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Chu Z, Zheng B, Yan L. Incidence and predictors of chronic pain after inguinal hernia surgery: a systematic review and meta-analysis. Hernia 2024; 28:967-987. [PMID: 38538812 DOI: 10.1007/s10029-024-02980-7] [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: 09/20/2023] [Accepted: 01/25/2024] [Indexed: 08/03/2024]
Abstract
PURPOSE The mesh is currently the preferred treatment option for hernia repair surgery. Chronic postoperative inguinal pain (CPIP), lasting more than 3 months after surgery, is a complication that significantly impacts patients' quality of life. Currently, there is a lack of evidence-based information describing the incidence and independent predictive factors of chronic pain, posing a serious challenge in clinical practice for devising personalized prevention strategies. Hence, we conducted this systematic review and meta-analysis to investigate the incidence and predictive factors, aiming to provide a reference for developing plans to prevent chronic pain. METHODS We conducted a systematic search of PubMed, Cochrane, Embase, and Web of Science, with the retrieval cutoff date set at December 17, 2022. The included studies underwent assessment using the NOS scale, and subgroup analysis for the incidence was carried out based on different regions. RESULTS Ultimately, 18 studies were included, involving 29,466 patients. Meta-analysis showed that the pooled incidence of chronic pain was 17.01% (95%CI 12.78% ~ 21.71%). The incidence was 18.65% (95%CI 13.59% ~ 24.29%) in Europe, 14.70% (95%CI 7.87% ~ 23.17%) in Asia, and 6.04%(95%CI 4.62 ~ 7.64) in North America. Furthermore, We also found that the risk factors for CPIP are younger age [OR = 2.261 (95%CI 1.126 ~ 4.549)], presence of other postoperative complications [OR = 1.849 (95%CI 1.034 ~ 3.305)], hernial sac defect < 3 cm [OR = 1.370 (95%CI 1.012 ~ 1.853)], being female [OR = 1.885 (95%CI 1.024 ~ 3.472)], postoperative pain [OR = 1.553 (95%CI 1.276 ~ 1.889)], preoperative pain [OR = 2.321 (95%CI 1.354 ~ 3.979)], and having a history of ipsilateral inguinal hernia repair [OR = 2.706 (95% CI 1.445 ~ 5.069)]. CONCLUSIONS The incidence of persistent pain following hernia repair surgery is high in current clinical practice, a concern that should not be overlooked. Stratified assessment tools need to be established for patients experiencing early chronic pain, and personalized follow-up strategies and preventive interventions should be developed for those with potentially high risks. These measures aim to enhance the quality of life for patients after hernia repair.
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Affiliation(s)
- Z Chu
- Yan'an University, Yan'an, 716000, Shaanxi, China
| | - B Zheng
- First Department of General Surgery, Shaanxi Provincial People's Hospital, Huangyan Village, Beilin District, No. 256 Youyi West Road, Xi'an City, 710000, Shaanxi Province, China
| | - L Yan
- First Department of General Surgery, Shaanxi Provincial People's Hospital, Huangyan Village, Beilin District, No. 256 Youyi West Road, Xi'an City, 710000, Shaanxi Province, China.
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Sun T, Fan M, Peng D, Li L, Ree A, Flexman AM, Sutherland AM, Schwarz SKW, Jen TTH, Yarnold CH. Association of chronic poststernotomy pain and health-related quality of life: a prospective cohort study. Can J Anaesth 2024; 71:579-589. [PMID: 38424390 DOI: 10.1007/s12630-024-02706-4] [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: 08/16/2023] [Revised: 10/30/2023] [Accepted: 11/09/2023] [Indexed: 03/02/2024] Open
Abstract
PURPOSE Chronic poststernotomy pain (CPSP) after cardiac surgery is multifactorial and impacts patient recovery. We aimed to evaluate the association between CPSP severity and health-related quality of life at six months after cardiac surgery. METHODS This was a single-centre prospective cohort study of patients who underwent cardiac surgery with median sternotomy between September 2020 and March 2021. Telephone interviews were conducted at six and 12 months postoperatively using the Short Form McGill Pain Questionnaire and the EQ-5D-5L. Strength of correlation was described using Spearman's correlation coefficient. Multivariable regression analysis was used to account for confounding variables. RESULTS A total of 252 patients responded to the six-month interview (response rate, 65%). The mean (standard deviation) age of respondents was 65 (13) yr. Twenty-nine percent of respondents (72/252) reported CPSP at six months, and 14% (41/252) reported more than mild pain (score ≥ 2/5). At 12 months, of the 89% (64/72) patients who responded, 47% (30/64) still reported pain. The strength of the correlation between pain scores and EQ-5D-5L was weak (Spearman's correlation coefficient, -0.3). Risk factors for CPSP at six months included higher pain score on postoperative day 1, history of chronic pain prior to surgery, and history of depression. Intraoperative infusion of dexmedetomidine or ketamine was associated with a reduced risk of CPSP at six months. CONCLUSION Chronic poststernotomy pain still affects patient recovery at six and 12 months after cardiac surgery. The severity of that pain is poorly correlated with patients' quality of life. STUDY REGISTRATION www.osf.io ( https://osf.io/52rsw ); registered 14 May 2022.
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Affiliation(s)
- Terri Sun
- Department of Anesthesia, St. Paul's Hospital/Providence Health Care, Level 3 Providence Building, 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada.
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada.
| | - Mikayla Fan
- Department of Anesthesia, St. Paul's Hospital/Providence Health Care, Vancouver, BC, Canada
| | - Defen Peng
- Centre for Cardiovascular Innovation, The University of British Columbia, Vancouver, BC, Canada
| | - Lauren Li
- Royal College of Surgeons in Ireland / University of Medicine and Health Sciences, Dublin, Ireland
| | - Alyson Ree
- Faculty of Medicine, McMaster University, Hamilton, ON, Canada
| | - Alana M Flexman
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada
- Department of Anesthesia, St. Paul's Hospital/Providence Health Care, Vancouver, BC, Canada
| | - Ainsley M Sutherland
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada
- Department of Anesthesia, St. Paul's Hospital/Providence Health Care, Vancouver, BC, Canada
| | - Stephan K W Schwarz
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada
- Department of Anesthesia, St. Paul's Hospital/Providence Health Care, Vancouver, BC, Canada
| | - Tim Ting Han Jen
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada
- Department of Anesthesia, St. Paul's Hospital/Providence Health Care, Vancouver, BC, Canada
| | - Cynthia H Yarnold
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada
- Department of Anesthesia, St. Paul's Hospital/Providence Health Care, Vancouver, BC, Canada
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Wynne R, Fredericks S, Hyde EK, Matthews S, Bowden T, O'Keefe-McCarthy S, Martorella G, Magboo R, Gjeilo KH, Jedwab RM, Keeping-Burke L, Murfin J, Bruneau J, Lie I, Sanders J. Multimodal Analgesic Effectiveness on Acute Postoperative Pain Management After Adult Cardiac Surgery: Protocol for a Systematic Review. J Cardiovasc Nurs 2024; 39:E21-E28. [PMID: 37052583 DOI: 10.1097/jcn.0000000000000989] [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] [Indexed: 04/14/2023]
Abstract
BACKGROUND Many patients report moderate to severe pain in the acute postoperative period. Enhanced recovery protocols recommend multimodal analgesics, but the optimal combination of these is unknown. PURPOSE The aim of this study was to synthesize the best available evidence about effectiveness of multimodal analgesics on pain after adult cardiac surgery. METHODS A systematic review to determine the effect of multimodal postoperative analgesics is proposed (International Prospective Register of Systematic Reviews Registration CRD42022355834). Multiple databases including the Cochrane Library, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, American Psychological Association, the Education Resources Information Centre, the Excerpta Medica database, the Medical Literature Analysis and Retrieval System Online, Scopus, Web of Science, and clinical trials databases will be searched. Screening in Covidence and quality assessment will be conducted by 2 authors. A grading of recommendations, assessment, development, and evaluation summary of findings will be presented if meta-analysis is possible.
