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Mogianos K, Undén J, Persson A. Effect of individualized anesthesia and analgesia on postoperative pain in patients stratified for pain sensitivity: A study protocol for the PeriOPerative individualization trial randomized controlled trial. Acta Anaesthesiol Scand 2024. [PMID: 38937954 DOI: 10.1111/aas.14487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 06/14/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Despite advancements in surgical and anesthesia techniques, acute and persistent postoperative pain are still a common challenge. Postoperative pain has direct effects on individual patient care and outcome, as well as putting strain on limited health care resources. Several prediction methods for postoperative pain have been described. One such method is the assessment of pain during peripheral venous cannulation (VCP). It is not known if different approaches to anesthesia and analgesia, depending on the evaluation of risk for postoperative pain, can improve outcome. The aim of this study is to evaluate if individualized anesthesia and analgesia can affect postoperative pain and recovery after surgery, in patients stratified by VCP. METHODS Adult patients scheduled for laparoscopic surgery undergo pain-sensitivity stratification using VCP on the day of surgery. Patients scoring VCP ≥2.0 on the visual analogue scale (pain-sensitive) are randomized to multimodal anaesthesia and analgesia with opioids or standard of care. Patients scoring VCP ≤1.9 (pain-tolerant) are randomized to opioid-free anaesthesia or standard of care. The primary outcome is acute postoperative pain measured with numeric rating scale in the postoperative care unit. Secondary outcomes include analysis of pain after 24 h, persistent postoperative pain and quality of recovery. DISCUSSION Individualized perioperative pain management has the potential to improve patient care. This study will examine the impact of different anesthesia and analgesia regimes, in patients with differing pain sensitivity, on postoperative pain. TRIAL REGISTRATION Prospectively posted at ClinicalTrials.gov, identifier NCT04751812.
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Affiliation(s)
- Krister Mogianos
- Department of Anesthesiology and Intensive Care Medicine, Halland Hospital Halmstad, Halmstad, Sweden
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Johan Undén
- Department of Anesthesiology and Intensive Care Medicine, Halland Hospital Halmstad, Halmstad, Sweden
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Anna Persson
- Department of Anesthesiology and Intensive Care Medicine, Halland Hospital Halmstad, Halmstad, Sweden
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
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Yuan X, Ju Z, Zhang X, Yin X. Perioperative Sleep Disturbance in Surgical Patients: A Concept Analysis. Clin Nurs Res 2024:10547738241258509. [PMID: 38867492 DOI: 10.1177/10547738241258509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
To investigate and define the concept of perioperative sleep disturbance (PSD) among surgical patients, with the goal of aiding clinical practice and research. Walker and Avant's eight-step approach of concept analysis was applied. A systematic search of English literature was conducted in the following databases: PubMed, Web of Science, and CINAHL, with a time restriction from 2010 to August 2023. Based on the 54 eligible studies, the attributes of PSD in surgical patients were identified as individualized symptom manifestation, difficulty initiating and/or maintaining sleep, and altered sleep patterns. The antecedents included poor psychological state, inaccurate perception, surgery and/or anesthesia-related physiological changes, and environmental interference. PSD in surgical patients was found to result in physical discomfort, psychological disorder, impaired neurocognitive function, and prolonged recovery. A clearly defined and distinguishable concept of PSD in surgical patients was achieved through concept analysis, which provides a conceptual basis for future development in both clinical practice and related research.
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Affiliation(s)
- Xi Yuan
- The First Affiliated Hospital of Soochow University, Soochow, China
| | - Zhengyu Ju
- The First Affiliated Hospital of Soochow University, Soochow, China
| | - Xinmei Zhang
- The First Affiliated Hospital of Soochow University, Soochow, China
| | - Xuequn Yin
- The First Affiliated Hospital of Soochow University, Soochow, China
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Zhu K, Chen S, Qin X, Bai W, Hao J, Xu X, Guo H, Bai H, Yang Z, Wang S, Zhao Z, Ji T, Kong D, Zhang W. Exploring the therapeutic potential of cannabidiol for sleep deprivation-induced hyperalgesia. Neuropharmacology 2024; 249:109893. [PMID: 38428482 DOI: 10.1016/j.neuropharm.2024.109893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/21/2024] [Accepted: 02/26/2024] [Indexed: 03/03/2024]
Abstract
Hyperalgesia resulting from sleep deprivation (SD) poses a significant a global public health challenge with limited treatment options. The nucleus accumbens (NAc) plays a crucial role in the modulation of pain and sleep, with its activity regulated by two distinct types of medium spiny neurons (MSNs) expressing dopamine 1 or dopamine 2 (D1-or D2) receptors (referred to as D1-MSNs and D2-MSNs, respectively). However, the specific involvement of the NAc in SD-induced hyperalgesia remains uncertain. Cannabidiol (CBD), a nonpsychoactive phytocannabinoid, has demonstrated analgesic effects in clinical and preclinical studies. Nevertheless, its potency in addressing this particular issue remains to be determined. Here, we report that SD induced a pronounced pronociceptive effect attributed to the heightened intrinsic excitability of D2-MSNs within the NAc in Male C57BL/6N mice. CBD (30 mg/kg, i.p.) exhibited an anti-hyperalgesic effect. CBD significantly improved the thresholds for thermal and mechanical pain and increased wakefulness by reducing delta power. Additionally, CBD inhibited the intrinsic excitability of D2-MSNs both in vitro and in vivo. Bilateral microinjection of the selective D2 receptor antagonist raclopride into the NAc partially reversed the antinociceptive effect of CBD. Thus, these findings strongly suggested that SD activates NAc D2-MSNs, contributing heightened to pain sensitivity. CBD exhibits antinociceptive effects by activating D2R, thereby inhibiting the excitability of D2-MSNs and promoting wakefulness under SD conditions.
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Affiliation(s)
- Kangsheng Zhu
- Department of Pharmacology of Chinese Materia Medica, Institution of Chinese Integrative Medicine, School of Chinese Integrative Medicine, The Key Laboratory of Neural and Vascular Biology, Ministry of Education, Hebei Medical University, Research Unit of Digestive Tract Microecosystem Pharmacology and Toxicology, Chinese Academy of Medical Sciences, Shijiazhuang, Hebei, 050017, China; Department of Anesthesiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050011, China
| | - Siruan Chen
- Department of Pharmacology of Chinese Materia Medica, Institution of Chinese Integrative Medicine, School of Chinese Integrative Medicine, The Key Laboratory of Neural and Vascular Biology, Ministry of Education, Hebei Medical University, Research Unit of Digestive Tract Microecosystem Pharmacology and Toxicology, Chinese Academy of Medical Sciences, Shijiazhuang, Hebei, 050017, China
| | - Xia Qin
- Department of Pharmacology of Chinese Materia Medica, Institution of Chinese Integrative Medicine, School of Chinese Integrative Medicine, The Key Laboratory of Neural and Vascular Biology, Ministry of Education, Hebei Medical University, Research Unit of Digestive Tract Microecosystem Pharmacology and Toxicology, Chinese Academy of Medical Sciences, Shijiazhuang, Hebei, 050017, China
| | - Wanjun Bai
- Department of Pharmacy, Hebei General Hospital, Shijiazhuang, Hebei, 050051, China
| | - Jie Hao
- Department of Pharmacology of Chinese Materia Medica, Institution of Chinese Integrative Medicine, School of Chinese Integrative Medicine, The Key Laboratory of Neural and Vascular Biology, Ministry of Education, Hebei Medical University, Research Unit of Digestive Tract Microecosystem Pharmacology and Toxicology, Chinese Academy of Medical Sciences, Shijiazhuang, Hebei, 050017, China
| | - Xiaolei Xu
- School of Nursing, Hebei Medical University, Shijiazhuang, Hebei, 050000, China
| | - Han Guo
- Department of Pharmacology of Chinese Materia Medica, Institution of Chinese Integrative Medicine, School of Chinese Integrative Medicine, The Key Laboratory of Neural and Vascular Biology, Ministry of Education, Hebei Medical University, Research Unit of Digestive Tract Microecosystem Pharmacology and Toxicology, Chinese Academy of Medical Sciences, Shijiazhuang, Hebei, 050017, China
| | - Hui Bai
- Department of Cardiac Ultrasound, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050017, China
| | - Zuxiao Yang
- Department of Pharmacology of Chinese Materia Medica, Institution of Chinese Integrative Medicine, School of Chinese Integrative Medicine, The Key Laboratory of Neural and Vascular Biology, Ministry of Education, Hebei Medical University, Research Unit of Digestive Tract Microecosystem Pharmacology and Toxicology, Chinese Academy of Medical Sciences, Shijiazhuang, Hebei, 050017, China
| | - Sheng Wang
- Hebei Key Laboratory of Neurophysiology, Shijiazhuang, Hebei, 050017, China
| | - Zongmao Zhao
- Department of Neurosurgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050011, China
| | - Tengfei Ji
- Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100050, China
| | - Dezhi Kong
- Department of Pharmacology of Chinese Materia Medica, Institution of Chinese Integrative Medicine, School of Chinese Integrative Medicine, The Key Laboratory of Neural and Vascular Biology, Ministry of Education, Hebei Medical University, Research Unit of Digestive Tract Microecosystem Pharmacology and Toxicology, Chinese Academy of Medical Sciences, Shijiazhuang, Hebei, 050017, China.
