{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,7,2]],"date-time":"2024-07-02T06:41:07Z","timestamp":1719902467365},"reference-count":38,"publisher":"Springer Science and Business Media LLC","issue":"9","license":[{"start":{"date-parts":[[2020,7,2]],"date-time":"2020-07-02T00:00:00Z","timestamp":1593648000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,7,2]],"date-time":"2020-07-02T00:00:00Z","timestamp":1593648000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Herzzentrum G\u00f6ttingen"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Anaesthesist"],"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Standard protocols or algorithms are considered essential to ensure adequate analgesia. Germany has widely adopted postoperative protocols for pain management including oral opioids for rescue medication, but the effectiveness of such protocols has only been evaluated longitudinally in a\u00a0before and after setting. The aim of this cohort analysis was to compare the effectiveness of an oral opioid rescue medication algorithm for postoperative management of pain to the gold standard of patient-controlled intravenous analgesia (PCIA).<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>This study compared cohorts of patients of two prospective observational studies undergoing elective total hip replacement. After surgery patients received piritramide to achieve a\u00a0pain score of \u22643\u00a0on the numeric rating scale (NRS 0\u201310). A\u00a0protocol was started consisting of oral long-acting oxycodone and ibuprofen (basic analgesia). Cohort\u00a01 (C1, 126 patients) additionally received an oral opioid rescue medication (hydromorphone) when reporting pain &gt;3 on the NRS. Cohort\u00a02 (C2, 88\u00a0patients) was provided with an opioid by PCIA (piritramide) for opioid rescue medication. Primary endpoints were pain intensity at rest, during movement, and maximum pain intensity within the first 24\u00a0h postoperative. Secondary endpoints were opioid consumption, functional outcome and patient satisfaction with pain management.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Pain during movement and maximum pain intensity were higher in C1 compared to C2: pain on movement median 1st\u20133rd\u00a0quartile: 6\u00a0(3.75\u20138) vs. 5\u00a0(3\u20137),<jats:italic>p<\/jats:italic>\u202f=\u20090.023; maximum pain intensity: 7\u00a0(5\u20139) vs. 5\u00a0(3\u20138),<jats:italic>p<\/jats:italic>\u202f=\u20090.008. There were no differences in pain intensity at rest or between women and men in either group. The mean opioid consumption in all patients (combined PACU, baseline, and rescue medication; mean\u202f\u00b1\u2009SD\u202fmg ME) was 126.6\u202f\u00b1\u200951.8\u202fmg oral ME (median 120 (87.47\u2013154.25) mg ME). Total opioid consumption was lower in C1 than C2 (117\u202f\u00b1\u200946\u202fmg vs 140\u202f\u00b1\u200956\u202fmg,<jats:italic>p<\/jats:italic>\u202f=\u20090.002) due to differences in rescue opioids (C1: 57\u202f\u00b1\u200937\u202fmg ME, C2: 73\u202f\u00b1\u200943\u202fmg ME,<jats:italic>p<\/jats:italic>\u202f=\u20090.006, Z\u202f=\u2009\u22122.730). Basic analgesia opioid use was comparable (C1: 54\u202f\u00b1\u200931\u202fmg ME, C2: 60\u202f\u00b1\u200936\u202fmg ME,<jats:italic>p<\/jats:italic>\u202f=\u20090.288, Z\u202f=\u2009\u22121.063). There were no differences in respect to the addition of non-opioids and reported quality of mobilization, sleep, frequency of nausea and vomiting, or general satisfaction with pain management.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In this study PCIA provided a\u00a0better reduction of pain intensity, when compared to a\u00a0standardized protocol with oral opioid rescue medication. This effect was associated with increased opioid consumption. There were no differences in frequencies of opioid side effects. This study was a\u00a0retrospective analysis of two cohorts of a\u00a0major project. As with all retrospective studies, our analysis has several limitations to consider. Data can only represent the observation of clinical practice. It cannot reflect the quality of a\u00a0statement of a\u00a0randomized controlled trial. Observational studies do not permit conclusions on causal relationships.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00101-020-00806-6","type":"journal-article","created":{"date-parts":[[2020,7,2]],"date-time":"2020-07-02T13:40:46Z","timestamp":1593697246000},"page":"639-648","update-policy":"http:\/\/dx.doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The effectiveness of an oral opioid rescue medication algorithm for postoperative pain management compared to PCIA"],"prefix":"10.1007","volume":"69","author":[{"given":"J.","family":"Erlenwein","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. 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Erlenwein received a lecture fee from Gr\u00fcnenthal. M. Przemeck received research support from MSD, Biotest, and Ratiopharm; a lecture fee from Johnson & Johnson. M.I. Emons, F. Petzke, M. Quintel, and I. Staboulidou declare that they have no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional and\/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical standards"}}]}}