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Sun M, Chen WM, Wu SY, Zhang J. The influence of advanced age on long-term postsurgical analgesic use in patients receiving neuraxial anaesthesia for elective surgery. Eur J Pain 2024; 28:408-420. [PMID: 37830408 DOI: 10.1002/ejp.2191] [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] [Received: 03/30/2023] [Revised: 08/28/2023] [Accepted: 09/26/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE To determine the relationship between age and long-term postsurgical analgesic use in patients who underwent elective surgery with neuraxial anaesthesia. DESIGN Retrospective observational study using data from the National Health Insurance Research Database of Taiwan from 2015 to 2019. SETTING National Health Insurance Research Database of Taiwan. PATIENTS A total of 12,810 patients (6405 younger and 6405 older) matched using propensity score matching. INTERVENTIONS Older (≥65 years). MEASUREMENTS The use of long-term (3 or 6 months) postoperative analgesics, including opioids, as a surrogate marker of chronic postsurgical pain (CPSP) was analysed using logistic regression. MAIN RESULTS After 3 months of surgery, older adults had higher use of all analgesics (odds ratio [OR] = 1.15; 95% CI = 1.03-1.28) and opioids (OR = 1.18; 95% CI = 1.09-1.28) compared to younger patients. Similar results were observed after 6 months of surgery (all analgesic use: OR = 1.11; 95% CI = 1.03-1.20; opioid use: OR = 1.33; 95% CI = 1.07-1.81). CONCLUSION The findings from this study suggest that older adults are more likely to experience CPSP and have increased use of long-term analgesics, including opioids, after undergoing elective surgery with neuraxial anaesthesia. The study highlights the need for improved pain management strategies for older adults after surgery. SIGNIFICANCE Older age is an independent risk factor for long-term analgesic use after surgery under neuraxial anaesthesiaanesthesia, indicating an increased risk for chronic postsurgical pain.
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Affiliation(s)
- Mingyang Sun
- Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Wan-Ming Chen
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan
- Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan
| | - Szu-Yuan Wu
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan
- Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan
- Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan
- Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
- Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
- Cancer Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
- Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Management, College of Management, Fo Guang University, Yilan, Taiwan
| | - Jiaqiang Zhang
- Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
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Karamesinis AD, Neto AS, Shi J, Fletcher C, Hinton J, Xing Z, Penny-Dimri JC, Ramson D, Liu Z, Plummer M, Smith JA, Segal R, Bellomo R, Perry LA. Sex Differences in Opioid Administration After Cardiac Surgery. J Cardiothorac Vasc Anesth 2024; 38:701-708. [PMID: 38238202 DOI: 10.1053/j.jvca.2023.11.044] [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: 01/15/2023] [Revised: 09/21/2023] [Accepted: 11/30/2023] [Indexed: 02/18/2024]
Abstract
OBJECTIVES To assess whether there are sex-based differences in the administration of opioid analgesic drugs among inpatients after cardiac surgery. DESIGN A retrospective cohort study. SETTING At a tertiary academic referral center. PARTICIPANTS Adult patients who underwent cardiac surgery from 2014 to 2019. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The primary outcome was the cumulative oral morphine equivalent dose (OMED) for the postoperative admission. Secondary outcomes were the daily difference in OMED and the administration of nonopioid analgesics. The authors developed multivariate regression models controlling for known confounders, including weight and length of stay. A total of 3,822 patients (1,032 women and 2,790 men) were included. The mean cumulative OMED was 139 mg for women and 180 mg for men, and this difference remained significant after adjustment for confounders (adjusted mean difference [aMD], -33.21 mg; 95% CI, -47.05 to -19.36 mg; p < 0.001). The cumulative OMED was significantly lower in female patients on postoperative days 1 to 5, with the greatest disparity observed on day 5 (aMD, -89.83 mg; 95% CI, -155.9 to -23.80 mg; p = 0.009). By contrast, women were more likely to receive a gabapentinoid (odds ratio, 1.91; 95% CI, 1.42-2.58; p < 0.001). The authors found no association between patient sex and the administration of other nonopioid analgesics or specific types of opioid analgesics. The authors found no association between patient sex and pain scores recorded within the first 48 hours after extubation, or the number of opioids administered in close proximity to pain assessments. CONCLUSIONS Female sex was associated with significantly lower amounts of opioids administered after cardiac surgery.
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Affiliation(s)
- Alexandra D Karamesinis
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Australia
| | - Ary S Neto
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Department of Critical Care, Melbourne Medical School, University of Melbourne, Austin Hospital, Melbourne, Australia; Department of Intensive Care, Austin Hospital, Melbourne, Australia; Department of Critical Care, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Jenny Shi
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Australia
| | - Calvin Fletcher
- Department of Anaesthesiology and Perioperative Medicine, The Alfred Hospital, Melbourne, Australia
| | - Jake Hinton
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Australia
| | - Zhongyue Xing
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Australia
| | - Jahan C Penny-Dimri
- Department of Surgery (School of Clinical Sciences at Monash Health), Monash University and Department of Cardiothoracic Surgery, Monash Health, Clayton, Australia
| | - Dhruvesh Ramson
- Department of Surgery (School of Clinical Sciences at Monash Health), Monash University and Department of Cardiothoracic Surgery, Monash Health, Clayton, Australia
| | - Zhengyang Liu
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Australia; Department of Critical Care, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Australia
| | - Mark Plummer
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Austin Hospital, Melbourne, Australia; Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Julian A Smith
- Department of Surgery (School of Clinical Sciences at Monash Health), Monash University and Department of Cardiothoracic Surgery, Monash Health, Clayton, Australia; Department of Cardiothoracic Surgery, Monash Health, Clayton, Australia
| | - Reny Segal
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Australia; Department of Critical Care, Melbourne Medical School, University of Melbourne, Austin Hospital, Melbourne, Australia
| | - Rinaldo Bellomo
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Department of Critical Care, Melbourne Medical School, University of Melbourne, Austin Hospital, Melbourne, Australia; Department of Intensive Care, Austin Hospital, Melbourne, Australia; Monash University School of Public Health and Preventive Medicine, Monash University, Clayton, Australia; Data Analytics Research and Evaluation Centre, Austin Hospital, Heidelberg, Australia
| | - Luke A Perry
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Australia; Department of Critical Care, Melbourne Medical School, University of Melbourne, Austin Hospital, Melbourne, Australia.