| | - Wei Zhang
- Department of Pharmacology of Chinese Materia Medica, Institution of Chinese Integrative Medicine, School of Chinese Integrative Medicine, The Key Laboratory of Neural and Vascular Biology, Ministry of Education, Hebei Medical University, Research Unit of Digestive Tract Microecosystem Pharmacology and Toxicology, Chinese Academy of Medical Sciences, Shijiazhuang, Hebei, 050017, China.
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Guo H, Li LH, Lv XH, Su FZ, Chen J, Xiao F, Shi M, Xie YB. Association Between Preoperative Sleep Disturbance and Postoperative Delirium in Elderly: A Retrospective Cohort Study. Nat Sci Sleep 2024; 16:389-400. [PMID: 38646462 PMCID: PMC11032121 DOI: 10.2147/nss.s452517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 04/04/2024] [Indexed: 04/23/2024] Open
Abstract
Purpose Postoperative sleep disturbance, characterized by diminished postoperative sleep quality, is a risk factor for postoperative delirium (POD); however, the association between pre-existing sleep disturbance and POD remains unclear. This study aimed to evaluate the association between preoperative sleep disturbance and POD in elderly patients after non-cardiac surgery. Patients and methods This retrospective cohort study was conducted at a single center and enrolled 489 elderly patients who underwent surgery between May 1, 2020, and March 31, 2021. Patients were divided into the sleep disorder (SD) and non-sleep disorder (NSD) groups according to the occurrence of one or more symptoms of insomnia within one month or sleep- Numerical Rating Scale (NRS)≥6 before surgery. The primary outcome was the incidence of POD. Propensity score matching analysis was performed between the two groups. Multiple logistic regression analysis was performed to identify the risk factors for POD. Results In both the unmatched cohort (16.0% vs 6.7%, P=0.003) and the matched cohort (17.0% vs 6.2%, P=0.023), the incidence of POD was higher in the SD group than in the NSD group. In addition, the postoperative sleep quality and the VAS score at postoperative 24 h were significantly lower in the SD group than in the NSD group. Multivariate logistic regression analysis indicated that age (Odds Ratio, 1.13 [95% CI: 1.04-1.23], P=0.003) and preoperative sleep disturbance (Odds Ratio, 3.03 [95% CI: 1.09-9.52], P=0.034) were independent risk factors for the development of POD. Conclusion The incidence of POD was higher in patients with pre-existing sleep disturbance than those without it. Whether improving sleep quality for preoperative sleep disturbance may help prevent POD remains to be determined.
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Affiliation(s)
- Hao Guo
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Li-Heng Li
- Department of Anesthesiology, The Guilin Municipal Hospital of Traditional Chinese Medicine, Guangxi, People’s Republic of China
| | - Xiao-Hong Lv
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Feng-Zhi Su
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Jie Chen
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Fei Xiao
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
- Guangxi Key Laboratory of Enhanced Recovery after Surgery for Gastrointestinal Cancer, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Min Shi
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Yu-Bo Xie
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
- Guangxi Key Laboratory of Enhanced Recovery after Surgery for Gastrointestinal Cancer, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
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Bertram W, Penfold C, Glynn J, Johnson E, Burston A, Rayment D, Howells N, White S, Wylde V, Gooberman-Hill R, Blom A, Whale K. REST: a preoperative tailored sleep intervention for patients undergoing total knee replacement - feasibility study for a randomised controlled trial. BMJ Open 2024; 14:e078785. [PMID: 38508646 PMCID: PMC10961562 DOI: 10.1136/bmjopen-2023-078785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 02/19/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVES To test the feasibility of a randomised controlled trial (RCT) of a novel preoperative tailored sleep intervention for patients undergoing total knee replacement. DESIGN Feasibility two-arm two-centre RCT using 1:1 randomisation with an embedded qualitative study. SETTING Two National Health Service (NHS) secondary care hospitals in England and Wales. PARTICIPANTS Preoperative adult patients identified from total knee replacement waiting lists with disturbed sleep, defined as a score of 0-28 on the Sleep Condition Indicator questionnaire. INTERVENTION The REST intervention is a preoperative tailored sleep assessment and behavioural intervention package delivered by an Extended Scope Practitioner (ESP), with a follow-up phone call 4 weeks postintervention. All participants received usual care as provided by the participating NHS hospitals. OUTCOME MEASURES The primary aim was to assess the feasibility of conducting a full trial. Patient-reported outcomes were assessed at baseline, 1-week presurgery, and 3 months postsurgery. Data collected to determine feasibility included the number of eligible patients, recruitment rates and intervention adherence. Qualitative work explored the acceptability of the study processes and intervention delivery through interviews with ESPs and patients. RESULTS Screening packs were posted to 378 patients and 57 patients were randomised. Of those randomised, 20 had surgery within the study timelines. An appointment was attended by 25/28 (89%) of participants randomised to the intervention. Follow-up outcomes measures were completed by 40/57 (70%) of participants presurgery and 15/57 (26%) postsurgery. Where outcome measures were completed, data completion rates were 80% or higher for outcomes at all time points, apart from the painDETECT: 86% complete at baseline, 72% at presurgery and 67% postsurgery. Interviews indicated that most participants found the study processes and intervention acceptable. CONCLUSIONS This feasibility study has demonstrated that with some amendments to processes and design, an RCT to evaluate the clinical and cost-effectiveness of the REST intervention is feasible. TRIAL REGISTRATION NUMBER ISRCTN14233189.
