Articles: analgesics.
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Journal of women's health · Dec 2024
Developing and Implementing a Patient-Centered Opioid Prescribing Algorithm among Gynecological Oncology Patients.
Background: The opioid epidemic is a public health crisis. However, opioid prescription recommendations have not been established in gynecological oncology, and guidelines that incorporate patient-reported pain are lacking. Objectives: The article aims to evaluate prescribing patterns, utilization, and patient-reported pain control in gynecological oncology patients at a large tertiary academic center. ⋯ Conclusions: Opioids were substantially overprescribed in gynecological oncology patients undergoing hysterectomy. Our study found that the surgical route and last 24-hour MME inpatient usage were reliable predictors of outpatient opioid use. We developed and implemented a standardized opioid prescription algorithm that was validated by comparing the pain control measures in the two phases.
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The authors describe a case study of a quality improvement initiative to implement the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain2 ("2016 CDC Guideline") into nurse-led primary care practices in central Appalachia. ⋯ Interventions to improve opioid and pain management through quality improvement efforts require policy changes, clinician and patient education, and electronic record tools.
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Introduction: Methadone is used to treat intractable cancer pain when other opioid analgesics are ineffective. Methadone tablets may be difficult to administer in cases of gastrointestinal passage obstruction. However, changing the route of methadone tablet administration is possible. ⋯ Conclusion: Using a simple suspension method to administer methadone is a safe pain management method when accompanied by careful monitoring. To date, no study has examined the tube administration safety of methadone tablets. Thus, this case report is of important clinical significance.
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Managing postoperative pain in patients with obesity is challenging. Although multimodal analgesia has proved effective for pain relief, the specific impacts of different nonopioid i.v. analgesics and adjuvants on these patients are not well-defined. This study aims to assess the effectiveness of nonsteroidal antiinflammatory drugs, paracetamol, ketamine, α-2 adrenergic receptor agonists, lidocaine, magnesium, and oral gabapentinoids in reducing perioperative opioid consumption and, secondarily, in mitigating the occurrence of general and postoperative pulmonary complications (POPCs), nausea, vomiting, PACU length of stay (LOS), and hospital LOS among surgical patients with obesity. ⋯ CRD42023399373 (PROSPERO).
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Review Meta Analysis
Efficacy and safety of neuraxial hydromorphone: A systematic review and meta-analysis with trial sequential analysis.
Neuraxial hydromorphone provides postoperative pain relief. However, the magnitude of this effect and the optimal dose remain unknown. The objective of this study is to clarify these uncertainties. ⋯ If neuraxial hydromorphone is to be used regularly, trials focusing on the optimal dose and side-effects should be performed before widely administering this medication into the neuraxial space. More trials focusing on the optimal dose and side-effects should be performed before widely administering this medication into the neuraxial space.