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Watanabe Y, Nikaido T, Yabuki S, Abe J, Suzuki H, Shishido K, Kobayashi H, Yoshida R, Iinuma K, Nagamine S, Ono Y, Sato M, Oi N. Gender differences on preoperative psychologic factors affecting acute postoperative pain in patients with lumbar spinal disorders. J Orthop Sci 2023:S0949-2658(23)00258-0. [PMID: 37838597 DOI: 10.1016/j.jos.2023.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/16/2023] [Accepted: 08/29/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Psychosexual factors are one of the preoperative factors influencing acute postoperative pain. Because of gender differences in pain, the preoperative factors that influence acute postoperative pain may also differ between males and females. However, there have been no reports on such factors in patients with spinal disorders that focused on gender differences. Therefore, the purpose of this study was to examine the preoperative factors that influence acute postoperative pain, focusing on gender differences. METHODS The subjects were 75 males and 60 females admitted for surgery for lumbar spinal disorders. Preoperatively, the following were assessed: low back pain using the Numeric Rating Scale (NRS); anxiety and depression using the Japanese version of the Hospital Anxiety and Depression Scale (HADS); catastrophic thinking using the Pain Catastrophizing Scale (PCS); psychiatric problems using the Brief Scale for Psychiatric Problems in Orthopaedic Patients (BS-POP); and neurological assessments. Acute postoperative pain was also assessed using the NRS within 48 h, postoperatively. Based on these data, we analyzed gender differences in preoperative factors affecting acute postoperative pain in patients with lumbar spinal disorders. RESULTS Postoperative NRS and preoperative PCS scores were higher in females compared to males. In the males, the coefficient of determination of the multiple regression equation was 0.088, and PCS (β = 0.323, p = 0.015) was extracted as a significant factor. In the females, the coefficient of determination of the multiple regression equation was 0.075, and BS-POP (β = 0.300, p = 0.019) was extracted as a significant factor. CONCLUSION Preoperative factors influencing acute postoperative pain for patients with lumbar spinal disorders vary by gender. It was suggested that males should be screened using PCS. In females, on the other hand, PCS alone is not sufficient for evaluation. It was suggested that evaluation using BS-POP should be considered in addition to PCS.
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Affiliation(s)
- Yuki Watanabe
- Department of Rehabilitation Center, Fukushima Medical University Hospital, Fukushima City, Fukushima, Japan.
| | - Takuya Nikaido
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan
| | - Shoji Yabuki
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan
| | - Jumpei Abe
- Department of Rehabilitation Center, Fukushima Medical University Hospital, Fukushima City, Fukushima, Japan
| | - Hideki Suzuki
- Department of Rehabilitation Center, Fukushima Medical University Hospital, Fukushima City, Fukushima, Japan
| | - Keita Shishido
- Department of Rehabilitation Center, Fukushima Medical University Hospital, Fukushima City, Fukushima, Japan
| | - Hirotaka Kobayashi
- Department of Rehabilitation Center, Fukushima Medical University Hospital, Fukushima City, Fukushima, Japan
| | - Rii Yoshida
- Department of Rehabilitation Center, Fukushima Medical University Hospital, Fukushima City, Fukushima, Japan
| | - Kaori Iinuma
- Department of Rehabilitation Center, Fukushima Medical University Hospital, Fukushima City, Fukushima, Japan
| | - Sakiko Nagamine
- Department of Rehabilitation Center, Fukushima Medical University Hospital, Fukushima City, Fukushima, Japan
| | - Yoko Ono
- Department of Rehabilitation Center, Fukushima Medical University Hospital, Fukushima City, Fukushima, Japan
| | - Mari Sato
- Department of Rehabilitation Center, Fukushima Medical University Hospital, Fukushima City, Fukushima, Japan; Department of Rehabilitation Medicine, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan
| | - Naoyuki Oi
- Department of Rehabilitation Center, Fukushima Medical University Hospital, Fukushima City, Fukushima, Japan; Department of Rehabilitation Medicine, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan
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Grundström H, Fredrikson M, Alehagen S, Berterö C, Kjølhede P. Incidence of self-reported pelvic pain and risk factors for pain 1 year after benign hysterectomy: A register study from the Swedish National Quality Registry for Gynecological Surgery. Acta Obstet Gynecol Scand 2023; 102:1359-1370. [PMID: 36073635 PMCID: PMC10541156 DOI: 10.1111/aogs.14455] [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: 03/23/2022] [Revised: 06/14/2022] [Accepted: 08/24/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The primary aim of this study was to determine the incidence of patient-reported pain 1 year after hysterectomy for benign gynecological conditions in relation to occurrence of preoperative pain. The secondary aim was to analyze clinical risk factors for pain 1 year after the hysterectomy in women with and without preoperatively reported pelvic/lower abdominal pain. MATERIAL AND METHODS This was a historical cohort study using data from the Swedish National Quality Registry for Gynecological Surgery on 16 694 benign hysterectomies. Data were analyzed using multivariable logistic regression models. RESULTS One year after surgery, 22.4% of women with preoperative pain reported pelvic pain and 7.8% reported de novo pelvic pain. For those with preoperative pain younger age (adjusted odds ratio [aOR] 1.75, 95% confidence interval [CI] 1.38-2.23 and aOR 1.21, 95% CI 1.10-1.34 for women aged <35 and 35-44 years, respectively), not being gainfully employed (aOR 1.43, 95% CI 1.26-1.63), pelvic pain as the main symptom leading to hysterectomy (aOR 1.51, 95% CI 1.19-1.90), endometriosis (aOR 1.18, 95% CI 1.06-1.31), and laparoscopic hysterectomy (aOR 1.30, 95% CI 1.07-1.58), were clinically relevant independent risk factors for pelvic/lower abdominal pain 1 year after surgery, as were postoperative complications within 8 weeks after discharge. Meanwhile, clinically relevant independent risk factors for reporting de novo pain 1 year after surgery were younger age (aOR 2.05, 95% CI 1.08-3.86 and aOR 1.29, 95% CI 1.04-1.60 for women aged <35 and 35-44 years, respectively), and postoperative complications within 8 weeks after discharge. CONCLUSIONS The incidence of pelvic pain and de novo pain 1 year after hysterectomy was relatively high. Women with and without reported preoperative pelvic/lower abdominal pain represented clinically different populations. The risk factors for pelvic pain seemed to differ in these two populations. The differences in risk factors could be taken into consideration in the preoperative counseling and in the decision-making concerning method of hysterectomy, provided that large well-designed studies confirm these risk factors.
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Affiliation(s)
- Hanna Grundström
- Department of Health, Medicine and Caring SciencesLinköping UniversityLinköpingSweden
- Department of Obstetrics and Gynecology in Norrköping, and Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
| | - Mats Fredrikson
- Forum Östergötland and Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
| | - Siw Alehagen
- Department of Health, Medicine and Caring SciencesLinköping UniversityLinköpingSweden
| | - Carina Berterö
- Department of Health, Medicine and Caring SciencesLinköping UniversityLinköpingSweden
| | - Preben Kjølhede
- Department of Obstetrics and Gynecology in Linköping, and Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
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Babino JM, Thornton JD, Putney K, Bethany Taylor R, Wanat MA. Evaluation of Discharge Opioid Prescribing in Coronary Artery Bypass Patients Following an Opioid Stewardship Intervention for Providers. J Pharm Pract 2023; 36:1077-1084. [PMID: 35410543 DOI: 10.1177/08971900221088797] [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] [Indexed: 09/22/2023]
Abstract
Introduction: Opioid stewardship efforts can promote safe and effective use of opioids to optimize pain control and minimize unintended consequences. The purpose of this study is to assess the difference in post-operative opioid discharge prescribing in patients undergoing coronary artery bypass graft (CABG) surgery following implementation of a tripartite opioid stewardship intervention. Methods: This was a single-center, quality improvement study at a large, quaternary academic medical center. Adult patients undergoing CABG from July 2019 to June 2020 (pre-intervention) and November 2020 to February 2021 (post-intervention) were included. The intervention included adopting hospital-wide post-surgical opioid discharge prescribing guidelines, discharge prescriber education, and electronic medical record changes. The primary outcome was the proportion of patients receiving an opioid prescription at discharge. Secondary outcomes included total morphine milligram equivalents (MME) prescribed and non-opioid analgesics prescribed at discharge. Results: A total of 200 patients were included in the study; 100 pre- and 100 post-intervention. There was no difference in opioid discharge prescribing at discharge (74% pre-intervention vs. 72% post-intervention; P = .87). There was no difference in MMEs prescribed at discharge (145.6 ± 57 pre- vs. 162.2 ± 95 post-; P = .202). No difference was seen in non-opioid analgesic prescriptions prescribed at discharge (35% pre- vs. 40% post-; P = .56). Conclusion: A multipronged opioid stewardship intervention did not lead to a reduction in opioid prescribing at discharge. Post-intervention, there was a non-statistically significant increase in the proportion of patients who received non-opioid analgesics discharge. Future studies should assess the effect of different stewardship interventions on prescribing and patient outcomes.