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Affiliation(s)
- Wendy Bertram
- Musculoskeletal Research Unit, University of Bristol Medical School, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
| | - Chris Penfold
- Musculoskeletal Research Unit, University of Bristol Medical School, Bristol, UK
| | - Joel Glynn
- University of Bristol Medical School, Bristol, UK
| | - Emma Johnson
- University of Bristol Medical School, Bristol, UK
| | - Amanda Burston
- Musculoskeletal Research Unit, University of Bristol Medical School, Bristol, UK
| | | | | | - Simon White
- Cardiff and Vale University Health Board, Cardiff, UK
| | - Vikki Wylde
- Musculoskeletal Research Unit, University of Bristol Medical School, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
| | - Rachael Gooberman-Hill
- NIHR Bristol Biomedical Research Centre, Bristol, UK
- University of Bristol Medical School, Bristol, UK
| | | | - Katie Whale
- Musculoskeletal Research Unit, University of Bristol Medical School, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
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Wang L, Qin F, Zhen L, Li R, Tao S, Li G. Development of a nomogram for predicting acute pain among patients after abdominal surgery: A prospective observational study. J Clin Nurs 2024. [PMID: 38379369 DOI: 10.1111/jocn.17031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/29/2023] [Accepted: 01/15/2024] [Indexed: 02/22/2024]
Abstract
AIMS To develop a nomogram to provide a screening tool for recognising patients at risk of post-operative pain undergoing abdominal operations. BACKGROUND Risk prediction models for acute post-operative pain can allow initiating prevention strategies, which are valuable for post-operative pain management and recovery. Despite the increasing number of studies on risk factors, there were inconsistent findings across different studies. In addition, few studies have comprehensively explored predictors of post-operative acute pain and built prediction models. DESIGN A prospective observational study. METHODS A total of 352 patients undergoing abdominal operations from June 2022 to December 2022 participated in this investigation. A nomogram was developed for predicting the probability of acute pain after abdominal surgery according to the results of binary logistic regression. The nomogram's predictive performance was assessed by discrimination and calibration. Internal validation was performed via Bootstrap with 1000 re-samplings. RESULTS A total of 139 patients experienced acute post-operative pain following abdominal surgery, with an incidence of 39.49%. Age <60, marital status (unmarried, divorced, or widowed), consumption of intraoperative remifentanil >2 mg, indwelling of drainage tubes, poor quality sleep, high pain catastrophizing, low pain self-efficacy, and PCIA not used were predictors of inadequate pain control in patients after abdominal surgery. Using these variables, we developed a nomogram model. All tested indicators showed that the model has reliable discrimination and calibration. CONCLUSIONS This study established an online dynamic predictive model that can offer an individualised risk assessment of acute pain after abdominal surgery. Our model had good differentiation and calibration and was verified internally as a useful tool for risk assessment. RELEVANCE TO CLINICAL PRACTICE The constructed nomogram model could be a practical tool for predicting the risk of experiencing acute post-operative pain in patients undergoing abdominal operations, which would be helpful to realise personalised management and prevention strategies for post-operative pain. REPORTING METHOD The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines were adopted in this study. PATIENT OR PUBLIC CONTRIBUTION Before the surgery, research group members visited the patients who met the inclusion criteria and explained the purpose and scope of the study to them. After informed consent, they completed the questionnaire. The patients' pain scores (VAS) were regularly assessed and documented by the bedside nurse for the first 3 days following surgery. Other information was obtained from medical records.
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Affiliation(s)
- Ling Wang
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Fang Qin
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Li Zhen
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Ruihua Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Siqi Tao
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Guoxin Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
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Chen D, Yang H, Yang L, Tang Y, Zeng H, He J, Chen W, Qu Y, Hu Y, Xu Y, Liu D, Song H, Li Q. Preoperative psychological symptoms and chronic postsurgical pain: analysis of the prospective China Surgery and Anaesthesia Cohort study. Br J Anaesth 2024; 132:359-371. [PMID: 37953200 DOI: 10.1016/j.bja.2023.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Both preoperative psychological symptoms and chronic postsurgical pain (CPSP) are prevalent conditions and major concerns among surgery patients, with inconclusive associations. METHODS Based on the China Surgery and Anaesthesia Cohort (CSAC), we recruited 8350 surgery patients (40-65 yr old) from two medical centres between July 2020 and March 2023. Patients with preoperative psychological symptoms (i.e. anxiety, depression, stress reaction, and poor sleep quality) were identified using corresponding well-established scales. We then examined the associations of individual preoperative psychological symptoms and major patterns of preoperative psychological symptoms (identified by k-means clustering analysis) with CPSP, and different pain trajectories within 3 months. Lastly, mediation analyses were conducted to elucidate the mediating role of surgery/anaesthesia-related factors and the presence of 1-month postoperative psychological symptoms on the studied associations. RESULTS We included 1302 (1302/8350, 15.6%) CPSP patients. When analysed separately, all studied preoperative psychological symptoms were associated with increased CPSP risk, with the most pronounced odds ratio noted for anxiety (1.52, 95% confidence interval [CI] 1.23-1.86). Compared with patients clustered in the minor symptom group, excess risk of CPSP and experiencing an increasing pain trajectory was increased among patients with preoperative psychological symptoms featured by sleep disturbances (odds ratio=1.46, 95% CI 1.25-1.70 for CPSP and 1.58, 95% CI 1.20-2.08 for increasing pain trajectory) and multiple psychological symptoms (1.84 [95% CI 1.48-2.28] and 4.34 [95% CI 3.20-5.88]). Mediation analyses revealed acute/subacute postsurgical pain and psychological symptoms existing 1 month after surgery as notable mediators of the observed associations. CONCLUSIONS The presence of preoperative psychological symptoms might individually or jointly increase the risk of chronic postsurgical pain or experiencing deterioration in pain trajectory. Interventions for managing acute/subacute postsurgical pain and psychological symptoms at 1 month after surgery might help reduce such risk. CLINICAL TRIAL REGISTRATION ChiCTR2000034039.
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Affiliation(s)
- Dongxu Chen
- Department of Anaesthesiology and West China Biomedical Big Data Centre, West China Hospital, Sichuan University, Chengdu, China; Laboratory of Anaesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, China; West China Biomedical Big Data Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Huazhen Yang
- West China Biomedical Big Data Centre, West China Hospital, Sichuan University, Chengdu, China; Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Lei Yang
- Department of Anaesthesiology and West China Biomedical Big Data Centre, West China Hospital, Sichuan University, Chengdu, China; Laboratory of Anaesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuling Tang
- Department of Anaesthesiology and West China Biomedical Big Data Centre, West China Hospital, Sichuan University, Chengdu, China; Laboratory of Anaesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Huolin Zeng
- Department of Anaesthesiology and West China Biomedical Big Data Centre, West China Hospital, Sichuan University, Chengdu, China; Laboratory of Anaesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Junhui He
- Department of Anaesthesiology and West China Biomedical Big Data Centre, West China Hospital, Sichuan University, Chengdu, China; Laboratory of Anaesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Wenwen Chen
- West China Biomedical Big Data Centre, West China Hospital, Sichuan University, Chengdu, China; Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Yuanyuan Qu
- West China Biomedical Big Data Centre, West China Hospital, Sichuan University, Chengdu, China; Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Yao Hu
- West China Biomedical Big Data Centre, West China Hospital, Sichuan University, Chengdu, China; Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Yueyao Xu
- West China Biomedical Big Data Centre, West China Hospital, Sichuan University, Chengdu, China; Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Di Liu
- West China Biomedical Big Data Centre, West China Hospital, Sichuan University, Chengdu, China; Med-X Center for Informatics, Sichuan University, Chengdu, China; Sichuan University - Pittsburgh Institute, Sichuan University, Chengdu, China
| | - Huan Song
- West China Biomedical Big Data Centre, West China Hospital, Sichuan University, Chengdu, China; Med-X Center for Informatics, Sichuan University, Chengdu, China; Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland.
| | - Qian Li
- Department of Anaesthesiology and West China Biomedical Big Data Centre, West China Hospital, Sichuan University, Chengdu, China; Laboratory of Anaesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, China.
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8
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Yang L, Chen W, Chen D, He J, Wang J, Qu Y, Yang Y, Tang Y, Zeng H, Deng W, Liu H, Huang L, Li X, Du L, Liu J, Li Q, Song H. Cohort profile: the China surgery and anesthesia cohort (CSAC). Eur J Epidemiol 2024; 39:207-218. [PMID: 38198037 PMCID: PMC10904502 DOI: 10.1007/s10654-023-01083-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 11/12/2023] [Indexed: 01/11/2024]
Abstract
The China Surgery and Anaesthesia Cohort (CSAC) study was launched in July 2020 and is an ongoing prospective cohort study recruiting patients aged 40-65 years who underwent elective surgeries with general anaesthesia across four medical centres in China. The general objective of the CSAC study is to improve our understanding of the complex interaction between environmental and genetic components as well as to determine their effects on a wide range of interested surgery/anaesthesia-related outcomes. To achieve this goal, we collected enriched phenotypic data, e.g., sociodemographic characteristics, lifestyle factors, perioperative neuropsychological changes, anaesthesia- and surgery-related complications, and medical conditions, at recruitment, as well as through both active (at 1, 3, 7 days and 1, 3, 6, 12 months after surgery) and passive (for more than 1 year after surgery) follow-up assessments. We also obtained omics data from blood samples. In addition, COVID-19-related information was collected from all participants since January 2023, immediately after COVID-19 restrictions were eased in China. As of July 18, 2023, 12,766 participants (mean age = 52.40 years, 57.93% were female) completed baseline data collection (response rate = 94.68%), among which approximately 70% donated blood and hair samples. The follow-up rates within 12 months after surgery were > 92%. Our initial analyses have demonstrated the incidence of and risk factors for chronic postsurgical pain (CPSP) and postoperative cognitive dysfunction (POCD) among middle-aged Chinese individuals, which may prompt further mechanistic exploration and facilitate the development of effective interventions for preventing those conditions. Additional studies, such as genome-wide association analyses for identifying the genetic determinants of CPSP and POCD, are ongoing, and their findings will be released in the future.
