Editor's Note Eliminating opioids from general anesthesia is safe and effective and significantly decreases postoperative nausea, finds this study presented October 23 at the Anesthesiology 2017 annual meeting in Boston. Of 1,009 patients who received general anesthesia without opioids, only 11% experienced postoperative nausea--typically 50% to 80% of patients have…

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Editor's Note Patients significantly overestimate the amount of pain they will experience after surgery, which can cause unnecessary anxiety, finds a study presented October 21 at the Anesthesiology 2017 annual meeting in Boston. A total of 223 patients completed a questionnaire before and after surgery to evaluate the level of…

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Editor's Note The Joint Commission has issued a new R3 Report to help accredited hospitals better understand and comply with its new and revised pain management standards, which are effective January 1, 2018. This R3 Report provides in-depth rationale, references, and evidence used in the development of the new and…

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Editor's Note Postoperative pain trajectories can identify patients at risk for 30-day readmissions and emergency department (ED) visits, and are not mediated by postdischarge complications, this study finds. In this analysis of 211,231 surgical procedures (45.4% orthopedic, 37.0% general, and 17.6% vascular), the 30-day unplanned readmission rate was 10.8%, and…

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Editor's Note In this meta-analysis of the effectiveness of nonpharmacological interventions for pain after total knee arthroplasty, electrotherapy and acupuncture were associated with reduced and delayed opioid consumption, but there was low or very low certainty that they improved pain. Continuous passive motion and preoperative exercise did not improve pain…

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Editor's Note The initial event associated with exposure to prescription opioids is often thought to be an injury or surgical procedure, but this study finds that opioid use rarely starts with surgical procedures. Of 117,118 patients with sustained prescription opioid use who were analyzed, just 800 (0.7%) received their initial…

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Editor's Note Emergency department (ED) visits after total joint procedures were numerous and mostly for pain-related diagnoses, and Medicaid patients had almost double the risk of an ED or pain-related ED visit, this study finds. Of 152,783 patients analyzed, 3.42% returned to the inpatient setting and 5.81% visited the ED…

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Editor's Note Ketamine does not decrease delirium or lower levels of pain in older adults after major surgery and might cause harm by inducing hallucinations and nightmares, this study finds. A total of 672 patients were randomly assigned to a placebo group (222 patients), a 0.5 mg/kg ketamine group (227),…

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Editor's Note The Accreditation Association for Ambulatory Health Care (AAAHC) on May 8 announced the release of its new Opioid Stewardship Toolkit to help providers review and assess the volume and length of opioid prescriptions and dosages to mitigate risk of patient overdose and death. AAAHC created the toolkit to…

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Editor's Note The combination of femoral and sciatic nerve blocks is the overall best approach to pain management after total knee arthroplasty, finds this meta-analysis. The best five modalities for pain at rest were: femoral/obturator, femoral/sciatic/obturator, lumbar plexus/sciatic, femoral/sciatic, and fascia iliaca compartment blocks. For reducing opioid consumption, the best…

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