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Affiliation(s)
- Justin M Babino
- Department of Pharmacy, Baylor St Luke's Medical Center, Houston, TX, USA
| | - James Douglas Thornton
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX, USA
- Prescription Drug Misuse Education and Research Center, University of Houston College of Pharmacy, Houston, TX, USA
| | - Kimberly Putney
- Department of Pharmacy, Baylor St Luke's Medical Center, Houston, TX, USA
| | | | - Matthew A Wanat
- Prescription Drug Misuse Education and Research Center, University of Houston College of Pharmacy, Houston, TX, USA
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, TX, USA
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Göktuna G, Dağcan N, Arslan GG. The Effect of Hand Reflexology Massage on Pain and Anxiety After Coronary Artery Bypass Graft Surgery: A Double-Blind, Randomized, Placebo-Controlled Trial. J Cardiovasc Nurs 2023:00005082-990000000-00111. [PMID: 37548394 DOI: 10.1097/jcn.0000000000001033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
BACKGROUND Pain and anxiety are common postoperative problems that impair recovery and quality of life in patients undergoing coronary artery bypass graft (CABG) surgery. Reflexology is a nonpharmacologic method used to control pain and anxiety. OBJECTIVE The aim of this study was to examine the effects of reflexology hand massage and stroking massage on pain and anxiety in patients in the immediate postoperative period after CABG. METHODS In this double-blind, randomized, placebo-controlled study, we compared the effects of a 20-minute hand-reflexology massage to placebo stroking massage on pain and anxiety in newly extubated patients in the intensive care unit who had undergone CABG surgery. Pain was measured by visual analog scale and anxiety by the State-Trait Anxiety Inventory before and at 5, 30, and 60 minutes post intervention. RESULTS A total of 48 patients were enrolled: 24 in the intervention group and 24 in the placebo. Mean pain scores were significantly reduced in the group who received reflexology compared with the placebo group (F = 36.569, P = .000). Mean anxiety scores were significantly reduced at 60 minutes for the reflexology group compared with the control group (P = .000). CONCLUSIONS We found that hand reflexology massage was effective in reducing pain and anxiety in patients during the immediate postoperative period after CABG.
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Hu JH, Shi HJ, Han ZY, Liu H, Ji FH, Peng K. Protocol for Development and Validation of Multivariable Prediction Models for Chronic Postsurgical Pain Following Video-Assisted Thoracic Surgery. J Pain Res 2023; 16:2251-2256. [PMID: 37425224 PMCID: PMC10328098 DOI: 10.2147/jpr.s416450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/30/2023] [Indexed: 07/11/2023] Open
Abstract
Purpose Chronic postsurgical pain (CPSP) is a common complication after thoracic surgery and associated with long-term adverse outcomes. This study aims to develop two prediction models for CPSP after video-assisted thoracic surgery (VATS). Methods and Analysis This single-center prospective cohort study will include a total of 500 adult patients undergoing VATS lung resection (n = 350 for development and n = 150 for external validation). Patients will be enrolled continuously at The First Affiliated Hospital of Soochow University in Suzhou, China. The cohort for external validation will be recruited in another time period. The outcome is CPSP, which is defined as pain with the numerical rating scale score of 1 or higher 3 months after VATS. Univariate and multivariable logistic regression analyses will be performed to develop two CPSP prediction models based on patients' data of postoperative day 1 and day 14, respectively. For internal validation, we will use the bootstrapping validation technique. For external validation, the discrimination capability of the models will be assessed using the area under the receiver operating characteristic curve, and the calibration will be evaluated using the calibration curve and Hosmer-Lemeshow goodness-of-fit statistic. The results will be presented in model formulas and nomograms. Conclusion Based on the development and validation of the prediction models, our results contribute to early prediction and treatment of CPSP after VATS. Trial Registration Chinese Clinical Trial Register (ChiCTR2200066122).
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Affiliation(s)
- Jing-Hui Hu
- Departments of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
- Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Hai-Jing Shi
- Departments of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
- Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Zhen-Yu Han
- Department of Thoracic Surgery, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Hong Liu
- Department of Anesthesiology and Pain Medicine, University of California Davis Health, Sacramento, CA, USA
| | - Fu-Hai Ji
- Departments of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
- Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Ke Peng
- Departments of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
- Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, People’s Republic of China
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11
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Sun M, Chen WM, Wu SY, Zhang J. Chronic pain following elective surgery under general anesthesia in older adults. J Anesth 2023:10.1007/s00540-023-03215-2. [PMID: 37354352 DOI: 10.1007/s00540-023-03215-2] [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: 05/04/2023] [Accepted: 06/03/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND The purpose of this study was to investigate the association between age and chronic postsurgical pain (CPSP) in patients who underwent elective surgery under general anesthesia, with a focus on long-term postsurgical analgesic use. To our knowledge, no previous study has examined this relationship in detail between older and younger patients. METHODS We conducted a propensity score-matched (PSM) study to compare the rates of long-term (3 or 6 months) postoperative analgesic use between older adult (≥ 65 years) and younger (< 65 years) patients. Multivariate logistic regression was used to assess the use of analgesics as a surrogate indicator of CPSP. RESULTS The PSM analysis included 62,784 surgical patients (31,392 in each group). Three months after surgery, the rates of analgesic use were significantly higher in the older age group (adjusted odds ratio [aOR], 1.45; 95% confidence interval [CI], 1.41-1.49) as well as for opioid use specifically (aOR, 1.34; 95% CI, 1.29-1.39). Six months after surgery, the rates of analgesic use remained higher in the older age group (aOR, 1.52; 95% CI, 1.47-1.58), and similarly for opioid use specifically (aOR, 1.42; 95% CI, 1.36-1.48). CONCLUSIONS Our findings suggest that older adults have higher rates of long-term analgesic use for CPSP after elective surgery under general anesthesia. This study highlights the importance of addressing CPSP in older adult patients and considering age-related factors when managing postoperative pain.
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Affiliation(s)
- Mingyang Sun
- Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Wan-Ming Chen
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan
- Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan
| | - Szu-Yuan Wu
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan.
- Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan.
- Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan.
- Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, No. 83, Nanchang St., Luodong Township, Yilan County 265, Taiwan.
- Division of Radiation Oncology, Department of Medicine, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, No. 83, Nanchang St., Luodong Township, Yilan County 265, Taiwan.
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan.
- Cancer Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, No. 83, Nanchang St., Luodong Township, Yilan County 265, Taiwan.
- Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
- Department of Management, College of Management, Fo Guang University, Yilan, Taiwan.
| | - Jiaqiang Zhang
- Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan, China.
