epidural and regional anesthetic techniques, and common pitfalls to avoid when managing postoperative pain. This review does not discuss chronic pain management.

Randomized Prospective Evaluation of Intraoperative Intravenous Acetaminophen in Pediatric Adenotonsillectomy

2017 ◽  
Vol 158 (2) ◽  
pp. 368-374 ◽  
Author(s):  
Christopher A. Roberts ◽  
Shivani Shah-Becker ◽  
Ashley O’Connell Ferster ◽  
Aaron Baker ◽  
Lauren E. Stahl ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Breakthrough Pain ◽  
Medical Center ◽  
Academic Medical Center ◽  
Postoperative Nausea And Vomiting ◽  
Postoperative Pain Management ◽  
Pain Medication ◽  
Pain Scores ◽  
Pain Medications ◽  
Group 2

Objective To establish the safety and efficacy of single-dose intraoperative intravenous (IV) acetaminophen in postoperative pain management following adenotonsillectomy in addition to a standardized regimen of oral pain medication. Study Design Randomized, controlled prospective clinical trial. Setting Single academic medical center. Subjects and Methods Patients between the ages of 3 and 17 years scheduled for tonsillectomy or adenotonsillectomy by a single surgeon between December 2014 and November 2016 were recruited. Patients were randomly assigned to 1 of 2 groups; group 1 received a single intraoperative dose of IV acetaminophen, and group 2 did not. Induction and maintenance of anesthesia, as well as operative technique, were standardized. Nursing pain scores, pain medications administered, and recovery times were reviewed during the 24-hour postoperative period. Postoperative pain regimen included standing alternating oral acetaminophen and ibuprofen. Results In total, 260 patients were included in the study, and 131 (50.4%) received a single intraoperative dose of IV acetaminophen. Patients receiving IV acetaminophen were more likely to experience postoperative nausea and vomiting than patients who did not receive IV acetaminophen (1.53% vs 0.00%, P = .016). There were no significant differences noted for postoperative pain scores, requirements for breakthrough pain medications, time to discharge from the recovery room or hospital, or postoperative complications. Conclusion The use of a single intraoperative dose of IV acetaminophen was associated with minimal additional adverse effects. However, a single intraoperative IV dose of acetaminophen added to standard narcotic and nonnarcotic pain medication does not provide a statistically significant improvement in pain control.

Postoperative pain management with tramadol after craniotomy: evaluation and cost analysis

2010 ◽  
Vol 112 (2) ◽  
pp. 268-272 ◽  
Author(s):  
Scott Y. Rahimi ◽  
Cargill H. Alleyne ◽  
Eric Vernier ◽  
Mark R. Witcher ◽  
John R. Vender
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Management Strategies ◽  
Length Of Hospital Stay ◽  
Postoperative Pain Management ◽  
Control Group ◽  
Pain Scores ◽  
Pain Medications ◽  
Hospitalization Costs ◽  
Hospital Stays

Object Patients undergoing craniotomies have traditionally received opiates with acetaminophen for the management of their postoperative pain. The use of narcotic pain medications can be costly, decrease rates of early postoperative ambulation, lengthen hospital stays, and alter a patient's neurological examination. The use of alternative pain medications such as tramadol may benefit patients by resolving many of these issues. Methods The authors conducted a randomized, blinded prospective study to evaluate the efficacy of alternative pain management strategies for patients following craniotomies. Fifty patients were randomly assigned either to a control group who received narcotics and acetaminophen alone or an experimental group who received tramadol in addition to narcotic pain medications (25 patients assigned to each group). Results The control group was noted to have statistically significant higher visual analog scale pain scores, an increased length of hospital stay, and increased narcotic use compared with the tramadol group. The narcotics and acetaminophen group also had increased hospitalization costs when compared with the tramadol group. Conclusions The use of scheduled atypical analgesics such as tramadol in addition to narcotics with acetaminophen for the management of postoperative pain after craniotomy may provide better pain control, decrease the side effects associated with narcotic pain medications, encourage earlier postoperative ambulation, and reduce total hospitalization costs.

Postoperative Pain Management in the Elderly Undergoing Thoracic Surgery

2009 ◽  
Vol 19 (3) ◽  
pp. 353-361 ◽  
Author(s):  
Marie N. Hanna ◽  
Jamie D. Murphy ◽  
Kanupriya Kumar ◽  
Christopher L. Wu
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Thoracic Surgery ◽  
Postoperative Pain Management ◽  
The Elderly
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