Postoperative pain survey in Italy (POPSI): a snapshot of current national practices.
ABSTRACT Over the last several years, significant efforts have been directed towards improving the quality of postoperative pain management. As data are lacking on the organization and quality of these services in Italy, we surveyed current Italian practices.
A 16-item questionnaire was randomly supplied to 650 anesthesiologists attending the Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care Medicine (SIAARTI) National Congress in 2006. The survey requested information concerning their current practices in analgesic techniques, use of guidelines, educational programs, availability of an Acute Pain Service (APS), and existing barriers to optimal postoperative pain management.
Based on 588 respondents, a sample of 163 hospitals was analyzed (24.4% of Italian public hospitals); 41.7% of the surveyed hospitals had an organized APS. University and teaching hospitals had an organized APS more frequently than did other hospitals (P<0.02). Continuous intravenous analgesia using elastomeric infusion systems was the most commonly used analgesic technique, performed in 44% of the treated patients. The frequency of both intravenous patient-controlled analgesia and epidural techniques was extremely low (5% and 13%, respectively). The main reasons given for suboptimal pain relief were inadequate training of surgeons and nurses (44.3%), poor organization (29.9%), and lack of equipment (21.5%). A total of 51.2% of the respondents would like to have a dedicated anesthesiologist assigned on a daily rotational basis to postoperative pain management.
A comparison to international survey data showed that postoperative pain management in Italy is still below the European standards. Additional efforts to overcome these hurdles and to reach an acceptable level of quality are required.
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ABSTRACT: BACKGROUND: In acute pain models, coadministration of low doses of morphine and oxycodone markedly enhanced analgesia relative to either opioid given alone. Enhanced analgesia with coadministration of morphine and oxycodone has also been reported in acute and chronic moderate to severe pain conditions during double-blind studies. OBJECTIVE: The goal of this study was to compare the efficacy and tolerability of a flexible dose regimen of the morphine/oxycodone combination versus oxycodone/acetaminophen and fixed low-dose morphine/oxycodone. METHODS: This was a 5-center, randomized, open-label study of hospitalized patients (n = 44) with acute moderate to severe postoperative pain after total knee arthroplasty. Inpatients were randomized to a flexible dose regimen of morphine/oxycodone (3 mg/2 mg to 24 mg/16 mg), fixed low-dose morphine/oxycodone regimen (3 mg/2 mg), or oxycodone/acetaminophen (5 mg/325 mg). Treatment was initiated following surgery after intravenous (IV) morphine patient-controlled analgesia. An algorithm was evaluated for converting the patient-controlled analgesia morphine dose to an initial oral dose of morphine/oxycodone. The primary efficacy variable was the time-weighted sum of pain intensity difference from 0 to 48 hours. RESULTS: The median values for the sum of the pain intensity difference from 0 to 48 hours for the morphine/oxycodone flexible dose and oxycodone/acetaminophen were similar and approximately twice that of fixed morphine/oxycodone 3 mg/2 mg (148.0, 139.5, and 71.3, respectively). Moderate to severe gastrointestinal adverse events occurred in 50% of patients in the oxycodone/acetaminophen group compared with 15% of the equianalgesic morphine/oxycodone group. On several items of the Brief Pain Inventory (general activity, walking ability, and sleep), the morphine/oxycodone flexible dose produced greater benefit than oxycodone/acetaminophen. CONCLUSIONS: Flexible dose morphine/oxycodone was superior to low-dose morphine/oxycodone and comparable to oxycodone/acetaminophen. Flexible dose morphine/oxycodone-treated patients had a lower rate of moderate to severe nausea or vomiting than equianalgesic oxycodone/acetaminophen-treated patients. Thus, morphine/oxycodone offers an attractive alternative to oxycodone/acetaminophen for the management of moderate to severe postoperative pain. ClinicalTrials.gov: identifier: NCT00818493.Clinical Therapeutics 03/2013; 35(4). DOI:10.1016/j.clinthera.2013.03.002 · 2.59 Impact Factor
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ABSTRACT: The combination of ketamine and remifentanil seems to be associated with better analgesia and duration. The aim of this study was to evaluate whether a ketamineremifentanil combination promotes improved postoperative analgesia. Prospective, randomized, double blind study of 40 patients undergoing video laparoscopic cholecystectomy. Anesthesia was performed with remifentanil, propofol, atracurium, and 50% oxygen. Group 1 (GI) patients received remifentanil (0.4mcg.kg(-1).min(-1)) and ketamine (5mcg.kg(-1).min(-1)) and Group 2 (G2) received remifentanil (0.4mcg.kg(-1).min(-1)) and saline solution. Morphine 0.1mg.kg(-1) was administered at the end of the procedure, and postoperative pain was treated with morphine via PCA. We evaluated the severity of postoperative pain by a numerical scale from zero to 10 during 24hours. We registered the time to the first analgesic supplementation, amount of morphine used in the first 24hours, and adverse effects. There was a decrease in pain severity between extubation and other times evaluated in G1 and G2. There was no signifi cant difference in pain intensity between the groups. There was no difference between G1 (22±24.9min) and G2 (21.5±28.1min) regarding time to first dose of morphine and dose supplement of morphine consumed in G1 (29±18.4mg) and G2 (25.1±13.3mg). The combination of ketamine (5mcg.kg(-1).min(-1)) and remifentanil (0.4mcg.kg(-1).min(-1)) for cholecystectomy did not alter the severity of postoperative pain, time to first analgesic supplementation or dose of morphine in 24hours.Revista brasileira de anestesiologia 03/2013; 63(2):178-82. DOI:10.1016/S0034-7094(13)70211-3 · 0.42 Impact Factor
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ABSTRACT: T he control of postoperative pain is a central issue in the management of patients under-going surgery. Effective postoperative pain relief is associated with improved patient satisfaction and quality of life, 1, 2 whereas uncontrolled pain may affect clinical outcomes. 3, 4 Inadequately controlled acute pain may increase the likeli-hood of chronic pain after surgery; 2, 5 moreover, postoperative pain prolongs hospital stays lead-ing to increased healthcare costs. 6 Several guidelines addressing the management of pain in the perioperative setting have been is-sued over the last decade. 7-11 Optimal pain con-trol is achieved by an interdisciplinary effort involving anesthesiologists and other healthcare professionals, and by careful assessment of pain ITalian Observational Study of the management of mild-to-moderate Post-Operative Pain (ITOSPOP)Minerva anestesiologica 01/2012; 78(15):15-25. · 2.27 Impact Factor