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Sun H, Zhong Y, Wang M, Niu S, Yang R, Tian Y, Li B. Postoperative Dexmedetomidine Infusion and Chronic Postsurgical Pain in Thoracoscopic Pulmonary Nodule Surgery: A Retrospective Study with Propensity-Score-Matched Analysis. Pain Ther 2024; 13:865-881. [PMID: 38805167 PMCID: PMC11254894 DOI: 10.1007/s40122-024-00611-8] [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: 02/27/2024] [Accepted: 05/03/2024] [Indexed: 05/29/2024] Open
Abstract
INTRODUCTION Patients frequently suffer from debilitating chronic postsurgical pain (CPSP) subsequent to thoracoscopic surgery. The impact of postoperative dexmedetomidine infusion on CPSP remains elusive. This study aimed to scrutinize the effect of dexmedetomidine on both 1-year incidence of CPSP and the quality of recovery after thoracoscopic pulmonary nodule surgery. METHODS This retrospective analysis encompassed clinical and follow-up data from 1148 patients undergoing thoracoscopic pulmonary nodule surgery at our institution between September 2021 and August 2022. Depending on whether dexmedetomidine was infused intravenously or not on the first night after surgery, patients were stratified into the dexmedetomidine group or the control group, with propensity score matching applied to harmonize baseline characteristics. Comparative analysis sought to delineate distinctions of CPSP and recovery quality 1 year after surgery. RESULTS Following propensity score matching, a cohort of 258 patients in each group underwent analysis. Comparisons after matching revealed no statistically significant disparities in 1-year CPSP incidence [76/258 (29.5%) versus 78/258 (30.2%), P = 0.847], moderate-to-severe pain occurrence [17/76 (22.4%) versus 22/78 (28.2%), P = 0.405], neuropathic pain occurrence [11/76 (14.5%) versus 11/78 (14.1%), P = 0.948], and postoperative recovery quality assessed by 12-Item Short Form Health Survey (SF-12) score (113.1 [107.2, 116.0] versus 113.0 [107.4, 116.0], P = 0.328). Multivariate logistic regression analysis encompassing the entire cohort identified being female [odds ratio (OR) 2.10, 95% confidence interval (CI) 1.59-2.79, P < 0.001) and postoperative rescue analgesia (OR 1.47, 95% CI 1.09-1.96, P = 0.010) as risk factors for CPSP, while intraoperative fentanyl dosage (OR 0.92, 95% CI 0.87-0.98, P = 0.006) emerged as a protective factor. CONCLUSION The prolonged administration of dexmedetomidine did not yield discernible amelioration in either 1-year CPSP or the recovery quality after thoracoscopic surgery. Noteworthy risk factors for CPSP encompassed female sex, postoperative rescue analgesia, and diminished fentanyl dosage intraoperatively.
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Affiliation(s)
- Hang Sun
- Department of Anesthesiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, 321 Zhongshan Road, Nanjing, 210000, China
| | - Yiwei Zhong
- Department of Anesthesiology, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, 321 Zhongshan Road, Nanjing, 210000, China
| | - Min Wang
- Department of Anesthesiology, Nanjing Drum Tower Hospital, Clinical College of Xuzhou Medical University, 321 Zhongshan Road, Nanjing, 210000, China
| | - Shujie Niu
- Department of Anesthesiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, 321 Zhongshan Road, Nanjing, 210000, China
| | - Rusong Yang
- Department of Thoracic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, 321 Zhongshan Road, Nanjing, 210000, China
| | - Yali Tian
- Department of Anesthesiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, 321 Zhongshan Road, Nanjing, 210000, China.
| | - Bingbing Li
- Department of Anesthesiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, 321 Zhongshan Road, Nanjing, 210000, China.
- Department of Anesthesiology, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, 321 Zhongshan Road, Nanjing, 210000, China.
- Department of Anesthesiology, Nanjing Drum Tower Hospital, Clinical College of Xuzhou Medical University, 321 Zhongshan Road, Nanjing, 210000, China.
