Journal ArticleDOI
Postoperative Multimodal Analgesia Pain Management With Nonopioid Analgesics and Techniques: A Review.
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TLDR
Multimodal analgesia is readily available and the evidence is strong to support its efficacy, and surgeons should use this effective approach for patients both using and not using the ERAS pathway to reduce opioid consumption.Abstract:
Importance Amid the current opioid epidemic in the United States, the enhanced recovery after surgery pathway (ERAS) has emerged as one of the best strategies to improve the value and quality of surgical care and has been increasingly adopted for a broad range of complex surgical procedures. The goal of this article was to outline important components of opioid-sparing analgesic regimens. Observations Regional analgesia, acetaminophen, nonsteroidal anti-inflammatory agents, gabapentinoids, tramadol, lidocaine, and/or theN-methyl-d-aspartate class of glutamate receptor antagonists have been shown to be effective adjuncts to narcotic analgesia. Nonsteroidal anti-inflammatory agents are not associated with an increase in postoperative bleeding. A meta-analysis of 27 randomized clinical trials found no difference in postoperative bleeding between the groups taking ketorolac tromethamine (33 of 1304 patients [2.5%]) and the control groups (21 of 1010 [2.1%]) (odds ratio [OR], 1.1; 95% CI, 0.61-2.06;P = .72). After adoption of the multimodal analgesia approach for a colorectal ERAS pathway, most patients used less opioids while in the hospital and many did not need opioids after hospital discharge, although approximately 50% of patients received some opioid during their stay. Conclusions and Relevance Multimodal analgesia is readily available and the evidence is strong to support its efficacy. Surgeons should use this effective approach for patients both using and not using the ERAS pathway to reduce opioid consumption.read more
Citations
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Journal ArticleDOI
Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU
John W. Devlin,John W. Devlin,Yoanna Skrobik,Céline Gélinas,Dale M. Needham,Arjen J. C. Slooter,Pratik P. Pandharipande,Paula L. Watson,Gerald L. Weinhouse,Mark E. Nunnally,Bram Rochwerg,Michele C. Balas,Mark van den Boogaard,Karen J. Bosma,Karen J. Bosma,Nathaniel E. Brummel,Gerald Chanques,Linda Denehy,Xavier Drouot,Gilles L. Fraser,Jocelyn E. Harris,Aaron M. Joffe,Michelle E. Kho,John P. Kress,Julie A. Lanphere,Sharon McKinley,Karin J. Neufeld,Margaret A. Pisani,Jean François Payen,Brenda T. Pun,Kathleen Puntillo,Richard R. Riker,Bryce R.H. Robinson,Yahya Shehabi,Paul M. Szumita,Chris Winkelman,John Centofanti,Carrie Price,Sina Nikayin,Cheryl Misak,Pamela Flood,Ken Kiedrowski,Waleed Alhazzani +42 more
TL;DR: Substantial agreement was found among a large, interdisciplinary cohort of international experts regarding evidence supporting recommendations, and the remaining literature gaps in the assessment, prevention, and treatment of Pain, Agitation/sedation, Delirium, Immobility (mobilization/rehabilitation), and Sleep (disruption) in critically ill adults.
Journal ArticleDOI
Guidelines for Perioperative Care in Cardiac Surgery: Enhanced Recovery After Surgery Society Recommendations.
Daniel T. Engelman,Walid Ben Ali,Judson B. Williams,Louis P. Perrault,V. Seenu Reddy,Rakesh C. Arora,Eric E. Roselli,Ali Khoynezhad,Marc W. Gerdisch,Jerrold H. Levy,Kevin W. Lobdell,N. Fletcher,Matthias Kirsch,Gregg Nelson,Richard M. Engelman,Alexander J. Gregory,Edward M. Boyle +16 more
TL;DR: In this paper, the authors present consensus recommendations for the optimal perioperative management of patients undergoing cardiac surgery based on a review of meta-analyses, randomized clinical trials, large nonrandomized studies, and reviews.