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Affiliation(s)
- Lei Yang
- Department of Anesthesiology and West China Biomedical Big Data Center, West China Hospital, Sichuan University, Guo Xue Lane 37, Chengdu, China
| | - Wenwen Chen
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Guo Xue Lane 37, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Dongxu Chen
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Junhui He
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Junren Wang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Guo Xue Lane 37, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Yuanyuan Qu
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Guo Xue Lane 37, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Yao Yang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Guo Xue Lane 37, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Yuling Tang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Huolin Zeng
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Wanxin Deng
- Surgical Anesthesia Center, The First People's Hospital of Longquanyi District, Chengdu, China
| | - Hongxin Liu
- Surgical Anesthesia Center, The First People's Hospital of Longquanyi District, Chengdu, China
| | - Lining Huang
- Department of Anesthesiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xuze Li
- Department of Anesthesiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lei Du
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jin Liu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Qian Li
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China.
| | - Huan Song
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Guo Xue Lane 37, Chengdu, China.
- Med-X Center for Informatics, Sichuan University, Chengdu, China.
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland.
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.
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9
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Liu Y, Li Y, Liu M, Zhang M, Wang J, Li J. Effects of Acupuncture-Point Stimulation on Perioperative Sleep Disorders: A Systematic Review with Meta-Analysis and Trial Sequential Analysis. Int J Clin Pract 2024; 2024:6763996. [PMID: 38222288 PMCID: PMC10783988 DOI: 10.1155/2024/6763996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/01/2023] [Accepted: 12/27/2023] [Indexed: 01/16/2024] Open
Abstract
Background Perioperative sleep disorders exert a severe adverse impact on postoperative recovery. Recently, some observational studies reported that acupuncture-point stimulation (APS) provided benefits for promoting perioperative sleep quality. However, the effects of APS on perioperative sleep disorders following general anesthesia have not been thoroughly assessed by any systematic study and meta-analysis. Therefore, we conducted this systematic review and meta-analysis to reveal the effects of APS on perioperative sleep disorders. Methods Eight databases (Chinese: CNKI, VIP, CBM, and Wanfang; English: PubMed, Embase, Web of Science, and Cochrane Library) were thoroughly searched to find randomized controlled trials (RCTs) that indicated a link between APS and the occurrence of perioperative sleep disorders. We applied RevMan 5.4 (Cochrane Collaboration) and Stata 16.0 (Stata Corp) to conduct our meta-analysis. In addition, the trial sequential analysis (TSA) tool was utilized to estimate the validity and reliability of the data. Results In this study, nine RCTs with 719 patients were conducted. Compared to the control group, APS significantly improved perioperative subjective sleep quality (SMD: -1.36; 95% CI: -1.71 to -1.01; P < 0.00001). Besides, it increased perioperative TST (preoperative period MD = 24.29, 95% CI: 6.4 to 42.18, P = 0.0008; postoperative period MD = 45.86, 95% CI: 30.00 to 61.71, P < 0.00001) and SE (preoperative MD = 3.62, 95% CI: 2.84 to 4.39, P < 0.00001; postoperative MD = 6.43, 95% CI: 0.95 to 11.73, P < 0.00001). The consequence of trial sequential analysis further confirmed the reliability of our meta-analysis results. Conclusion According to the currently available evidence, APS could effectively improve perioperative sleep quality and play an essential role in decreasing the incidence of perioperative sleep disorders.
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Affiliation(s)
- Ying Liu
- Department of Anaesthesiology, Hebei General Hospital, Shijiazhuang, China
- Hebei Medical University, Shijiazhuang, China
| | - Yi Li
- Department of Anaesthesiology, Hebei General Hospital, Shijiazhuang, China
| | - Meinv Liu
- Department of Anaesthesiology, Hebei General Hospital, Shijiazhuang, China
| | - Meng Zhang
- Department of Anaesthesiology, Hebei General Hospital, Shijiazhuang, China
| | - Jing Wang
- Department of Anaesthesiology, Hebei General Hospital, Shijiazhuang, China
| | - Jianli Li
- Department of Anaesthesiology, Hebei General Hospital, Shijiazhuang, China
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10
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Mekkawy KL, Rodriguez HC, Gosthe RG, Corces A, Roche MW. Immediate Postoperative Zolpidem Use Increases Risk of Falls and Implant Complication Rates Following Total Hip Arthroplasty: A Retrospective Case-Control Analysis. J Arthroplasty 2024; 39:169-173.e1. [PMID: 37562745 DOI: 10.1016/j.arth.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/31/2023] [Accepted: 08/03/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Zolpidem is the most widely used hypnotic in the United States and has known side effects. However, the morbidity of zolpidem use following total hip arthroplasty (THA) is not well-defined. Thus, the aim of this study was to assess the effects that zolpidem use has on medical and implant complications, falls, lengths of stay, and medical utilizations following THA. METHODS A retrospective query of a nationwide insurance claims database was conducted from 2010 to 2020. All cases of THA and hypnotic use were identified using procedural and national drug codes. Patients who were prescribed zolpidem within 90 days of surgery were matched to hypnotic naive patients 1:5 based on demographic and comorbidity profiles. The 90-day medical complications, falls, fragility fractures, costs, and readmission rates, as well as 2-year implant complications were compared between cohorts. A total of 50,328 zolpidem patients were matched to 251,286 hypnotic naive patients. RESULTS The zolpidem group had significantly higher rates of medical complications, falls, and fragility fractures when compared to the hypnotic-naive group. The zolpidem group had significantly higher rates of dislocation, mechanical loosening, and periprosthetic fracture. Likewise, healthcare utilization was significantly greater in the zolpidem group. CONCLUSION Zolpidem use following THA is associated with significant risk of medical and implant complications, as well as fall risks, increased costs, lengths of stay, and readmissions. The findings of this study may affect discussions between orthopaedic surgeons and their patients on the benefits of sleep quality in their recovery versus the incurred risks of zolpidem use. LEVEL OF EVIDENCE III, retrospective case-control study.
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Affiliation(s)
- Kevin L Mekkawy
- Holy Cross Orthopedic Research Institute, Holy Cross Health, Fort Lauderdale, Florida; Hospital for Special Surgery, West Palm Beach, Florida; Department of Surgery, South Shore Universtiy Hospital, Bay Shore, New York
| | - Hugo C Rodriguez
- Hospital for Special Surgery, West Palm Beach, Florida; Larkin Community Hospital, Department of Orthopaedic Surgery, South Miami, Florida
| | - Raul G Gosthe
- Holy Cross Orthopedic Research Institute, Holy Cross Health, Fort Lauderdale, Florida
| | - Arturo Corces
- Larkin Community Hospital, Department of Orthopaedic Surgery, South Miami, Florida
| | - Martin W Roche
- Holy Cross Orthopedic Research Institute, Holy Cross Health, Fort Lauderdale, Florida; Hospital for Special Surgery, West Palm Beach, Florida
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11
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Wang Y, Jiang Y, Chen T, Xia Q, Wang X, Lv Q, Li X, Shao Y. Prediction of risk factors of sleep disturbance in patients undergoing total hip arthroplasty. Sleep Biol Rhythms 2024; 22:85-91. [PMID: 38476846 PMCID: PMC10899975 DOI: 10.1007/s41105-023-00484-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 08/06/2023] [Indexed: 03/14/2024]
Abstract
The purpose of this study was to assess sleep quality in patients undergoing total hip arthroplasty (THA) from preoperatively to 12 weeks postoperatively and to establish a risk predictor for postoperative sleep disturbance to enable early care and intervention. A self-designed data collection form was used. Patients were assessed preoperatively and at 5 postoperative time points using visual analog scale (VAS) for pain, sleep quality and neuropsychological status with the following assessment tools: the Chinese versions of the Pittsburgh Sleep Quality Index (CPSQI), the Epworth Sleepiness Scale (CESS), the Zung Self-Rating Anxiety Scale (ZSAS) and the Epidemiological Studies Depression Scale (CESD). Univariate and multivariate logistic regression analysis was used for the identification of risk factors for postoperative sleep disturbance. The receiver operating characteristic (ROC) curve was plotted to evaluate the regression model. Of the 290 eligible patients, 193 (133 women) were included in the study. There was a 60.6% prevalence of preoperative sleep disturbance. The CPSQI score increased significantly at 2 weeks postoperatively compared to preoperative baseline, but appeared to decrease at 4 weeks postoperatively. Multivariate logistic regression analysis showed that pain (VAS score: OR = 1.202 [95% CI = 1.002-1.446, P < 0.05]), daytime sleepiness (CESS score: OR = 1.134 [95% CI = 1.015-1.267, P < 0.05]) and anxiety (ZSAS score: OR = 1.396 [95% CI = 1.184-1.645, P < 0.001]) were risk factors associated with postoperative sleep disturbance at 2 weeks. The ROC curve showed that the AUC was 0.762, the sensitivity was 83.19% and the specificity was 64.86%. Postoperative sleep disturbance is highly prevalent in the first 2 weeks after THA. The risk prediction model constructed according to the above factors has good discriminant ability for the risk prediction of sleep disturbance after THA. The use of this risk prediction model can improve the recognition of patients and medical providers and has good ability to guide clinical nursing observation and early screening of sleep disturbance after THA.