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Onyeaka H, Adeola J, Xu R, Pappy AL, Adeola S, Smucker M, Chang A, Fraga A, Ufondu W, Osman M, Hasoon J, Orhurhu VJ. Intravenous Lidocaine for the Management of Chronic Pain: A Narrative Review of Randomized Clinical Trials. PSYCHOPHARMACOLOGY BULLETIN 2024; 54:73-96. [PMID: 38993659 PMCID: PMC11235581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
Background Chronic pain remains a serious health problem with significant impact on morbidity and well-being. Available treatments have only resulted in relatively modest efficacy. Thus, novel therapeutic treatments with different mechanisms have recently generated empirical interest. Lidocaine is postulated to provide anti-inflammatory and anti-nociceptive effect through its action at the N-methyl-D-aspartate (NMDA) and voltage gated calcium receptors. Emerging research indicates that lidocaine could be a reasonable alternative for treating chronic pain. Objective Considering the evidence surrounding lidocaine's potential as a therapeutic modality for chronic pain, we conducted a narrative review on the evidence of lidocaine's therapeutic effects in chronic pain. Methods A review of the PubMed, and Google scholar databases was undertaken in May 2022 to identify completed studies that investigated the effectiveness of lidocaine in the treatment of chronic pain from database inception to June 2022. Results A total of 25 studies were included in the narrative review. Findings on available studies suggest that intravenous infusion of lidocaine is an emerging and promising option that may alleviate pain in some clinical populations. Our narrative synthesis showed that evidence for intravenous lidocaine is currently mixed for a variety of chronic pain syndromes. Findings indicate that evidence for efficacy is limited for: CRPS, and cancer pain. However, there is good evidence supporting the efficacy of intravenous lidocaine as augmentation in chronic post-surgical pain. Conclusion Lidocaine may be a promising pharmacologic solution for chronic pain. Future investigation is warranted on elucidating the neurobiological mechanisms of lidocaine in attenuating pain signaling pathways.
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Affiliation(s)
- Henry Onyeaka
- Onyeaka, Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Mclean Hospital, Belmont, MA, USA
| | - Janet Adeola
- Janet Adeola, Department of Anesthesiology and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Rebecca Xu
- Xu, Department of Anesthesiology and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Adlai Liburne Pappy
- Pappy, Department of Anesthesiology and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Sarah Adeola
- Sarah Adeola, Howard University, Washington, USA
| | | | - Albert Chang
- Chang, Department of Physical Medicine and Rehabilitation, University of Washington, USA
| | - Anthony Fraga
- Fraga, Department of Anesthesiology, Stanford University, California, USA
| | - Wisdom Ufondu
- Ufondu, Department of Biology, Program in Liberal Medical Education (PLME), Brown University, Providence, RI, USA
| | - Moyasar Osman
- Osman, Department of Psychology, New York University, New York, NY, USA
| | - Jamal Hasoon
- Hasoon, Department of Anesthesiology, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Vwaire J Orhurhu
- Orhurhu, University of Pittsburgh Medical Center, Susquehanna, Williamsport, PA, USA; MVM Health, East Stroudsburg, PA, USA
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Zeng M, Xu X, Li R, Zhang X, Ma T, Cui Q, Wang J, Li S, Peng Y. Dexmedetomidine Prevents Chronic Incisional Pain After Brain Tumor Resection: A Secondary Analysis of the Randomized Control Trial. Anesth Analg 2024; 138:839-847. [PMID: 37307232 DOI: 10.1213/ane.0000000000006563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Dexmedetomidine was reported to reduce postoperative acute pain after neurosurgery. However, the efficacy of dexmedetomidine for preventing chronic incisional pain is uncertain. METHODS This article is a secondary analysis of a randomized, double-blind, placebo-controlled trial. Eligible patients were randomly allocated to either the dexmedetomidine group or the placebo group. Patients assigned to the dexmedetomidine group were given a 0.6 μg kg -1 dexmedetomidine bolus followed by a 0.4 μg kg -1 h -1 maintenance dose until dural closure; placebo patients were given comparable amounts of normal saline. The primary end point was the incidence of incisional pain at 3 months after craniotomy evaluated by numerical rating scale scores and defined as any score >0. The secondary end points were postoperative acute pain scores, sleep quality, and Short-Form McGill Pain Questionnaire (SF-MPQ-2) at 3 months after craniotomy. RESULTS From January 2021 to December 2021, a total of 252 patients were included in the final analysis: the dexmedetomidine group (n = 128) and the placebo group (n = 124). The incidence of chronic incisional pain was 23.4% (30 of 128) in the dexmedetomidine group versus 42.7% (53 of 124) in the placebo group (risk ratio, 0.55; 95% confidence interval, 0.38-0.80; P = .001). The overall severity of chronic incisional pain was mild in both groups. Patients in the dexmedetomidine group had lower acute pain severity on movement than those in the placebo group for the first 3 days after surgery (all adjusted P < .01). Sleep quality did not differ between groups. However, the SF-MPQ-2 total sensory ( P = .01) and neuropathic pain descriptor ( P = .023) scores in the dexmedetomidine group were lower than those in the placebo group. CONCLUSIONS Prophylactic intraoperative dexmedetomidine infusion reduces the incidence of chronic incisional pain as well as acute pain score after elective brain tumor resections.