Journal ArticleDOI
Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations—2019 update
Gregg Nelson,Jamie N. Bakkum-Gamez,Eleftheria Kalogera,Gretchen E. Glaser,Alon D. Altman,Larissa A. Meyer,Jolyn S. Taylor,Maria D. Iniesta,Javier Lasala,Gabriel E. Mena,Michael J. Scott,Chelsia Gillis,Kevin M. Elias,Lena Wijk,Jeffrey Huang,Jonas Nygren,Olle Ljungqvist,Pedro T. Ramirez,Sean C. Dowdy +18 more
TL;DR: This is the first updated Enhanced Recovery After Surgery (ERAS) Society guideline presenting a consensus for optimal perioperative care in gynecologic/oncology surgery, and the updated evidence base and recommendation are presented.
Journal ArticleDOI
Perioperative Use of Gabapentinoids for the Management of Postoperative Acute Pain.
Michael Verret,François Lauzier,Ryan Zarychanski,Caroline Perron,Xavier Savard,Anne-Marie Pinard,Guillaume Leblanc,Marie-Joëlle Cossi,Xavier Neveu,Alexis F. Turgeon +9 more
TL;DR: The routine use of pregabalin or gabapentin for the management of postoperative pain in adult patients is not supported, as no clinically significant analgesic effect for the perioperative use of gABapentinoids was observed and there was also no effect on the prevention of post operative chronic pain and a greater risk of adverse events.
Journal ArticleDOI
Impact of Enhanced Recovery After Surgery and Opioid-Free Anesthesia on Opioid Prescriptions at Discharge From the Hospital: A Historical-Prospective Study
Delara Brandal,Michelle S. Keller,Carol Lee,Tristan Grogan,Yohei Fujimoto,Yann Gricourt,Takashige Yamada,Siamak Rahman,Ira Hofer,Kevork Kazanjian,Jonathan Sack,Aman Mahajan,Anne Lin,Maxime Cannesson +13 more
TL;DR: Although an ERAS intervention for colorectal surgery led to an increase in opioid-free anesthesia and multimodal analgesia, the findings are very likely to also be observed in non-ERAS settings and offers an opportunity to modify opioid prescribing practices on discharge after surgery.
References
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Journal ArticleDOI
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Terese T. Horlocker,Denise J. Wedel,John C. Rowlingson,F. Kayser Enneking,Sandra L. Kopp,Honorio T. Benzon,David L. Brown,John A. Heit,Michael F. Mulroy,Richard W. Rosenquist,Michael Tryba,Chun-Su Yuan +11 more
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Journal ArticleDOI
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Laxmaiah Manchikanti,Standiford Helm,Bert Fellows,Jeffrey W. Janata,Vidyasagar Pampati,Jay S. Grider,Mark V. Boswell +6 more
TL;DR: The obstacles that must be surmounted are primarily inappropriate prescribing patterns, which are largely based on a lack of knowledge, perceived safety, and inaccurate belief of undertreatment of pain.
Journal ArticleDOI
Efficacy of Postoperative Epidural Analgesia: A Meta-analysis
Brian M. Block,Spencer S. Liu,Andrew J. Rowlingson,Anne R. Cowan,John A. Cowan,Christopher L. Wu +5 more
TL;DR: Epidural analgesia, regardless of analgesic agent, location of catheter placement, and type and time of pain assessment, provided better postoperative analgesia compared with parenteral opioids.
Journal ArticleDOI
A Flood of Opioids, a Rising Tide of Deaths
TL;DR: Faced with an epidemic of drug abuse and overdose deaths, the FDA has proposed a Risk Evaluation and Mitigation Strategy for prescription opioid pain relievers, involving improved education for physicians and patients about risks associated with long-acting opioids.
Journal ArticleDOI
Does multimodal analgesia with acetaminophen, nonsteroidal antiinflammatory drugs, or selective cyclooxygenase-2 inhibitors and patient-controlled analgesia morphine offer advantages over morphine alone? Meta-analyses of randomized trials.
TL;DR: There is evidence that the combination of nonsteroidal antiinflammatory drugs with patient-controlled analgesia morphine offers some advantages over morphine alone, and a decrease in morphine consumption is not a good indicator of the usefulness of a supplemental analgesic.
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