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12
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Sepolvere G, Scialdone VR. Chronic pain in cardiac surgery. Minerva Anestesiol 2023; 89:230-231. [PMID: 36880323 DOI: 10.23736/s0375-9393.22.16881-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Affiliation(s)
- Giuseppe Sepolvere
- Department of Anesthesia and Cardiac Surgery Intensive Care Unit, San Michele Hospital, Maddaloni, Caserta, Italy
| | - Valeria R Scialdone
- Department of Anesthesia and Cardiac Surgery Intensive Care Unit, San Michele Hospital, Maddaloni, Caserta, Italy -
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13
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Prevalence and Predictors of Chronic Postsurgical Pain After Video-Assisted Thoracoscopic Surgery: A Systematic Review and Meta-analysis. Pain Ther 2023; 12:117-139. [PMID: 36227420 PMCID: PMC9845490 DOI: 10.1007/s40122-022-00439-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 09/15/2022] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Determining the prevalence of chronic postsurgical pain (CPSP) after video-assisted thoracoscopic surgery (VATS) and identifying CPSP predictors should improve the prognosis of patients undergoing VATS. Although several studies have investigated predictors of CPSP after VATS, there were significant dissimilarities in the findings due to the confounding of predictors. METHODS PubMed, Cochrane, MEDLINE, Web of Science, Chinese Biomedical Literature, and China National Knowledge Infrastructure databases were comprehensively searched using the Medical Subject Headings terms "pain, postoperative," "thoracic surgery, video-assisted," and all related free terms from inception until March 27, 2022. The Stata metaprop package was used to comprehensively analyze the incidence of CPSP following VATS. Furthermore, the pooled odds ratios (OR) or the standardized mean differences (SMD) and their corresponding 95% confidence intervals (95% CI) were calculated, and qualitative analyses were performed for predictors that could not be assessed quantitatively to evaluate the effects of the included risk factors on the occurrence of CPSP. Unadjusted odds ratios were utilized to consider the impact of non-significant estimates if the original study did not report them. RESULTS Of the 4302 studies, 183 were considered eligible, and 17 were finally included in this study. The overall incidence of CPSP after VATS was 35.3% (95% CI 27.1-43.5%). The qualitative synthesis results revealed that female sex, age, and acute postoperative pain were definite predictors of CPSP after VATS. The number of ports, operation time, duration of drainage, and insufficient analgesia were also considered predictors. Consistent, quantitative synthesis results also showed that the aforementioned predictors were closely related to the occurrence of CPSP after VATS. Only by quantitative analysis, postoperative chemotherapy and an educational level less than junior school were also risk factors for CPSP. Other predictors displayed no evidence or unclear evidence of association with CPSP after VATS. CONCLUSION This study preliminarily determined the incidence of CPSP after VATS based on the existing literature. Female sex, age, and acute pain were identified as risk factors for CPSP after VATS, and other potential risk factors were also identified and analyzed. However, as a result of the inclusion of retrospective studies and inevitable limitations in this systematic review and meta-analysis, the results of this study still need to be verified by large-scale prospective clinical studies. TRIAL REGISTRATION CRD42022323179.
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14
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Dong Y, Zhang L, Chen LW, Luo ZR. Music therapy for pain and anxiety in patients after cardiac valve replacement: a randomized controlled clinical trial. BMC Cardiovasc Disord 2023; 23:32. [PMID: 36650441 PMCID: PMC9845817 DOI: 10.1186/s12872-023-03058-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/11/2023] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE This study aimed to assess how listening to music after cardiac valve replacements affected patients' pain, anxiety, and vital signs. METHOD In Fuzhou, China's Fujian Medical University Union Hospital, the cardiac surgery division conducted a randomized controlled clinical experiment. 86 patients were enrolled, and 43 were assigned randomly to each group (control and experimental group). The standard treatment was given to the control group, while the experimental group was given standard treatment + a 15-min music intervention 3 times. Indicators include pain, anxiety and vital signs (respiratory rate, heart rate, and blood pressure). RESULTS In comparison to the control group, the experimental group, over time, demonstrated a statistically substantial decrease in pain, anxiety, systolic blood pressure, heart rate and respiratory rate (all P < 0.001), yet, there were no discernible variations (P > 0.05) in diastolic blood pressure. CONCLUSIONS In conclusion, these results provide additional proof for using music therapy to minimize cardiac postoperative pain and anxiety, as well as systolic blood pressure, heart rate and respiratory rate. Moreover, it should be regarded as a supplementary treatment for pain and anxiety after cardiac valve replacement and other medical procedures with comparable postoperative pain.
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Affiliation(s)
- Yi Dong
- grid.256112.30000 0004 1797 9307Department of Cardiovascular Surgery and Cardiac Disease Center, Union Hospital, Fujian Medical University, Fuzhou, 350001 People’s Republic of China ,grid.256112.30000 0004 1797 9307Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, People’s Republic of China
| | - Lin Zhang
- grid.256112.30000 0004 1797 9307Department of Cardiovascular Surgery and Cardiac Disease Center, Union Hospital, Fujian Medical University, Fuzhou, 350001 People’s Republic of China ,grid.256112.30000 0004 1797 9307Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, People’s Republic of China
| | - Liang-Wan Chen
- grid.256112.30000 0004 1797 9307Department of Cardiovascular Surgery and Cardiac Disease Center, Union Hospital, Fujian Medical University, Fuzhou, 350001 People’s Republic of China ,grid.256112.30000 0004 1797 9307Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, People’s Republic of China
| | - Zeng-Rong Luo
- grid.256112.30000 0004 1797 9307Department of Cardiovascular Surgery and Cardiac Disease Center, Union Hospital, Fujian Medical University, Fuzhou, 350001 People’s Republic of China ,grid.256112.30000 0004 1797 9307Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, People’s Republic of China
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15
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Sanders J, Bowden T, Woolfe-Loftus N, Sekhon M, Aitken LM. Predictors of health-related quality of life after cardiac surgery: a systematic review. Health Qual Life Outcomes 2022; 20:79. [PMID: 35585633 PMCID: PMC9118761 DOI: 10.1186/s12955-022-01980-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health-related quality of life (HRQoL) is important in determining surgical success, particularly from the patients' perspective. AIMS To identify predictors for HRQoL outcome after cardiac surgery in order to identify potentially modifiable factors where interventions to improve patient outcomes could be targeted. METHODS Electronic databases (including MEDLINE, CINAHL, Embase) were searched between January 2001 and December 2020 for studies determining predictors of HRQoL (using a recognised and validated tool) in adult patients undergoing cardiac surgery. Data extraction and quality assessments were undertaken and data was summarised using descriptive statistics and narrative synthesis, as appropriate. RESULTS Overall, 3924 papers were screened with 41 papers included in the review. Considerable methodological heterogeneity between studies was observed. Most were single-centre (75.6%) prospective observational studies (73.2%) conducted in patients undergoing coronary artery bypass graft (CABG) (n = 51.2%) using a version of the SF-36 (n = 63.4%). Overall, 103 independent predictors (62 pre-operative, five intra-operative and 36 post-operative) were identified, where 34 (33.0%) were reported in more than one study. Potential pre-operative modifiable predictors include alcohol use, BMI/weight, depression, pre-operative quality of life and smoking while in the post-operative period pain and strategies to reduce post-operative complications and intensive care and hospital length of stay are potential therapeutic targets. CONCLUSION Despite a lack of consistency across studies, several potentially modifiable predictors were identified that could be targeted in interventions to improve patient or treatment outcomes. This may contribute to delivering more person-centred care involving shared decision-making to improve patient HRQoL after cardiac surgery.
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Affiliation(s)
- Julie Sanders
- St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, EC1A 7DN, UK.