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Affiliation(s)
- Min Zeng
- From the Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xin Xu
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Ruowen Li
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Xingyue Zhang
- From the Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Tingting Ma
- From the Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Qianyu Cui
- From the Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Juan Wang
- From the Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Shu Li
- From the Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yuming Peng
- From the Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
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Chen A, Duan W, Hao R, Wang C, Xu X. Ultrasound-guided dexmedetomidine combination with modified high fascia iliaca compartment block for arthroscopic knee surgery: what is the optimal dose of dexmedetomidine? BMC Anesthesiol 2023; 23:400. [PMID: 38057762 PMCID: PMC10699007 DOI: 10.1186/s12871-023-02361-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/27/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is a common orthopedic procedure for end-stage knee osteoarthritis. Although effective in relieving pain and improving function, postoperative pain is still a common and distressing problem for many patients. This study aims to investigate efficacy of combined administration of dexmedetomidine and modified high fascia iliaca compartment block (H-FICB) in managing acute and chronic pain after TKA, as well as to identify the optimal dosage of dexmedetomidine. METHODS A double-blind, randomized controlled trial was conducted to evaluate the effects of dexmedetomidine in patients undergoing TKA. A total of 96 patients undergoing TKA were randomly assigned to one of three groups, were treated with different doses of dexmedetomidine All groups received H-FIB. Pain scores, opioid consumption, side effects, and quality of life were recorded 48 h postoperatively. RESULTS The intraoperative consumption of remifentanil and propofol in Group Db was significantly reduced compared with that in Group D0 and Da (P < 0.05). Compared with D0 and Da group, Db group had the lowest number of rescue analgesia, analgesia time and morphine accumulative dosage 48 h after operation (P < 0.05). The Db group had the lowest scores on the numerical rating scale at rest (P < 0.05) and during movement (P < 0.01), followed by the Da group and then the D0 group. Additionally, the incidence of nausea and vomiting was significantly reduced in the Db group (P < 0.05). Furthermore, the Db group had the lowest incidence of chronic pain (P < 0.05). DISCUSSION In comparison to the other two groups, the administration of combined dexmedetomidine and H-FIB resulted in a significant reduction in pain scores, opioid consumption, and side effects. The optimal dosage of dexmedetomidine was determined to be 1 μg/kg, which provided the most favorable pain relief with minimal adverse effects.
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Affiliation(s)
- An Chen
- Department of Anesthesiology, Affiliated Hospital of Nantong University, Nantong, 226001, China
| | - Wanqing Duan
- Department of Anesthesiology, Affiliated Hospital of Nantong University, Nantong, 226001, China
| | - Ruijinlin Hao
- Department of Anesthesiology, Affiliated Hospital of Nantong University, Nantong, 226001, China
| | - Chen Wang
- Department of Anesthesiology, Affiliated Hospital of Nantong University, Nantong, 226001, China
| | - Xingguo Xu
- Department of Anesthesiology, Affiliated Hospital of Nantong University, Nantong, 226001, China.
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Perrodin SF, Trinh WH, Streitberger K, Di Pietro Martinelli C, Harnik MA, Holzgang M, Candinas D, Beldi G. Risk factors for chronic postsurgical pain in visceral surgery: a matched case–control analysis. Langenbecks Arch Surg 2022; 407:3771-3781. [DOI: 10.1007/s00423-022-02709-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/09/2022] [Indexed: 10/31/2022]
Abstract
Abstract
Purpose
Chronic postsurgical pain (CPSP) after abdominal visceral surgery is an underestimated long-term complication with relevant impact on health-related quality of life and socioeconomic costs. Early identification of affected patients is important. We aim to identify the incidence and risk factors for CPSP in this patient population.
Methods
Retrospective case–control matched analysis including all patients diagnosed with CPSP after visceral surgery in our institution between 2016 and 2019. One-to-two case–control matching was based on operation category (HPB, upper-GI, colorectal, transplantation, bariatric, hernia and others) and date of surgery. Potential risk factors for CPSP were identified using conditional multivariate logistic regression.
Results
Among a cohort of 3730 patients, 176 (4.7%) were diagnosed with CPSP during the study period and matched to a sample of 352 control patients. Independent risk factors for CPSP were age under 55 years (OR 2.64, CI 1.51–4.61), preexisting chronic pain of any origin (OR 3.42, CI 1.75–6.67), previous abdominal surgery (OR 1.99, CI 1.11–3.57), acute postoperative pain (OR 1.29, CI 1.16–1.44), postoperative use of non-steroidal anti-inflammatory drugs (OR 3.73, OR 1.61–8.65), opioid use on discharge (OR 3.78, CI 2.10–6.80) and length of stay over 3 days (OR 2.60, CI 1.22–5.53). Preoperative Pregabalin intake was protective (OR 0.02, CI 0.002–0.21).
Conclusion
The incidence of CPSP is high and associated with specific risk factors, some of them modifiable. Special attention should be given to sufficient treatment of preexisting chronic pain and acute postoperative pain.
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