From the *Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen; †Department of Anaesthesia, Frederiksberg Hospital, Copenhagen University Hospital, Frederiksberg; ‡Department of Anaesthesia, Glostrup Hospital, Copenhagen University Hospital, Glostrup; §Section of Acute Pain Management, Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen; and ?Department of Surgery, Glostrup Hospital, Copenhagen University Hospital, Glostrup, Denmark.
Femoral nerve block (FNB), a commonly used postoperative pain treatment after total knee arthroplasty (TKA), reduces quadriceps muscle strength essential for mobilization. In contrast, adductor canal block (ACB) is predominately a sensory nerve block. We hypothesized that ACB preserves quadriceps muscle strength as compared with FNB (primary end point) in patients after TKA. Secondary end points were effects on morphine consumption, pain, adductor muscle strength, morphine-related complications, and mobilization ability.
We performed a double-blind, randomized, controlled study of patients scheduled for TKA with spinal anesthesia. The patients were randomized to receive either a continuous ACB or an FNB via a catheter (30-mL 0.5% ropivacaine given initially, followed by a continuous infusion of 0.2% ropivacaine, 8 mL/h for 24 hours). Muscle strength was assessed with a handheld dynamometer, and we used the percentile change from baseline for comparisons. The trial was registered at clinicaltrials.gov (Identifier: NCT01470391).
We enrolled 54 patients, of which 48 were analyzed. Quadriceps strength as a percentage of baseline was significantly higher in the ACB group compared with the FNB group: (median [range]) 52% [31-71] versus 18% [4-48], (95% confidence interval, 8-41; P = 0.004). There was no difference between the groups regarding morphine consumption (P = 0.94), pain at rest (P = 0.21), pain during flexion of the knee (P = 0.16), or adductor muscle strength (P = 0.39); neither was there a difference in morphine-related adverse effects or mobilization ability (P > 0.05).
Adductor canal block preserved quadriceps muscle strength better than FNB, without a significant difference in postoperative pain.
The efficacy of application of tramadol and naclofen for analgesia after performance of orthopedic operations was studied up. There were examined 112 patients, to whom were done total endoprosthesis of coxofemoral joint, 19--total endoprosthesis of the knee joint, 54--the knee joint arthroscopy. The analgesia efficacy was estimated according to visual-analogue scale and to the sensations index. High efficacy of the tramadol application for postoperative analgesia was established. In patients, to whom tramadol and naclofen were administered, maximal analgetic effect was noted.
the analgesic drug use has been reported to increase in general in nursing home patients. However, there is insufficient evidence in terms of what agents are used, variations of use over time and to whom these drugs are prescribed.
we investigated the prescribing patterns of scheduled analgesic drugs in Norwegian nursing home patients from 2000 to 2011, with the association to age, gender, cognitive function and type of nursing home unit.
secondary analyses of four study samples (three observational studies and one randomised controlled trial).
nursing home patients included in study samples from 2000 (n = 1,926), 2004 (n = 1,163), 2009 (n = 850) and 2011 (n = 1,858) located in 14 Norwegian counties.
trend analyses of analgesic drug prescriptions. Percentages were described using t-test, ?(2) and Mann-Whitney U test and multivariate logistic regression.
the odds ratio for receiving any pain medication in 2011 compared with 2000 was 2.6 (95% CI 2.23-2.91), this is corresponding to a 65% increase from 34.9 to 57.6%. The paracetamol prescription increased by 113%, from 22.7% in 2000 to 48.4% in 2011. Strong opioids (fentanyl, buprenorphine, morphine, oxycodone) increased from 1.9% in 2000 to 17.9% in 2011 (P
Comment In: Age Ageing. 2016 Jan;45(1):7-826764389
Erratum In: Age Ageing. 2016 Mar;45(2):32326941355
Pain is often underrecognized and undertreated among older people. However, older people may be particularly susceptible to adverse drug reactions linked to prescription and nonprescription analgesics.
The aims of this study were to assess the prevalence of analgesic use among a random sample of community-dwelling people aged >or=75 years, and to investigate factors associated with daily and as-needed analgesic use.