- William Harvey Research Institute, Charterhouse Square, Queen Mary University of London, London, EC1M 6BQ, UK.
| | - Tracey Bowden
- School of Health Sciences, City, University of London, London, EC1V 0HB, UK
| | - Nicholas Woolfe-Loftus
- St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, EC1A 7DN, UK
| | - Mandeep Sekhon
- School of Health Sciences, City, University of London, London, EC1V 0HB, UK
| | - Leanne M Aitken
- School of Health Sciences, City, University of London, London, EC1V 0HB, UK
- School of Nursing and Midwifery, Griffith University, Nathan, QLD, 4111, Australia
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16
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Aoki Y, Iwata H, Akinaga C, Shiko Y, Kawasaki Y, Kobayashi K, Nozawa H, Kinoshita H, Nakajima Y. Intraoperative Remifentanil Dosage in Surgery for Adolescent Idiopathic Scoliosis Does Not Increase Postoperative Opioid Consumption When Combined With Epidural Analgesia: A Retrospective Cohort Study. Cureus 2021; 13:e17361. [PMID: 34567901 PMCID: PMC8454257 DOI: 10.7759/cureus.17361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2021] [Indexed: 11/05/2022] Open
Abstract
Background In adults, high-dose remifentanil during surgery has been reported to increase postoperative opioid consumption, but this has not been well documented in children. Multimodal analgesia is recommended in the perioperative period for adolescent idiopathic scoliosis (AIS), but no report has examined opioid consumption under epidural analgesia, which is one of the most common types of analgesia. Aims To investigate the association between intraoperative remifentanil dosage and postoperative opioid consumption in AIS in the setting of combined epidural analgesia for postoperative multimodal analgesia. Methods In this retrospective cohort study, patients aged 10-18 years who underwent surgery for scoliosis and epidural analgesia for postoperative pain between July 2012 and April 2019 were included. The primary endpoint was the association between intraoperative cumulative weight-adjusted remifentanil dosage and logarithmic transformation of cumulative weight-adjusted fentanyl consumption in the intensive care unit (ICU). Nonopioid analgesics were investigated as secondary endpoints. An epidural catheter was inserted by the surgeon intraoperatively, and a local anesthetic was administered at the end of the surgery. Multivariate linear regression analysis with adjustment for confounders was performed for all analyses. Results In total, 142 patients were included, and the median intraoperative remifentanil dosage for all patients was 0.27 (interquartile range, 0.24-0.34) µg/kg/min. No association was observed between cumulative weight-adjusted intraoperative dosage of remifentanil and fentanyl, even after adjusting for potential confounders (slope = -1.25; 95% confidence interval [CI], -4.35 to 1.85; P = 0.43). No association was observed between nonopioid analgesic use and intraoperative remifentanil dosage. Conclusion No association was noted between remifentanil dosage during surgery for AIS and postoperative opioid consumption with epidural analgesia. However, this study has limitations due to its retrospective design; thus, further prospective studies are warranted.
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Affiliation(s)
- Yoshitaka Aoki
- Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University School of Medicine, Hamamatsu, JPN
| | - Hiroki Iwata
- Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University School of Medicine, Hamamatsu, JPN
| | - Chieko Akinaga
- Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University School of Medicine, Hamamatsu, JPN
| | - Yuki Shiko
- Clinical Research Center, Chiba University Hospital, Chiba, JPN
| | - Yohei Kawasaki
- Clinical Research Center, Chiba University Hospital, Chiba, JPN
| | - Kensuke Kobayashi
- Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University School of Medicine, Hamamatsu, JPN
| | - Hiroki Nozawa
- Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University School of Medicine, Hamamatsu, JPN
| | - Hiroyuki Kinoshita
- Department of Anesthesiology, Seirei Mikatahara General Hospital, Hamamatsu, JPN
| | - Yoshiki Nakajima
- Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University School of Medicine, Hamamatsu, JPN
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17
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Goree JH, Srinivasan N, Cucciare MA, Zaller N, Byers L, Boateng B, Hayes CJ. Video-Based, Patient-Focused Opioid Education in the Perioperative Period Increases Self-Perceived Opioid-Related Knowledge: A Pilot Study. J Pain Res 2021; 14:2583-2592. [PMID: 34466026 PMCID: PMC8403019 DOI: 10.2147/jpr.s303850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 07/21/2021] [Indexed: 11/24/2022] Open
Abstract
Objective The aim of this study was to evaluate whether a video-based, patient-focused opioid education tool delivered in the perioperative period would decrease acute and chronic post-operative opioid prescription dispensations and increase self-rated knowledge about opioids. Methods We enrolled 110 patients with no reported opioid use in the previous 30 days, undergoing ambulatory surgery for breast, orthopedic, gynecologic, or other outpatient procedures for which opioids would be prescribed. Patients were randomized to receive either post-operative opioid education by the surgical team (control arm) or pre-operative education via a novel 5-minute video plus post-operative education by the surgical team (intervention arm). All patients received follow-up phone calls on post-operative day (POD) 7 to assess self-rated knowledge of opioids on a scale of 1 to 10, 10 being most informed, and self-reported opioid use (primary outcome). Arkansas Prescription Drug Monitoring Program (AR PDMP) data were obtained to assess opioid dispensations at POD 90–150 days. Results Seventy-seven percent of participants completed POD7 survey. Participants in the intervention arm rated their knowledge of opioids after surgery significantly higher than those in the control arm (p=0.013). Data from the AR PDMP reveal trends (non-significant) that show increased use of opioids in the control group when compared to the video intervention group at POD 30 (88.7% vs 76%) and POD 90–150 (22.6% vs 10%). Conclusion Video-based, patient-focused opioid education can be effectively implemented in a large university hospital during the perioperative period and is effective for increasing a patient’s perception of opioid-related knowledge. A fully powered, randomized control trial is needed to further explore observed trends and determine if this novel tool can decrease chronic post-operative opioid dispensations.
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Affiliation(s)
- Johnathan H Goree
- Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Michael A Cucciare
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, USA.,Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA
| | - Nickolas Zaller
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Lauren Byers
- Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Beatrice Boateng
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Corey J Hayes
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, USA.,Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Bhakta P, O'Brien B, Karim HMR. Can TAP Block, as a Component of Multimodal Analgesia in Robotic Nephrectomy, Offer Long-term Benefits Without Any Medium-term Effects? Our Reply to the Article by Covotta et al. PAIN MEDICINE 2021; 22:1228-1229. [PMID: 31904848 DOI: 10.1093/pm/pnz339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Pradipta Bhakta
- Department of Anaesthesia and Intensive Care, Temple Street Children's University Hospital, Dublin, Ireland
| | - Brian O'Brien
- Department of Anaesthesia and Intensive Care, Cork University Hospital, Cork, Ireland
| | - Habib Md Reazaul Karim
- Department of Anaesthesia and Critical Care, All India Institute of Medical Sciences, Raipur, India
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Yu H, Xu Z, Dai SH, Jiang JL, He LL, Zheng JQ, Yu H. The Effect of Propofol Versus Volatile Anesthetics on Persistent Pain After Cardiac Surgery: A Randomized Controlled Trial. J Cardiothorac Vasc Anesth 2020; 35:2438-2446. [PMID: 33183935 DOI: 10.1053/j.jvca.2020.10.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/01/2020] [Accepted: 10/14/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Sternal incisions can generate persistent and intense post-sternotomy pain. Propofol has been shown to improve postoperative analgesia, but the preventive effect on persistent pain after cardiac surgery is unknown. The hypothesis of the present study was that intraoperative propofol-based anesthesia compared with volatile anesthesia could reduce the risk of chronic pain after cardiac surgery. DESIGN A single-center, two-arm, patient-and-evaluator-blinded, randomized controlled trial. SETTING A single major urban teaching and university hospital. PATIENTS Five-hundred adult patients undergoing cardiac surgery via sternotomy randomly were assigned. With six withdrawals from the study and five from surgery, 244 in the total intravenous anesthesia group and 245 in the volatile group were included in the modified intention-to-treat analysis. INTERVENTIONS Patients randomly were assigned to receive either propofol-based total intravenous anesthesia or volatile anesthesia during surgery. MEASUREMENTS AND MAIN RESULTS The primary outcomes were the incidence of pain at three, six, and 12 months after surgery defined as pain score >0 on the numeric rating scale. The secondary outcomes included acute pain, opioid use during the first 72 hours after surgery, and quality of life. The use of propofol did not significantly affect chronic pain at three months (55.4% v 52.9%, difference 2.5%, 95% confidence interval [CI] -6.6 to 11.6; p = 0.656), six months (35.5% v 37.5%, difference -2.0%, 95% CI -10.9 to 6.9; p = 0.657), or 12 months (18.2% v 20.7%, difference -2.5%, 95% CI -9.8 to 4.8; p = 0.495) compared with volatile anesthetics. Furthermore, there were no differences in acute pain score; morphine-equivalent consumption during the first 72 hours; and quality of life at three, six, and 12 months after surgery. CONCLUSIONS Intraoperative administration of propofol did not reduce persistent pain after cardiac surgery compared with volatile anesthetics.
