Showing posts with label non-opioid. Show all posts
Showing posts with label non-opioid. Show all posts

Saturday, December 14, 2019

Continuous Infusion of Lidocaine

I covered the 2015 version of meta-analysis back in April when I couldn't get my hands on this one, the 2018 version. I appreciate the Cochrane Library for making this free. You could get to it from my website. The last time I posted about Lidocaine was in April when I had fewer than 1500 followers and this community is extremely helpful in shaping how we all practice. Not to mention that my posts at that time were even harder to read than they are now!
At that time, a follower named @ameliahlaws commented on how her shop uses lidocaine for their trauma patients and have seen great results. That was definitely encouraging. I do not have experience with this in my practice because it cannot be used in patients with renal nor heart failure due to the active metabolites which can cause accumulation and toxicity respectively. As I primarily take care of medical ICU patients at the moment, using this medication would not be helpful.

This meta-analysis was one heck of an endeavor. Let me summarize the 285 pages in several words: we need more data. That was the conclusion that these authors came to as well because ultimately the quality of the data is so poor, or how they described it "very low quality". It hurts to write that because, as many of you know, I do not do research myself, and that seems like a kick in the face to those out there who work so hard doing the necessary research that ultimately improves patient care.

I have added the Forest Plots to my slides because they look pretty and make it seem like it's of substantial impact but in reality it's not. Sigh.

As mentioned, many of the findings were "very low quality". That doesn't mean that it doesn't work, nor that future studies won't prove that it does work, but rather that we just don't know YET.

The authors are recommending someone, anyone, conduct a study with more than 200 patients. I guess that's why this is "cutting edge" stuff at the time of this post. They also cannot make any recommendations regarding dosing, duration, timing, and the type of surgery where this would benefit the most.

-EJ


Link to Article (FREE)

Link to PDF

Weibel S, Jelting Y, Pace NL, et al. Continuous intravenous perioperative lidocaine infusion for postoperative pain and recovery in adults. Cochrane Database of Systematic Reviews 2018; 6: CD009642.

Although great care has been taken to ensure that the information in this post is accurate, eddyjoemd, LLC shall not be held responsible or in any way liable for the continued accuracy of the information, or for any errors, omissions or inaccuracies, or for any consequences arising therefrom.

Tuesday, December 3, 2019

Pregabalin to Avoid Opioids

I’m hard at work on a protocol for my shop to decrease opioid usage as well as preparing my lectures on opioid sparing medications. Amongst those are the gabapentinoids. You’ve seen them often, I’m sure, mostly to treat neuropathic pain such as diabetic neuropathy as well as trigeminal neuralgia but what about for actual painful procedures? This family of medications reduce the abnormal hypersensitivity induced by inflammatory responses or nerve injury. What not just place it in the drinking water for our patients? That’s kind of where I’m going with this.

This study was published in 2011 and they gave patients Pregabalin, also known as Lyrica, to see how much opioids the pts would need. They got 150mg before the surgery and then 75mg twice a day until post-op day 5. The main drawback is how it delayed the time to extubation. I don’t know if I am interpreting the data correctly but patients on Pregabalin were on the vent for about 2 hours longer than those not on it. Perhaps the 150mg 1 hour before the surgery was too much. Either way, as noted on the abstract slide, it reduced the post-op consumption of opioids by 44-48%. That’s a big win.

Do you all routinely use Pregabalin or Gabapentin for pain management at your institutions? I’m going to go through more data on this topic in the upcoming week.


-EJ



Link to Abstract

Link to FULL FREE Article

Pesonen A, Suojaranta-Ylinen R, Hammaren E, Kontinen VK, Raivio P, Tarkkila P, Rosenberg PH. Pregabalin has an opioid sparing effect in elderly patients after cardiac surgery: a randomized placebo-controlled trial. Br J Anaesth 2011;106:873–81


Although great care has been taken to ensure that the information in this post is accurate, eddyjoemd, LLC shall not be held responsible or in any way liable for the continued accuracy of the information, or for any errors, omissions or inaccuracies, or for any consequences arising therefrom.