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Affiliation(s)
- YuZhu Wang
- Department of Pharmacy, Zhongshan Hospital Fudan University, 180# Feng Lin Road, Shanghai, 200032 Republic of China
| | - YunQi Jiang
- Department of Orthopedics, Zhongshan Hospital Fudan University, 180# Feng Lin Road, Shanghai, 200032 Republic of China
| | - TingTing Chen
- Department of Pharmacy, Zhongshan Hospital Fudan University, 180# Feng Lin Road, Shanghai, 200032 Republic of China
| | - Qing Xia
- Department of Orthopedics, Zhongshan Hospital Fudan University, 180# Feng Lin Road, Shanghai, 200032 Republic of China
| | - XiaoFeng Wang
- Department of Orthopedics, Zhongshan Hospital Fudan University, 180# Feng Lin Road, Shanghai, 200032 Republic of China
| | - QianZhou Lv
- Department of Pharmacy, Zhongshan Hospital Fudan University, 180# Feng Lin Road, Shanghai, 200032 Republic of China
| | - XiaoYu Li
- Department of Pharmacy, Zhongshan Hospital Fudan University, 180# Feng Lin Road, Shanghai, 200032 Republic of China
| | - YunChao Shao
- Department of Orthopedics, Zhongshan Hospital Fudan University, 180# Feng Lin Road, Shanghai, 200032 Republic of China
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12
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Hamilton KR, Hughes AJ, Campbell CM, Owens MA, Pester BD, Meints SM, Taylor JL, Edwards RR, Haythornthwaite JA, Smith MT. Perioperative insomnia trajectories and functional outcomes after total knee arthroplasty. Pain 2023; 164:2769-2779. [PMID: 37343150 PMCID: PMC10733550 DOI: 10.1097/j.pain.0000000000002977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 05/09/2023] [Indexed: 06/23/2023]
Abstract
ABSTRACT Longitudinal total knee arthroplasty (TKA) studies indicate that a substantial percentage of patients continue to experience clinically significant pain and functional impairment after surgery. Insomnia has been associated with poorer surgical outcomes; however, previous work has largely focused on long-term postsurgical insomnia. This study builds on previous work by examining sleep and pain outcomes about perioperative insomnia trajectories. Insomnia symptoms (using the Insomnia Severity Index) during the acute perioperative period (2 weeks pre-TKA to 6 weeks post-TKA) were used to classify participants into perioperative insomnia trajectories: (1) No Insomnia (ISI < 8), (2) New Insomnia (baseline < 8; postoperative ≥ 8 or ≥6-point increase), (3) Improved Insomnia (baseline ≥ 8, postoperative < 8 or ≥6-point decrease), and (4) Persistent Insomnia (ISI ≥ 8). Insomnia, pain, and physical functioning were assessed in participants with knee osteoarthritis (n = 173; M age = 65 ± 8.3, 57.8% female) at 5 time points: 2 weeks pre-TKA, post-TKA: 6 weeks, 3 months, 6 months, and 12 months. Significant main effects were seen for insomnia trajectory and time, and trajectory-by-time interactions for postoperative insomnia, pain severity, and physical functioning ( P' s < 0.05). The Persistent Insomnia trajectory had the worst postoperative pain at all follow-ups and marked insomnia and physical functioning impairment post-TKA ( P' s < 0.05). The New Insomnia trajectory had notable long-term insomnia (6 weeks to 6 months) and acute (6 weeks) postoperative pain and physical functioning ( P' s < 0.05). Findings indicated a significant relationship between perioperative insomnia trajectory and postoperative outcomes. Results of this study suggest that targeting presurgical insomnia and preventing the development of acute postoperative insomnia may improve long-term postoperative outcomes, with an emphasis on persistent perioperative insomnia due to poorer associated outcomes.
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Affiliation(s)
- Katrina R. Hamilton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Abbey J. Hughes
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Claudia M. Campbell
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael A. Owens
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Bethany D. Pester
- Department of Anesthesiology & Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - Samantha M. Meints
- Department of Anesthesiology & Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - Janiece L. Taylor
- Johns Hopkins Center for Innovative Care in Aging, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Robert R. Edwards
- Department of Anesthesiology & Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - Jennifer A. Haythornthwaite
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael T. Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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13
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Rosenberger DC, Segelcke D, Pogatzki-Zahn EM. Mechanisms inherent in acute-to-chronic pain after surgery - risk, diagnostic, predictive, and prognostic factors. Curr Opin Support Palliat Care 2023; 17:324-337. [PMID: 37696259 DOI: 10.1097/spc.0000000000000673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
PURPOSE OF REVIEW Pain is an expected consequence of a surgery, but it is far from being well controlled. One major complication of acute pain is its risk of persistency beyond healing. This so-called chronic post-surgical pain (CPSP) is defined as new or increased pain due to surgery that lasts for at least 3 months after surgery. CPSP is frequent, underlies a complex bio-psycho-social process and constitutes an important socioeconomic challenge with significant impact on patients' quality of life. Its importance has been recognized by its inclusion in the eleventh version of the ICD (International Classification of Diseases). RECENT FINDINGS Evidence for most pharmacological and non-pharmacological interventions preventing CPSP is inconsistent. Identification of associated patient-related factors, such as psychosocial aspects, comorbidities, surgical factors, pain trajectories, or biomarkers may allow stratification and selection of treatment options based on underlying individual mechanisms. Consequently, the identification of patients at risk and implementation of individually tailored, preventive, multimodal treatment to reduce the risk of transition from acute to chronic pain is facilitated. SUMMARY This review will give an update on current knowledge on mechanism-based risk, prognostic and predictive factors for CPSP in adults, and preventive and therapeutic approaches, and how to use them for patient stratification in the future.
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Affiliation(s)
- Daniela C Rosenberger
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
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14
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Owens MA, Mun CJ, Hamilton KR, Hughes A, Campbell CM, Edwards RR, Smith MT. Presurgical sleep and pain behaviors predict insomnia symptoms and pain after total knee arthroplasty: a 12-month longitudinal, observational study. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:1224-1233. [PMID: 37578438 PMCID: PMC10628977 DOI: 10.1093/pm/pnad106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 05/31/2023] [Accepted: 06/06/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE Up to 40% of individuals who undergo total knee arthroplasty (TKA) experience some degree of pain following surgery. Presurgical insomnia has been identified as a predictor of postsurgical pain; however, modifiable presurgical behaviors related to insomnia have received minimal attention. The objective of the present study was to develop a 2-item sleep and pain behavior scale (SP2) to investigate a maladaptive sleep and pain behavior and is a secondary analysis of a larger, parent study. METHODS Patients (N = 109) completed SP2 at baseline and 12 months and questionnaires assessing sleep and pain at baseline (pre-TKA), 6 weeks, 3, 6, and 12 months post-TKA. SP2 demonstrated adequate preliminary psychometric properties. RESULTS As hypothesized, even after controlling for baseline insomnia, pain, anxiety and other covariates, baseline SP2 predicted insomnia symptom severity at 6 weeks (β = 2.828), 3 (β = 2.140), 6 (β = 2.962), and 12 months (β = 1.835) and pain at 6 weeks (β = 6.722), 3 (β = 5.536), and 6 months (β = 7.677) post-TKA (P < .05). Insomnia symptoms at 6-weeks post-TKA mediated the effect of presurgical SP2 on pain at 3 (95% CI: 0.024-7.054), 6 (95%CI: 0.495-5.243), and 12 months (95% CI: 0.077-2.684). CONCLUSIONS This provides preliminary evidence that patients who cope with pain by retiring to their bed and bedroom have higher rates of post-surgical insomnia and pain and supports efforts to target this maladaptive sleep and pain behavior to reduce postsurgical pain.