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Affiliation(s)
- Hong Yu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China; The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
| | - Zhao Xu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China; The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
| | - Shun-Hui Dai
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China; The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
| | - Jia-Li Jiang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China; The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
| | - Lei-Lei He
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China; The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
| | - Jian-Qiao Zheng
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China; The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
| | - Hai Yu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China; The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China.
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20
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Hung KC, Lin YT, Chen KH, Wang LK, Chen JY, Chang YJ, Wu SC, Chiang MH, Sun CK. The Effect of Perioperative Vitamin C on Postoperative Analgesic Consumption: A Meta-Analysis of Randomized Controlled Trials. Nutrients 2020; 12:E3109. [PMID: 33053814 PMCID: PMC7600013 DOI: 10.3390/nu12103109] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 09/22/2020] [Accepted: 10/01/2020] [Indexed: 01/09/2023] Open
Abstract
Because the analgesic effect of vitamin C against acute pain remains poorly addressed, this meta-analysis aimed at investigating its effectiveness against acute postoperative pain. A total of seven randomized controlled trials with placebo/normal controls were identified from PubMed, Cochrane Library, Medline, Google Scholar, and Embase databases. Pooled analysis showed a lower pain score (standardized mean difference (SMD) = -0.68, 95% CI: -1.01 to -0.36, p < 0.0001; I2 = 57%) and a lower morphine consumption (weighted mean difference (WMD) = -2.44 mg, 95% CI: -4.03 to -0.86, p = 0.003; I2 = 52%) in the vitamin group than that in the placebo group within postoperative 1-2 h. At postoperative 24 h, a lower pain score (SMD = -0.65, 95% CI: -1.11 to -0.19, p = 0.005; I2 = 81%) and lower morphine consumption (WMD = -6.74 mg, 95% CI: -9.63 to -3.84, p < 0.00001; I2 = 85%) were also noted in the vitamin group. Subgroup analyses demonstrated significant reductions in pain severity and morphine requirement immediately (1-2 h) and 24 h after surgery for patients receiving intravenous vitamin C but not in the oral subgroup. These findings showed significant reductions in pain score and opioid requirement up to postoperative 24 h, respectively, suggesting the effectiveness of perioperative vitamin C use. Further large-scale trials are warranted to elucidate its optimal intravenous dosage and effectiveness against chronic pain in the postoperative pain control setting.
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Affiliation(s)
- Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City 71004, Taiwan; (K.-C.H.); (Y.-T.L.); (L.-K.W.); (J.-Y.C.); (Y.-J.C.)
- Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan City 71710, Taiwan
| | - Yao-Tsung Lin
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City 71004, Taiwan; (K.-C.H.); (Y.-T.L.); (L.-K.W.); (J.-Y.C.); (Y.-J.C.)
- Center of General Education, Chia Nan University of Pharmacy and Science, Tainan City 71710, Taiwan
| | - Kee-Hsin Chen
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei City 11042, Taiwan;
- Cochrane Taiwan, Taipei Medical University, Taipei City 11042, Taiwan
- Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei City 11042, Taiwan
- Evidence-Based Knowledge Translation Center, Wan Fang Hospital, Taipei Medical University, Taipei City 11042, Taiwan
| | - Li-Kai Wang
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City 71004, Taiwan; (K.-C.H.); (Y.-T.L.); (L.-K.W.); (J.-Y.C.); (Y.-J.C.)
- Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan City 71710, Taiwan
| | - Jen-Yin Chen
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City 71004, Taiwan; (K.-C.H.); (Y.-T.L.); (L.-K.W.); (J.-Y.C.); (Y.-J.C.)
- Department of the Senior Citizen Service Management, Chia Nan University of Pharmacy and Science, Tainan City 71710, Taiwan
| | - Ying-Jen Chang
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City 71004, Taiwan; (K.-C.H.); (Y.-T.L.); (L.-K.W.); (J.-Y.C.); (Y.-J.C.)
- College of Health Sciences, Chang Jung Christian University, Tainan City 71101, Taiwan
| | - Shao-Chun Wu
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City 83301, Taiwan;
| | - Min-Hsien Chiang
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City 83301, Taiwan;
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, Kaohsiung City 82445, Taiwan
- College of Medicine, I-Shou University, Kaohsiung City 82445, Taiwan
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Alameri R, Dean G, Castner J, Volpe E, Elghoneimy Y, Jungquist C. Efficacy of Precise Foot Massage Therapy on Pain and Anxiety Following Cardiac Surgery: Pilot Study. Pain Manag Nurs 2020; 21:314-322. [PMID: 31734151 DOI: 10.1016/j.pmn.2019.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 07/18/2019] [Accepted: 09/16/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND Pain is the most pervasive distressing symptom following cardiac surgery. Forty percent of postoperative cardiac patients report inadequate pain management. Undertreated acute pain results in increased anxiety, delayed wound healing, and increased chance of persistent chronic pain. Foot massage is a safe, visible complementary approach to manage acute pain following surgery. AIM The aim of this study is to evaluate the efficacy of integrating foot massage therapy for managing postcardiac pain. METHOD A randomized placebo controlled single blinded trial comparing foot massage to placebo was conducted at a large hospital in Saudi Arabia. Thirty-one patients who had undergone cardiac surgery (16 in experimental and 15 in placebo group) participated in the study. Ten-minute foot massage was delivered to the experimental group by a nurse researcher, twice during one day, within 30 minutes after receiving an opioid pain medication. RESULTS The findings of this study indicate that foot massage significantly (p < .05) decreases pain intensity and anxiety in patients who have undergone cardiac surgery compared with a placebo control group. CONCLUSION Providing non-pharmacologic interventions for pain is the responsibility of the nursing staff. Foot massage is within the scope of nursing practice and is a safe and effective manner of improving patient care. Foot massage in conjunction with pharmacological interventions is effective in improving pain and anxiety. Future studies should consider focusing on frequency, dose, feasibility, acceptability, and participants' satisfaction.