A random sample of people aged >or=75 years was drawn from the population register in Kuopio, Finland, in November 2003. Data on prescription and nonprescription analgesic use were elicited during nurse interviews conducted once for each participant in 2004. Self-reported drug utilization data were verified against medical records. The interview included items pertaining to sociodemographic factors, living conditions, social contacts, health behavior, and state of health. Physical function was assessed using the Instrumental Activities of Daily Living Scale, and the 10-item Barthel Index. Self-rated mobility was assessed by asking whether respondents could walk 400 meters (yes, yes with difficulty but without help, not without help, or no). Cognitive function was assessed using the Mini-Mental State Examination. The presence of depressive symptoms was assessed using the 15-item Geriatric Depression Scale. Respondents' self-rated health was determined using a 5-point scale (very poor, poor, moderate, good, or very good).
Of the initial random sample of participants (N = 1000), 700 provided consent to participate and were community dwelling. Among the participants, 318 (45.4%) were users of >or=1 analgesic on a daily or as-needed basis. Only 23.3% of analgesic users took an analgesic on a daily basis. Factors associated with any analgesic use included female sex (odds ratio [OR], 1.78 [95 degrees % CI, 1.17-2.71]), living alone (OR, 1.46 [95 degrees % CI, 1.02-2.11]), poor self-rated health (OR, 2.6 [95% CI, 1.22-3.84]), and use of >or=10 nonanalgesic drugs (OR, 2.21 [95% CI, 1.26-3.87]). Among users of >or=1 oral analgesic, factors associated with opioid use included moderate (OR, 2.46 [95% CI, 1.175.14]) and poor (OR, 2.57 [95% CI, 1.03-6.42]) self-rated health. Opioid use (OR, 0.19 [95% CI, 0.04-0.86]) and daily analgesic use (OR, 0.16 [95% CI, 0.34-0.74]) were inversely associated with depressive symptoms. Pain in the previous month was reported by 71.4% of analgesic users and 26.4% of nonusers of analgesics.
Analgesics were used by approximately 50% of community-dwelling people aged >or=75 years. However, age was not significantly associated with increased use of analgesics in multivariate analysis. The majority of analgesic drugs were used on an as-needed rather than a daily basis (76.7% vs 23.3%, respectively). Factors most significantly associated with analgesic use were female sex, living alone, poor self-rated health, and use of >or=10 nonanalgesic drugs.
To assess the prevalence of nonmedical prescription opioid use (NMPOU) in the Canadian general adult population in the context of rising overall prescription opioid (PO) consumption and related problems in North America.
The prevalence of NMPOU was assessed as a multiitem construct in the Canadian Alcohol and Drug Use Monitoring Survey (CADUMS; n = 16 672), an ongoing cross-sectional monthly random digit dialing telephone survey representative of the general Canadian population, aged 15 years and older. CADUMS data were collected between April and December of 2008 with a response rate of 43.5%.
About 22% of CADUMS respondents reported PO use in the last year, while 0.5% reported NMPOU during the same time frame. PO use was significantly higher among women than among men, and highest in the group aged 25 to 54 years. NMPOU was similar among men and women, and highest in the group aged 15 to 24 years.
CADUMS data indicate an extremely low rate of NMPOU, especially given the levels of overall PO use, other PO-use related problems, and NMPOU levels estimated in the general US population where NMPOU has been assessed to be 10 times higher than in Canada. NMPOU survey item construction and response rates appear to strongly influence and potentially compromise NMPOU survey data. Existing NMPOU data and survey methods need to be validated for this important indicator in Canada, where increasing PO use and problem levels have been recognized as a significant and rising public health problem.
The repeated use of prescription opioids may lead to serious side effects. It is therefore important to examine factors associated with such repeated use. The aim of this study was to investigate the association between the maternal use of prescription opioids and their use by offspring of these mothers.
Data were extracted from two nationwide registers linked by unique personal identity numbers: the 2001 Norwegian Population and Housing Census and the Norwegian Prescription Database 2004-2009. The study population consisted of 97,574 adolescents aged 15-16 years in 2001 and their mothers. The repeated use of opioids was defined as the issuing of >4 and >15 prescriptions to an adolescent and his/her mother, respectively, during the period 2004-2009. Non-steroidal anti-inflammatory drugs (NSAIDs) are not potentially addictive, and individuals issued prescriptions for NSAIDs were used as the reference analgesic drug group.
The proportion of repeated prescription opioid users was higher among adolescents whose mother was registered as a repeated user of prescription opioids (8.4 %) than among those whose mother did not repeatedly use prescription opioids (2.4 %). The odds ratio (OR) was 3.1 [95 % confidence interval (CI) 2.7-3.6] when adjusted for the mother's socioeconomic characteristics and the gender of the offspring. A lower socioeconomic position of the mother increased the risk of repeated opioid use by her offspring. Maternal repeated use of NSAIDs was associated with repeated use of NSAIDs among offspring (OR 1.8, 95 % CI 1.7-2.0).