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Affiliation(s)
- Michael A Owens
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224, United States
| | - Chung Jung Mun
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224, United States
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ 85004, United States
| | - Katrina R Hamilton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224, United States
| | - Abbey Hughes
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224, United States
| | - Claudia M Campbell
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224, United States
| | | | - Michael T Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224, United States
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15
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Pitaro NL, Herrera MM, Alasadi H, Shah KC, Kiani SN, Stern BZ, Zubizarreta N, Chen DD, Hayden BL, Poeran J, Moucha CS. Sleep Disturbance Trends in the Short-Term Postoperative Period for Patients Undergoing Total Joint Arthroplasty. J Am Acad Orthop Surg 2023; 31:e859-e867. [PMID: 37523691 DOI: 10.5435/jaaos-d-23-00059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/21/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Patients undergoing total joint arthroplasty (TJA) often experience preoperative/postoperative sleep disturbances. Although sleep quality generally improves > 6 months after surgery, patterns of sleep in the short-term postoperative period are poorly understood. This study sought to (1) characterize sleep disturbance patterns over the 3-month postoperative period and (2) investigate clinical and sociodemographic factors associated with 3-month changes in sleep. METHODS This retrospective analysis of prospectively collected data included 104 primary elective TJA patients. Patients were administered the PROMIS Sleep Disturbance questionnaire preoperatively and at 2 weeks, 6 weeks, and 3 months postoperatively. Median sleep scores were compared between time points using Wilcoxon signed-rank tests, stratified by preoperative sleep impairment. A multivariable logistic regression model identified factors associated with 3-month clinically improved sleep. RESULTS The percentage of patients reporting sleep within normal limits increased over time: 54.8% preoperatively and 58.0%, 62.5%, and 71.8% at 2 weeks, 6 weeks, and 3 months post-TJA, respectively. Patients with normal preoperative sleep experienced a transient 4.7-point worsening of sleep at 2 weeks ( P = 0.003). For patients with moderate/severe preoperative sleep impairment, sleep significantly improved by 5.4 points at 2 weeks ( P = 0.002), with improvement sustained at 3 months. In multivariable analysis, patients undergoing total hip arthroplasty (versus knee; OR: 3.47, 95% CI: 1.06 to 11.32, P = 0.039) and those with worse preoperative sleep scores (OR: 1.13, 95% CI: 1.04 to 1.23, P = 0.003) were more likely to achieve clinically improved sleep from preoperatively to 3 months postoperatively. DISCUSSION Patients experience differing patterns in postoperative sleep changes based on preoperative sleep disturbance. Hip arthroplasty patients are also more likely to experience clinically improved sleep by 3 months compared with knee arthroplasty patients. These results may be used to counsel patients on postoperative expectations and identify patients at greater risk of impaired postoperative sleep. STUDY DESIGN Retrospective analysis of prospectively collected data.
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Affiliation(s)
- Nicholas L Pitaro
- From the Leni and Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY (Pitaro, Herrera, Alasadi, Shah, Kiani, Stern, Zubizarreta, Chen, Hayden, Poeran, and Moucha), the Department of Population Health Science and Policy, Institute for Health Care Delivery Science, Icahn School of Medicine at Mount Sinai (Stern, Zubizarreta and Poeran), and the Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY (Poeran)
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16
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Tang S, Jin Y, Hou Y, Wang W, Zhang J, Zhu W, Zhang W, Gu X, Ma Z. Predictors of Chronic Pain in Elderly Patients Undergoing Total Knee and Hip Arthroplasty: A Prospective Observational Study. J Arthroplasty 2023; 38:1693-1699. [PMID: 37142067 DOI: 10.1016/j.arth.2023.04.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 04/10/2023] [Accepted: 04/13/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Chronic postsurgical pain (CPSP) after total knee arthroplasty and total hip arthroplasty (TKA and THA) is an important clinical problem in which many factors play a role. The risk factors for CPSP in elderly individuals are currently unknown. Therefore, our aim was to predict the risk factors for CPSP after TKA and THA and to provide help regarding early screening and interventions for elderly individuals at risk. METHODS In this prospective observational study, we collected and analyzed 177 TKA patients and 80 THA patients. Based on pain results at the 3-month follow-up, they were divided into the no chronic postsurgical pain and CPSP groups, respectively. The preoperative baseline conditions, including pain intensity (Numerical Rating Scale) and sleep quality (Pittsburgh Sleep Quality Index), as well as intraoperative and postoperative factors, were compared. Factors with P < .05 were included in binary regression analyses to establish prediction models for CPSP after TKA and THA. RESULTS The prevalence of CPSP was 20.9% after TKA and 7.5% after THA. The preoperative sleep disorders were an independent risk factor of CPSP after TKA, but no risk factors of CPSP after THA were identified. CONCLUSION This study indicated that the prevalence of CPSP after TKA was significantly higher than after THA, and that preoperative sleep disorders were an independent risk factor for CPSP after TKA, which may aid clinicians in screening people at risk for CPSP for primary prevention.
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Affiliation(s)
- Suhong Tang
- Department of Anesthesiology, Affiliated Drum Tower Hospital, Medical School, Nanjing University, Nanjing, China
| | - Yinan Jin
- Department of Anesthesiology, Affiliated Drum Tower Hospital, Medical School, Nanjing University, Nanjing, China
| | - Yunfan Hou
- Department of Anesthesiology, Affiliated Drum Tower Hospital, Medical School, Nanjing University, Nanjing, China
| | - Wenwen Wang
- Department of Anesthesiology, Affiliated Drum Tower Hospital, Medical School, Nanjing University, Nanjing, China
| | - Jinwei Zhang
- Department of Anesthesiology, Affiliated Drum Tower Hospital, Medical School, Nanjing University, Nanjing, China
| | - Wei Zhu
- Department of Anesthesiology, Affiliated Drum Tower Hospital, Medical School, Nanjing University, Nanjing, China
| | - Wei Zhang
- Department of Anesthesiology, Affiliated Drum Tower Hospital, Medical School, Nanjing University, Nanjing, China
| | - Xiaoping Gu
- Department of Anesthesiology, Affiliated Drum Tower Hospital, Medical School, Nanjing University, Nanjing, China
| | - Zhengliang Ma
- Department of Anesthesiology, Affiliated Drum Tower Hospital, Medical School, Nanjing University, Nanjing, China
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17
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Vitale JA, Banfi G, Viganò M, Negrini F. How do patients sleep after orthopaedic surgery? Changes in objective sleep parameters and pain in hospitalized patients undergoing hip and knee arthroplasty. INTERNATIONAL ORTHOPAEDICS 2023:10.1007/s00264-023-05862-2. [PMID: 37300562 PMCID: PMC10344973 DOI: 10.1007/s00264-023-05862-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE The aim of this observational cohort study was to assess actigraphy-based sleep characteristics and pain scores in patients undergoing knee or hip joint replacement and hospitalized for ten days after surgery. METHODS N=20 subjects (mean age: 64.0±10.39 years old) wore the Actiwatch 2 actigraph (Philips Respironics, USA) to record sleep parameters for 11 consecutive days. Subjective scores of pain, by a visual analog scale (VAS), were constantly monitored and the following evaluation time points were considered for the analysis: pre-surgery (PRE), the first (POST1), the fourth (POST4), and the tenth day (POST10) after surgery. RESULTS Sleep quantity and timing parameters did not differ from PRE to POST10, during the hospitalization whereas sleep efficiency and immobility time significantly decreased at POST1 compared to PRE by 10.8% (p=0.003; ES: 0.9, moderate) and 9.4% (p=0.005; ES: 0.86, moderate) respectively, and sleep latency increased by 18.7 min (+320%) at POST1 compared to PRE (p=0.046; ES: 0.70, moderate). Overall, all sleep quality parameters showed a trend of constant improvement from POST1 to POST10. VAS scores were higher in the first day post-surgery (4.58 ± 2.46; p=0.0011 and ES: 1.40, large) compared to POST10 (1.68 ± 1.58). During the time, mean VAS showed significant negative correlations with mean sleep efficiency (r = -0.71; p=0.021). CONCLUSION Sleep quantity and timing parameters were stable during the entire hospitalization whereas sleep quality parameters significantly worsened the first night after surgery compared to the pre-surgery night. High scores of pain were associated with lower overall sleep quality.
