Browsing by Subject "Multimodal analgesia"

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    Impact of Enhanced Recovery After Surgery pathway for cesarean delivery on postoperative pain
    (Elsevier, 2023-01-29) Grasch, Jennifer L.; Rojas, Jennymar C.; Sharifi, Mitra; McLaughlin, Megan M.; Bhamidipalli, Surya S.; Haas, David M.; Obstetrics and Gynecology, School of Medicine
    Background: Enhanced Recovery After Surgery pathways provide evidence-based recommendations to optimize perioperative care. Objective: This study aimed to holistically investigate the effect of implementing an Enhanced Recovery After Surgery pathway for all cesarean deliveries on postoperative pain experience. Study design: This was a prepost study comparing subjective and objective measures of postoperative pain before and after the implementation of an Enhanced Recovery After Surgery pathway for cesarean delivery. The Enhanced Recovery After Surgery pathway was developed by a multidisciplinary team and included preoperative, intraoperative, and postoperative components, with emphasis on preoperative preparation, hemodynamic optimization, early mobilization, and multimodal analgesia. All individuals undergoing cesarean delivery, whether scheduled, urgent, or emergent, were included. Demographic, delivery, and inpatient pain management data were obtained through medical record review. Of note, 2 weeks after discharge, patients were surveyed about their delivery experience, analgesic usage, and complications. The primary outcome was inpatient opioid use. Results: The study included 128 individuals, 56 in the preimplementation cohort and 72 in the Enhanced Recovery After Surgery cohort. Baseline characteristics between the 2 groups were similar. The survey response rate was 73% (94/128). Opioid use in the first 48 hours postoperatively was significantly lower in the Enhanced Recovery After Surgery group than the preimplementation group (9.4 vs 21.4 morphine milligram equivalents 0-24 hours after delivery [P<.001]; 14.1 vs 25.4 morphine milligram equivalents 24-48 hours after delivery [P<.001]) with no increase in either average or maximum postoperative pain scores. Individuals in the Enhanced Recovery After Surgery group used fewer opioid pills after discharge (10 vs 20; P<.001). Patient satisfaction and complication rates did not change after the implementation of an Enhanced Recovery After Surgery pathway. Conclusion: The implementation of an Enhanced Recovery After Surgery pathway for all cesarean deliveries decreased both inpatient and outpatient postpartum opioid use without increasing pain scores or decreasing patient satisfaction.
  • Thumbnail Image
    Item
    Meperidine-Ketorolac Combination Provides Better Analgesia than Meperidine Alone in Postoperative Patients
    (Marshfield Clinic, 2022) Umukoro, Nelly N.; Jamgbadi, Shola S.; Isamade, Erdoo S.; Anesthesia, School of Medicine
    Background: Our study objective was to assess if multi-modal analgesia with meperidine-ketorolac combination provides superior analgesia or reduces opioid requirement following surgery compared to Meperidine alone. Design: Double-blind randomized controlled trial. Setting: Postoperative pain control in orthopedic ward after spinal anesthesia. Patients: American Society of Anesthesiology (ASA) risk I or II (ASA I/II) patients who had lower limb implant surgery (88) at our center from September 2014 to July 2015. Interventions: Patients were randomly assigned to receive either 1 mg/kg of intravenous (IV) meperidine and 30 mg of IV ketorolac (treatment group) or 1 mg/kg of IV meperidine (control group) post-surgery, administered every hour for the first 6 hours during the first 24 hours post-surgery. In addition, patients received intravenous meperidine on an 'as needed basis' during the first 24 hours of the postoperative period. Measurements: Outcomes were time-to-first analgesia request postoperatively; cumulative opioid dose in first 24 hours post-surgery; frequency of side effects; and patient satisfaction with pain relief using a Likert scale. Numerical rating scale (NRS) pain scores hourly for the first 6 hours, then the 8th, 12th, 16th, 18th and 24th hour post-surgery were assessed. Results: There was a significant delay in time of first request for analgesia (460 min vs 225 min; P=0.03) and a reduction in opioid consumption in 24 hours (299 mg vs 325 mg; P=0.01) in the meperidine/ketorolac group compared with the meperidine alone group which were both statistically significant. Patient satisfaction with pain relief was better in the treatment group (P=0.01). Additionally, there were fewer side effects in the treatment group than in the control group but this was not statistically significant. Conclusions: Adding ketorolac to meperidine reduced postoperative pain, reduced patient daily opioid requirement, increased patient satisfaction with pain relief, without increasing the frequency of side effects. Therefore, IV ketorolac addition to opioids may be a reasonable option in multimodal analgesic protocol.