Among our study population, the maternal use of opioids was associated with the repeated use of prescription opioids among the respective offspring. The same association was seen with NSAIDs, but to a lesser extent.
To measure chronic pain patient volumes seen in primary care practice; to determine what medications physicians choose for the treatment of moderate to severe chronic pain; to identify barriers to the use of opioids in the treatment of chronic pain; and to assess physicians' attitudes toward the current management of chronic pain in Canada.
A computer-assisted telephone survey of 100 regionally representative Canadian physicians with a defined interest in palliative care (PC, n=30) or noncancer pain (GP, n=70).
A survey was conducted by Ipsos-Reid in June 2001. Only physicians who met the eligibility criteria of having written 20 or more prescriptions for moderate to severe pain in the preceding four weeks or having devoted 20% of time to palliative care were eligible to participate.
In one month, the average number of patients with moderate to severe chronic pain seen by PCs was 94.2; the average seen by GPs was 44.7. The pain experienced by 83.3% of GP patients was noncancer related. For chronic cancer pain, an opioid analgesic was the treatment of choice of 79% of physicians (48% preferred morphine, 21% codeine, 10% other). For moderate to severe chronic noncancer pain, opioids were the first-line treatment of only 32% of physicians (16% preferred codeine, 16% major opioids) because a significant number preferred either non-steroidal anti-inflammatory drugs (29%) or acetaminophen (16%). Thirty-five per cent of GPs and 23% of PCs would never use opioids for noncancer pain, even when described as severe. Chronic pain was deemed by 68% of physicians to be inadequately managed. Almost 60% thought that pain management could be enhanced by improved physician education. Identified barriers to opioid use included addiction potential (37%) and side effects (25%). Seventeen per cent of GPs and 10% of PCs thought that regulatory sanctions limited opioid prescribing.
Even among physicians experienced in chronic pain treatment, there is a reluctance to use opioids for severe nonmalignant pain. One-half of the survey participants believed that there was a need for improved physician education in pain management, including the use of opioids.
Comment In: Pain Res Manag. 2003 Winter;8(4):187-814679411
Finland belongs to the group of countries in which the consumption of strong opioids is low. This seems to reflect the general quality of cancer pain treatment. During the last 10 years, many efforts have been made to improve the treatment of cancer pain in Finland. To assess one parameter of change, the present study compared the quantity of opioid and nonopioid analgesics used in the treatment of terminal cancer pain in a Finnish general hospital in 1987, 1991, and 1994. Specifically, the records of all patients who died of cancer in Kymenlaakso Central Hospital (KCH) in 1991 and in 1994 and during the last 6 months of 1987 were reviewed to acquire information about the use of analgesic medication. The total proportion of cancer patients receiving analgesic medication on a regular basis was 39% in 1987, 63% in 1991, and 52% in 1994. The mean daily dose of strong opioids changed from 24 mg in 1987 to 58 mg in 1991, and to 43 mg in 1994. These data suggest a possible backlash in prescribing practices during recent years. In spite of various efforts to improve the treatment of cancer pain, the medical records demonstrate a decline in prescribing of the drugs needed for this treatment.
In elderly persons, pain is a common problem, and analgesic medicines are among the most frequently used drugs.
To describe the use of analgesic medication and its relation to daily pain and morbidity in home-dwelling elderly people aged at least 75 years.
A random sample of 700 subjects aged at least 75 years was drawn from the total population of Kuopio, Finland. A geriatrician and nurse carried out structured clinical examinations and interviews with 601 persons, 523 of whom were living at home.
Seventy percent (n = 364) of the elderly people were taking at least one analgesic, including most of those who suffered from daily interfering pain (85%) and nearly all of those experiencing daily pain at rest (93%). Nonsteroidal antiinflammatory drugs (NSAIDs; n = 226, 51%) and acetaminophen (n = 118, 23%) were the most commonly used analgesics. The use of opioids became more common with age, accounting for 16% of the drugs in the oldest patients (> or =85 y) and 6% among those aged 75-79 years. Analgesics were mainly taken when needed. Only 13% of NSAID users, 18% of acetaminophen users, and 21% of opioid users took these preparations regularly.
Although analgesics are commonly used by elderly patients, it appeared that many patients were still experiencing daily interfering pain and pain at rest.