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Affiliation(s)
| | - Giuseppe Banfi
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Viganò
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Francesco Negrini
- Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Varese, Italy.
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.
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Deng CM, Meng ZT, Yang J, Zhang CJ, Lu M, Wang YX, Mu DL. Effect of intraoperative remimazolam on postoperative sleep quality in elderly patients after total joint arthroplasty: a randomized control trial. J Anesth 2023:10.1007/s00540-023-03193-5. [PMID: 37055671 PMCID: PMC10390348 DOI: 10.1007/s00540-023-03193-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 04/05/2023] [Indexed: 04/15/2023]
Abstract
PURPOSE To investigate the effect of intraoperative remimazolam sedation on postoperative sleep quality in elderly patients after total joint arthroplasty. METHODS Between May 15, 2021 and March 26, 2022, 108 elderly patients (age ≥ 65 years) who received total joint arthroplasty under neuraxial anesthesia were randomized into remimazolam group (a loading dose of 0.025-0.1 mg/kg and followed by an infusion rate of 0.1-1.0 mg/kg/h till end of surgery) or routine group (sedation was given on patient's requirement by dexmedetomidine 0.2-0.7 μg/kg/h). Primary outcome was the subjective sleep quality at surgery night which was evaluated by Richards Campbell Sleep Questionnaire (RCSQ). Secondary outcomes included RCSQ scores at postoperative first and second nights and numeric rating scale pain intensity within first 3 days after surgery. RESULTS RCSQ score at surgery night was 59 (28, 75) in remimazolam group which was comparable with 53 (28, 67) in routine group (median difference 6, 95% CI - 6 to 16, P = 0.315). After adjustment of confounders, preoperative high Pittsburg sleep quality index was associated worse RCSQ score (P = 0.032), but not remimazolam (P = 0.754). RCSQ score at postoperative first night [69 (56, 85) vs. 70 (54, 80), P = 0.472] and second night [80 (68, 87) vs. 76 (64, 84), P = 0.066] were equivalent between two groups. Safety outcomes were comparable between the two groups. CONCLUSIONS Intraoperative remimazolam did not significantly improve postoperative sleep quality in elderly patients undergoing total joint arthroplasty. But it is proved to be effective and safe for moderate sedation in these patients. CLINICAL TRIAL NUMBER AND REGISTRY URL ChiCTR2000041286 ( www.chictr.org.cn ).
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Affiliation(s)
- Chun-Mei Deng
- Department of Anesthesiology, Peking University First Hospital, No. 8 Xishiku Street, Beijing, 100034, China
| | - Zhao-Ting Meng
- Department of Anesthesiology, Peking University First Hospital, No. 8 Xishiku Street, Beijing, 100034, China
| | - Jing Yang
- Department of Anesthesiology, Cangzhou People's Hospital, Cangzhou, Hebei, China
| | - Cai-Juan Zhang
- Department of Anesthesiology, Tangshan Gongren Hospital, Tangshan, Hebei, China
| | - Min Lu
- Department of Anesthesiology, Cangzhou People's Hospital, Cangzhou, Hebei, China
| | - Yue-Xin Wang
- Department of Anesthesiology, Cangzhou People's Hospital, Cangzhou, Hebei, China
| | - Dong-Liang Mu
- Department of Anesthesiology, Peking University First Hospital, No. 8 Xishiku Street, Beijing, 100034, China.
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19
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Butris N, Tang E, He D, Wang DX, Chung F. Sleep disruption in older surgical patients and its important implications. Int Anesthesiol Clin 2023; 61:47-54. [PMID: 36727706 DOI: 10.1097/aia.0000000000000391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Nina Butris
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Evan Tang
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - David He
- Department of Anesthesia and Pain Management, Mount Sinai Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Dong-Xin Wang
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Frances Chung
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
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20
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Yang D, Yang L, Li Q, Zuo Y. Pharmacotherapy for improving postoperative sleep quality: a protocol for a systematic review and network meta-analysis. BMJ Open 2023; 13:e069724. [PMID: 36822805 PMCID: PMC9950894 DOI: 10.1136/bmjopen-2022-069724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
INTRODUCTION Improving the quality of sleep may promote enhanced recovery in surgical patients. In addition to controversial or conflicting study conclusions, the current clinical studies on pharmacotherapy for improving postoperative sleep quality are mostly limited to evaluating the effect of a specific drug or supplement compared with placebo, and they lack comparisons between drugs or supplements. Therefore, we plan to conduct a systematic review and network meta-analysis to compare the efficacy of different drugs or supplements for improving postoperative sleep quality. METHODS AND ANALYSIS We will search the MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CNKI and Wanfang databases from the dates of their inception to December 2022. We will only include randomised controlled trials, irrespective of language and publication status. The primary outcome is postoperative sleep quality assessed by any validated tools or polysomnography. We will assess the quality of all included trials according to version 2 of the Cochrane risk-of-bias tool for randomised trials. We will use the GeMTC package of R software to perform direct and indirect comparisons via a Bayesian framework using a random-effects model. We will use the Confidence in Network Meta-Analysis approach to evaluate the quality of evidence. ETHICS AND DISSEMINATION Ethical approval is not required for this protocol because we will only be pooling published data. We plan to submit our review to academic conferences and peer-reviewed academic journals. PROSPERO REGISTRATION NUMBER CRD42022356508.
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Affiliation(s)
- Di Yang
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Anaesthesiology, Sichuan Academy of Medical Science and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Lei Yang
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qian Li
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yunxia Zuo
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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21
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Bella A, Diego AM, Finn DP, Roche M. Stress-induced changes in nociceptive responding post-surgery in preclinical rodent models. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2023; 3:1106143. [PMID: 36703943 PMCID: PMC9871907 DOI: 10.3389/fpain.2022.1106143] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023]
Abstract
Chronic post-surgical pain affects up to 85% of individuals depending on the type of surgery, the extent of inflammation, tissue and/or nerve damage. Pre-surgical stress is associated with greater pain intensity, prolonged recovery and is one of the main risk factors for the development of chronic post-surgical pain. Clinically valid animal models provide an important means of examining the mechanisms underlying the effects of stress on post-surgical pain and identifying potential novel therapeutic targets. This review discusses the current data from preclinical animal studies examining the effect of stress on post-surgical pain, the potential underlying mechanisms and gaps in the knowledge that require further investigation.
