Post-operative opioid consumption in Thoracic Surgery Patients: How much is actually used?

Publication date: Available online 2 November 2019Source: The Annals of Thoracic SurgeryAuthor(s): Kimberly A. Holst, Cornelius A. Thiels, Daniel S. Ubl, Shanda H. Blackmon, Stephen D. Cassivi, Francis C. Nichols, K. Robert Shen, Dennis A. Wigle, Matthew Thomas, Ian A. Makey, Staci E. Beamer, Dawn E. Jaroszewski, Mark S. Allen, Elizabeth B. HabermannAbstractBackgroundThe object of this initiative was to perform a prospective, multi-center survey of patients following lung resection to assess the amount of opioids consumed and disposition of unused opioids to inform the development of evidence-based prescribing guidelines.MethodsAdults undergoing lung resection via minimally invasive (MIS, n=108) or thoracotomy (n=45) were identified prospectively from three academic centers (3/2017 - 1/2018) to complete a 28-question telephone survey 21-35 days post-discharge. Discharge opioids were converted into Morphine Milligram Equivalents (MME) and compared across patient and surgical details.ResultsOf the 153 patients who completed the survey, 89.5% (137) received opioids at discharge with median prescription of 320 [IQR 225, 450] MME following MIS and 450 [IQR 300, 600] following thoracotomy, p=0.001. Median opioid consumption varied by surgical approach: 90 [IQR 0, 262.5] following MIS and 300 [50, 382.5] following thoracotomy, p
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research

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ConclusionIn lung cancer patients undergoing thoracotomy, three to five tDCS sessions significantly reduced cumulative postoperative morphine use, maximum VAS pain scores with cough, and pain interference with cough on postoperative day 5, but there was no obvious long-term benefit from tDCS.
Source: Frontiers in Pharmacology - Category: Drugs & Pharmacology Source Type: research
We present two cases of general anesthesia combined with erector spinae plane block as part of multimodal anesthesia in premature twins undergoing patent ductus arteriosus closure.DiscussionIn these cases, the use of erector spine plane block combined with general anesthesia was efficient to minimize the negative impact of surgery and allowed a reduction in the amount of intraoperative opioid use for patent ductus arteriosus closure.ResumoJustificativaA persistência do canal arterial em neonatos prematuros resulta em shunt esquerdo-direito com alterações hemodinâmicas e desconforto respirató...
Source: Brazilian Journal of Anesthesiology - Category: Anesthesiology Source Type: research
AbstractPurposeTo evaluate the effects of transcutaneous electrical nerve stimulation (TENS) compared to placebo TENS and a control group on pain, pulmonary function, respiratory muscle strength, and analgesic medications in the postoperative period of thoracotomy in an Intensive care unit (ICU).MethodsPatients who had undergone posterolateral thoracotomy were randomly allocated to receive TENS during ICU stay, or placebo TENS, or into the control group. All groups received conventional physiotherapy. We analysed the intensity of pain, pulmonary function, respiratory muscle strength, and use of analgesia medications. Outco...
Source: Lung - Category: Respiratory Medicine Source Type: research
Conditions:   Opioid Use;   Post-thoracotomy Pain Syndrome;   Local Anaesthetic Agent Overdose;   Local Anesthetic Complication;   Pain, Postoperative Intervention:   Procedure: Serratus anterior block Sponsor:   Indiana University Recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
Stamenkovic This prospective randomized study aims to evaluate the feasibility and cost-effectiveness of combining transcranial direct current stimulation (tDCS) with patient controlled intravenous morphine analgesia (PCA-IV) as part of multimodal analgesia after thoracotomy. Patients assigned to the active treatment group (a-tDCS, n = 27) received tDCS over the left primary motor cortex for five days, whereas patients assigned to the control group (sham-tDCS, n = 28) received sham tDCS stimulations. All patients received postoperative PCA-IV morphine. For cost-effectiveness analysis we used data about total amount ...
Source: International Journal of Environmental Research and Public Health - Category: Environmental Health Authors: Tags: Article Source Type: research
AbstractPulmonary arteriovenous malformation (PAVM) is a potential cause of hemothorax. The risk of PAVM rupture is reported to be higher during pregnancy for several reasons, including increased body fluid and a change in hormonal conditions. A 34-year-old pregnant woman suddenly felt right chest pain and dyspnea in the 28th week of gestation. Chest X-ray and computed tomography showed massive right pleural effusion. Her vital signs gradually deteriorated with hemorrhagic shock, necessitating emergency surgery. During exploratory thoracoscopy, active bleeding from the middle lobe was noticed and gauze packing was required...
Source: General Thoracic and Cardiovascular Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
Source: Indian Journal of Surgical Oncology - Category: Cancer & Oncology Source Type: research
Conditions:   Thoracotomy;   Hyperalgesia;   Hyperalgesia, Secondary;   Central Sensitisation;   Electroencephalography;   Persistent Postsurgical Pain;   Humans Interventions:   Other: electroencephalography (EEG);   Other: questionnaires;   Other: high frequency electrical stimulation of the forearm skin (HFS);   Other: cutaneous mechanical pinprick stimulation Sponsor:   Université Catholique de Louvain Not yet recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
Conditions:   Thoracotomy;   Hyperalgesia;   Hyperalgesia, Secondary;   Central Sensitisation;   Electroencephalography;   Persistent Postsurgical Pain;   Humans Interventions:   Other: electroencephalography (EEG);   Other: questionnaires;   Other: high frequency electrical stimulation of the forerarm skin (HFS);   Other: cutaneous mechanical pinprick stimulation Sponsor:   Université Catholique de Louvain Not yet recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
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