Re: Study determines how to give post-op pain relief toopioid-tolerant patients

[Guest guest]

Another group of physicians who deserve the Kiss Award!

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org

[ ] Study determines how to give post-op pain relief

toopioid-tolerant patients

> Public release date: 27-Apr-2004

>

>

> Contact: Phil Sahm

> 801-581-2517

> University of Utah Health Sciences Center

>

> Univeristy of Utah anesthesiologists on front lines in battle against

> post-operative pain

> Study determines how to give post-op pain relief to opioid-tolerant

patients

> SALT LAKE CITY -- Post-operative pain is the No. 1 issue for people

who've

> had surgery-and University of Utah anesthesiologists are helping these

> patients fight that battle on several fronts.

>

> Anesthesiologists at the U School of Medicine and hospital have

developed a

> way to determine precisely how much medication is needed to relieve

pain in

> major surgery patients who've become tolerant to opioids-the primary

drugs

> used to relieve post-operative pain. The U physicians just won the top

award

> for their presentation on pain control at the International Anesthesia

> Research Society meeting in Tampa, Fla

>

> They're also using two new techniques that not only alleviate

post-operative

> pain but also shorten the hospital stays for people who've had total

knee

> replacements, surgery on their anterior cruciate ligaments (ACL), or

who've

> experienced fractures or other injuries of the lower extremities.

>

> University Hospitals & Clinics is the only hospital in Utah using

these

> breakthrough techniques.

>

> As millions of Americans take Lortab, OxyContin, and other narcotics

to

> relieve chronic pain, the daily prescriptions of those drugs are

making it

> harder to get effective pain management after they've had major

surgery.

> That's because people who take daily prescription narcotics develop a

> tolerance to opioids. This has made recovery from major surgery more

painful

> for these patients because standard post-operative doses of morphine

haven't

> worked-until now.

>

> U of U anesthesiologists have developed a method that takes into

account a

> patient's opioid tolerance and helps physicians determine the right

amount

> of medication to stop post-operative pain in people who already take a

daily

> narcotic prescription.

>

> Opioid tolerance affects hundreds of patients who have surgery at

University

> Hospitals & Clinics, according to anesthesiologists D.

Swenson,

> M.D., associate professor, and J. , M.D., assistant

professor,

> at the U School of Medicine and lead authors of the paper.

>

> " Compared to five years ago, there's a huge number of people coming

into the

> hospital already taking narcotics, " Swenson said. " You give them

medication

> and, unfortunately, it doesn't touch the pain. "

>

> Swenson and other U anesthesiologists studied 20 opioid-tolerant

patients

> undergoing back surgery and who received the pain medication fentanyl

> immediately prior to their operations. Fentanyl is a synthetic opioid

used

> for pain control that is 100 times more potent than morphine.

>

> As each patient was anesthetized, he or she received fentanyl until

> respiratory depression was induced. When respiratory depression had

been

> reached, each patient then underwent general anesthesia. Using

software

> developed at Stanford University-but modified by U anesthesiologists

Talmage

> D. Egan, M.D., professor, and Kenward B. , M.D., associate

> professor-the concentration of fentanyl associated with respiratory

> depression was determined for each patient.

>

> Once the U anesthesiologists determined the fentanyl dose associated

with

> respiratory depression in each patient, the software helped them

calculate

> how much of the drug was needed for pain relief. By testing each

> individual's response to fentanyl, the anesthesiologist was able to

predict

> a safe and effective dose of opioid that was " tailor made " for each

patient.

>

> They found that the amount of fentanyl needed to cause respiratory

> depression in the opioid tolerant study subjects averaged 20.74

nanograms

> per milliliter. The amount needed for adequate pain relief averaged

7.07

> nanograms per milliliter. Both measurements were substantially higher

than

> for people who are not opioid-tolerant.

>

> The fentanyl dose required for pain relief among the individual

patients

> varied from 2.1 nanograms per milliliter to 22.3 nanograms per

milliliter.

> In other words, some patients required 10 times as much fentanyl for

pain

> relief.

>

> " That means standard doses of opioids could be as much as 10 times

lower

> than some patients need for adequate pain relief, " Swenson said.

>

> This method has become the standard protocol at University Hospital

and U

> anesthesiologists are using it 10-15 times a month for opioid-tolerant

> patients who undergo surgery.

>

> Along with Swenson, , Egan, and , other contributors to

the

> study included D. Dillon, M.D., and medical student H.

Hall.

>

> U anesthesiologists also are using a new method to control post-op

pain in

> 40-60 people who undergo knee surgery every month at University

Hospital.

>

> A fascia iliaca catheter, also called a femoral block, often is used

to

> control pain following knee replacement and ACL surgery. But instead

of

> placing the catheter right next to the nerve to administer local

anesthetic,

> which is the most common way of doing it, U of U anesthesiologists

insert

> the catheter in a space near the nerve without touching it. Then they

bathe

> the nerve in a local anesthetic, and the results for pain control have

been

> dramatic.

>

> Patients given a femoral block after surgery go home from the hospital

a

> full day sooner because of the pain relief. They're also able to take

pills

> instead of receiving pain medication intravenously.

>

> Employing a similar method, U anesthesiologists use a sciatic nerve

catheter

> for patients who have ankle fractures or other injuries below the

knee, and

> the results have been equally impressive, according to Swenson. This

> technique has allowed patients who might otherwise be hospitalized for

3-4

> days because of severe pain to go home with the catheter in place the

day

> after surgery.

>

> Between 20 and 30 surgery patients are given the sciatic nerve

catheter at

> University Hospital each month, Swenson said.