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Affiliation(s)
- Ariadni Bella
- Physiology, School of Medicine, University of Galway, Galway, Ireland,Centre for Pain Research, University of Galway, Galway, Ireland,Galway Neuroscience Centre, University of Galway, Galway, Ireland
| | - Alba M. Diego
- Centre for Pain Research, University of Galway, Galway, Ireland,Galway Neuroscience Centre, University of Galway, Galway, Ireland,Pharmacology and Therapeutics, School of Medicine, University of Galway, Galway, Ireland
| | - David P. Finn
- Centre for Pain Research, University of Galway, Galway, Ireland,Galway Neuroscience Centre, University of Galway, Galway, Ireland,Pharmacology and Therapeutics, School of Medicine, University of Galway, Galway, Ireland
| | - Michelle Roche
- Physiology, School of Medicine, University of Galway, Galway, Ireland,Centre for Pain Research, University of Galway, Galway, Ireland,Galway Neuroscience Centre, University of Galway, Galway, Ireland,Correspondence: Michelle Roche
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22
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Effects of Preoperative Sleep Disorders on Anesthesia Recovery and Postoperative Pain in Patients Undergoing Laparoscopic Gynecological Surgery under General Anesthesia. Mediators Inflamm 2022; 2022:7998104. [PMID: 36570021 PMCID: PMC9779992 DOI: 10.1155/2022/7998104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/15/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022] Open
Abstract
Sleep disorder dramatically affects people's physical and mental health. Here, we investigated the effect of preoperative sleep disorders on anesthesia recovery and postoperative pain in patients undergoing laparoscopic gynecological surgery under general anesthesia. 120 patients who underwent elective laparoscopic gynecological surgery under general anesthesia in Taizhou Central Hospital from November 2021 to March 2022 were included. According to the score of the Pittsburgh sleep quality index (PSQI), the participating patients were divided into four groups: control group (control group), mild sleep disorder group A (group A), moderate sleep disorder group B (group B), and severe sleep disorder group C (group C), with 30 patients in each group. The changes of mean arterial pressure (MAP) and heart rate (HR) at different time points, operation time, anesthesia time, extubation time, the time when Aldrete score reached 10 points, visual analog score (VAS) serum interleukin-6 (IL-6), interleukin-10 (IL-10), and tumor necrosis factor-α (TNF-α) were compared among different groups. Our study demonstrated that there were no significant differences in MAP and HR among the four groups at the same time points (all P > 0.05). Significant differences in the time of extubation and Aldrete score reaching 10 points had been found among the four groups (all P < 0.001), indicating more sleep disorder induced longer extubation and recovery time. There were significant differences in VAS scores among the four groups at both different and the same time points (all P < 0.001), suggesting more sleep disorders induced more pain in the sufferers. Serum IL-6 levels were significantly higher in the three sleep disorder groups than the control group at 6 h and 24 h after the operation (all P < 0.05), while group C has the highest IL-6 levels as compared to the other group (P = 0.09 and P < 0.001, respectively). At 6 h after operation, serum levels of TNF-α in group C were significantly higher than in the control group (P = 0.044), but no significant differences were found in the other two groups (all P > 0.05). Positive correlation with preoperative PSQI score has been found with the times of extubation, the time of Aldrete score reaching 10 points, the VAS at 1 h, 6 h, and 24 h after operation, the level of serum IL-6 at 1 day before operation and 6 h and 24 h after operation, and the TNF-α at 6 h and 24 h after operation (all P < 0.001). The present study showed that the degree of preoperative sleep disorders could affect the quality of postoperative awakening and pain of patients undergoing laparoscopic gynecological surgery under general anesthesia, which might be associated with the aggravation of inflammatory reactions in the body.
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23
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Varallo G, Giusti EM, Manna C, Castelnuovo G, Pizza F, Franceschini C, Plazzi G. Sleep disturbances and sleep disorders as risk factors for chronic postsurgical pain: a systematic review and meta-analysis. Sleep Med Rev 2022; 63:101630. [DOI: 10.1016/j.smrv.2022.101630] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/28/2022] [Accepted: 03/28/2022] [Indexed: 11/29/2022]
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24
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Bjurström MF, Smith MT, Olmstead R, Irwin MR. Response to: "The relationship between preoperative sleep quality and adverse pain outcomes is still unclear - A comment on Bjurström et al.". Eur J Pain 2022; 26:1177-1178. [PMID: 35212077 DOI: 10.1002/ejp.1927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Martin F Bjurström
- Department of Anesthesiology and Intensive Care, Skåne University Hospital, Lund, Sweden.,Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Norman Cousins Center for Psychoneuroimmunology, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA) Los Angeles, USA
| | - Michael T Smith
- Department of Psychiatry, Behavioral Medicine Division, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard Olmstead
- Norman Cousins Center for Psychoneuroimmunology, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA) Los Angeles, USA
| | - Michael R Irwin
- Norman Cousins Center for Psychoneuroimmunology, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA) Los Angeles, USA
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25
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O'Hagan ET, Gustin S. The relationship between preoperative sleep quality and adverse pain outcomes is still unclear - A Comment on Bjurström et al. Eur J Pain 2022; 26:941-942. [PMID: 35090064 DOI: 10.1002/ejp.1913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Edel T O'Hagan
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Sylvia Gustin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia.,NeuroRecovery Research Hub, School of Psychology, University of New South Wales, Sydney, Australia
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Gao Y, Chen X, Zhou Q, Song J, Zhang X, Sun Y, Yu M, Li Y. Effects of Melatonin Treatment on Perioperative Sleep Quality: A Systematic Review and Meta-Analysis with Trial Sequential Analysis of Randomized Controlled Trials. Nat Sci Sleep 2022; 14:1721-1736. [PMID: 36187327 PMCID: PMC9519126 DOI: 10.2147/nss.s381918] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/14/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Perioperative sleep disorders have attracted much attention due to their high prevalence and severe harm, and the current treatment methods are insufficient. Some randomized controlled trials (RCTs) have produced controversial results on whether melatonin can improve perioperative sleep quality. This review aimed to evaluate the effects of melatonin treatment on perioperative sleep quality. PATIENTS AND METHODS A systematic search of six databases was performed to identify RCTs investigating melatonin and perioperative sleep. The outcomes analyzed were subjective sleep quality, sleep latency (SL), total sleep time (TST), sleep efficiency (SE), the behavior of awakenings and daily naps, and the incidence of poor sleep quality. RevMan 5.4 and Stata 16 software was used for the meta-analysis and sensitivity analysis, and trial sequential analysis was conducted using TSA 0.9.5.10 Beta software. This study was registered in PROSPERO (registration number: CRD42022311378). RESULTS 10 studies containing 725 participants were included. Melatonin improved postoperative subjective sleep quality (SMD: -0.30; 95% CI: [-0.47, -0.14]; P = 0.0004) but not preoperative sleep quality (MD: -2.76; 95% CI: [-10.44, 4.91]; P = 0.48). In the postoperative period, 6mg dose had the best efficacy (SMD: -0.31; 95% CI: [-0.57, -0.04]; P = 0.02). Melatonin increased postoperative TST (P = 0.02) and SE (P = 0.002) and decreased the incidence of postoperative poor sleep quality (P = 0.002) but had no effect on SL (P = 0.11), the number and duration of awakenings (P = 0.28; P=0.55), and the number and duration of daily naps (P = 0.26; P = 0.38). The trial sequential analysis showed that the accumulated Z value crossed both the traditional boundary value and the TSA boundary value, further confirming the stability of the result of the meta-analysis. CONCLUSION Melatonin treatment can improve postoperative sleep quality. A 6mg daily dose of melatonin may have a better beneficial effect, which needs further exploration. This study supports the application of melatonin for improving postoperative sleep quality.
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Affiliation(s)
- Yi Gao
- Chifeng Clinical Medical College of Inner Mongolia Medical University, Chifeng, People's Republic of China
| | - Xuezhao Chen
- First Hospital of Shanxi Medical University, Taiyuan, People's Republic of China
| | - Qi Zhou
- Chifeng Clinical Medical College of Inner Mongolia Medical University, Chifeng, People's Republic of China.,Department of Anesthesiology, Chifeng Municipal Hospital, Chifeng, People's Republic of China
| | - Jiannan Song
- Chifeng Clinical Medical College of Inner Mongolia Medical University, Chifeng, People's Republic of China.,Department of Anesthesiology, Chifeng Municipal Hospital, Chifeng, People's Republic of China
| | - Xizhe Zhang
- Chifeng Clinical Medical College of Inner Mongolia Medical University, Chifeng, People's Republic of China.,Department of Anesthesiology, Chifeng Municipal Hospital, Chifeng, People's Republic of China
| | - Yi Sun
- Chifeng Clinical Medical College of Inner Mongolia Medical University, Chifeng, People's Republic of China.,Department of Anesthesiology, Chifeng Municipal Hospital, Chifeng, People's Republic of China
| | - Miao Yu
- Chifeng Clinical Medical College of Inner Mongolia Medical University, Chifeng, People's Republic of China.,Department of Anesthesiology, Chifeng Municipal Hospital, Chifeng, People's Republic of China
| | - Yun Li
- Chifeng Clinical Medical College of Inner Mongolia Medical University, Chifeng, People's Republic of China.,Department of Anesthesiology, Chifeng Municipal Hospital, Chifeng, People's Republic of China
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