Yale Center for Analgesic Research
Integral to the pain rotation is the collection of safety, efficacy, and outcome data. This subsection of the Pain Management Service provides numerous research opportunities for residents and fellows assigned to the Pain Service. In recent years, a number of residents have participated as investigators in clinical trials and have had their research presented at major Anesthesiology meetings. Basic and clinical research at Yale, and at other major medical centers, has increased our understanding of pain pathways, and has helped to develop novel analgesics and routes of administration improving analgesic efficacy and postoperative outcome. Optimal therapy employs preemptive analgesia (administration of analgesics prior to surgical incision) and multi-modal analgesia (utilizing a variety of medications in an effort to provide additive analgesic effects). Current research efforts are focused on determining whether analgesic regimens that emphasize these concepts lead to improvements in patient functionality and post-surgical outcome.
- The multimodal administration of non-opioid analgesics in an effort to improve pain control, reduce epidural and IV PCA opioid requirements. We are currently evaluating preoperative administration of IV acetaminophen and Oral COX-2 inhibitors as adjuncts to opioid-based analgesia. These agents were noted to reduce morphine requirements by 35-44%, while reducing pain with effort, such as ambulation and deep breathing or cough. We continue to test the hypothesis that reduction in opioid exposure may lead to improvements in cognitive function, particularly in elderly patients, and may reduce the incidence of opioid induced ileus. We are also testing whether multimodal improvements in effort dependent pain may improve post-surgical pulmonary function and reduce the incidence of pneumonia.
- We continue our leadership role documenting the safety and efficacy of hydromorphone for epidural infusions and patient-controlled epidural infusion. To date over 10,000 patients have been treated with solutions containing hydromorphone and hydromorphone plus bupivacaine. The quality of pain relief and the incidence of adverse effects have been entered into a large prospective database.
- We continue as a lead site evaluating the post-surgical application of E-TRANS Fentanyl, an iontophoretic transdermal PCA device that patients can use to self administer small doses of fentanyl, Dilaudid CR a 24hr sustained release oral opioid for control of moderate to severe acute pain, and DepoDur® a substantial release epidural formulation of morphine that provides up to 48 hours of pain relief. We will be testing our preparation for pain control in women recovering from cesarean delivery.
- We are the lead site evaluating EDLA-40K for post-orthopedic pain management. EDLA is a solution of extended release bupivacaine that can provide up to 72hrs of pain control following peripheral neural injection.