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Affiliation(s)
- Rana Alameri
- Department of Fundamental Nursing, College Nursing, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
| | - Grace Dean
- School of Nursing, The State University of New York, Buffalo, New York, USA
| | - Jessica Castner
- School of Nursing, The State University of New York, Buffalo, New York, USA
| | - Ellen Volpe
- School of Nursing, The State University of New York, Buffalo, New York, USA
| | - Yasser Elghoneimy
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Carla Jungquist
- School of Nursing, The State University of New York, Buffalo, New York, USA
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Gjeilo KH, Oksholm T, Follestad T, Wahba A, Rustøen T. Trajectories of Pain in Patients Undergoing Lung Cancer Surgery: A Longitudinal Prospective Study. J Pain Symptom Manage 2020; 59:818-828.e1. [PMID: 31733353 DOI: 10.1016/j.jpainsymman.2019.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/05/2019] [Accepted: 11/05/2019] [Indexed: 12/25/2022]
Abstract
CONTEXT Lung cancer surgery is among the surgical procedures associated with the highest prevalence of pain, but prospective longitudinal studies after the pain trajectory are scarce. OBJECTIVES We aimed to describe the pain trajectory in patients undergoing surgery for primary lung cancer and investigate whether distinct groups of patients could be identified based on different pain trajectories. METHODS Patients (n = 264; 95% thoracotomies) provided data on the average and worst pain intensity, pain location, and comorbidities before, and at one month and five, nine, and 12 months after surgery. Pain profiles were analyzed by latent class mixed models. RESULTS The occurrence of any pain increased from 40% before surgery to 69% after one month and decreased to 56%, 57%, and 55% at five, nine, and 12 months, respectively. Latent class mixed models identified two classes both for average and worst pain; one class started low with high ratings after one month, then returning to a level slightly higher than baseline. The other class started higher with similar scores through the trajectory. Patients reporting no pain (8%) were placed in a separate class. Higher comorbidity score, preoperative use of both pain and psychotropic medicine characterized the class with overall highest pain for average and/or worst pain. CONCLUSION Pain was highly prevalent after surgery, and subgroups could be identified based on different pain trajectories. Patients reported both postoperative pain and pain from chronic conditions. Knowledge about vulnerable patients and risk factors for pain is important to tailor interventions and information about pain.
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Affiliation(s)
- Kari Hanne Gjeilo
- Department of Cardiothoracic Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Cardiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; National Competence Centre for Complex Symptom Disorders, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Trine Oksholm
- VID Specialized University, Haraldsplass, Bergen, Norway
| | - Turid Follestad
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Alexander Wahba
- Department of Cardiothoracic Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tone Rustøen
- Department of Nursing Science, Faculty of Medicine, University of Oslo, Oslo, Norway; Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Ullevål, Oslo, Norway
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Yu H, Zheng JQ, Hua YS, Ren SF, Yu H. Influence of volatile anesthesia versus total intravenous anesthesia on chronic postsurgical pain after cardiac surgery using the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials criteria: study protocol for a prospective randomized controlled trial. Trials 2019; 20:645. [PMID: 31775854 PMCID: PMC6880356 DOI: 10.1186/s13063-019-3742-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 09/23/2019] [Indexed: 02/05/2023] Open
Abstract
Background Many patients develop chronic postsurgical pain (CPSP) after cardiac surgery, which interferes with their sleep, mood, and quality of life. Studies have suggested that propofol improves postoperative analgesia compared with volatile anesthetics, but its preventive effect on CPSP following cardiac surgery is still unknown. This study compares the incidence of CPSP following cardiac surgery for those receiving volatile anesthesia and those receiving propofol-based total intravenous anesthesia (TIVA) using criteria recommended by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT). Methods/design This is a prospective randomized controlled trial. In total, 500 adults undergoing cardiac surgery will be randomly allocated to the volatile or the TIVA group. The volatile group will receive sevoflurane or desflurane during surgery as general anesthesia. The TIVA group will receive propofol-based intravenous agents and no volatile agents during surgery. The primary outcomes will be the frequency of CPSP at 3 months, 6 months, and 1 year after surgery. In this case, CPSP is sternal or thoracic pain. It is defined as either (1) numerical rating scale (NRS) > 0 or (2) meeting all six IMMPACT criteria for CPSP. The IMMPACT criteria are validated pain instruments. Discussion To our knowledge, this is the first prospective randomized controlled trial to investigate the prevention of CPSP following cardiac surgery for patients receiving volatile anesthesia compared to those receiving propofol-based TIVA using validated pain instruments in accordance with the IMMPACT recommendations. This study will provide important information on which of these two anesthetic regimens is better for preventing CPSP after cardiac surgery. Trial registration Chictr.org.cn, ChiCTR1900020747. Registered on 16 January 2019.
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Affiliation(s)
- Hong Yu
- Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, 610041, People's Republic of China
| | - Jian-Qiao Zheng
- Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, 610041, People's Republic of China
| | - Yu-Si Hua
- Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, 610041, People's Republic of China
| | - Shuo-Fang Ren
- Department of Cardiovascular surgery, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, 610041, People's Republic of China
| | - Hai Yu
- Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, 610041, People's Republic of China.
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Boitor M, Martorella G, Maheu C, Laizner AM, Gélinas C. Effects of Massage in Reducing the Pain and Anxiety of the Cardiac Surgery Critically Ill-a Randomized Controlled Trial. PAIN MEDICINE 2019; 19:2556-2569. [PMID: 29618079 DOI: 10.1093/pm/pny055] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Objective To evaluate the effectiveness of hand massage on the pain and anxiety of the cardiac surgery critically ill. Design A three-arm randomized controlled trial. Setting This study was conducted in a medical-surgical intensive care unit in Canada. Subjects Adult patients who underwent elective cardiac surgery, who were able to speak French/English and to self-report symptoms, without a high risk of postoperative complications were eligible. Methods Patients were randomly allocated to standard care plus either two 20-minute hand massages (experimental), two 20-minute hand holdings (active control), or two 20-minute rest periods (passive control/standard care). Pain intensity, pain unpleasantness, anxiety, muscle tension, and vital signs were evaluated before, after, and 30 minutes later for each intervention. Results From the 83 patients recruited, 60 were randomized (20 massage, 19 hand holding, 21 standard care). After controlling for baseline scores, the massage group reported significantly lower pain intensity, pain unpleasantness, and anxiety for the first data collection set compared with both hand holding and standard care (analysis of covariance, P < 0.02), with an average decrease of two points on a 0-10 scale. No statistically significant differences were noted between hand holding and standard care for any of the symptoms. Similar results were observed for the second data collection set (N = 43). Patients had decreased muscle tension post massage. Vital signs did not differ significantly between groups. Conclusions Findings suggest that a 20-minute hand massage in addition to routine postoperative pain management can concomitantly reduce pain intensity, pain unpleasantness, and anxiety by two points on average on a 0-10 scale.
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Affiliation(s)
- Madalina Boitor
- Ingram School of Nursing, McGill University, 680 Sherbrooke West, Montréal, Québec, Canada
| | - Géraldine Martorella
- College of Nursing, Florida State University, 104F - Vivian M. Duxbury Hall, Florida, USA
| | - Christine Maheu
- Ingram School of Nursing, McGill University, 680 Sherbrooke West, Montréal, Québec, Canada
| | - Andréa Maria Laizner
- Ingram School of Nursing, McGill University, 680 Sherbrooke West, Montréal, Québec, Canada
| | - Céline Gélinas
- Ingram School of Nursing, McGill University, 680 Sherbrooke West, Montréal, Québec, Canada
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Crawford JH, Townsley MM. Steroids for Adult and Pediatric Cardiac Surgery: A Clinical Update. J Cardiothorac Vasc Anesth 2019; 33:2039-2045. [DOI: 10.1053/j.jvca.2018.11.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Indexed: 11/11/2022]
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Persistent postoperative pain after cardiac surgery: a systematic review with meta-analysis regarding incidence and pain intensity. Pain 2018; 158:1869-1885. [PMID: 28767509 DOI: 10.1097/j.pain.0000000000000997] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Persistent postoperative pain (PPP) has been described as a complication of cardiac surgery (CS). We aimed to study PPP after CS (PPPCS) by conducting a systematic review of the literature regarding its incidence, intensity, location, and the presence of neuropathic pain, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The review comprised 3 phases: a methodological assessment of 6 different databases identifying potential articles and screening for inclusion criteria by 2 independent reviewers; data extraction; and study quality assessment. Meta-analysis was used to estimate the pooled incidence rates using a random effects model. We have identified 442 potentially relevant studies through database searching. A total of 23 studies (involving 11,057 patients) met our inclusion criteria. Persistent postoperative pain affects 37% patients in the first 6 months after CS, and it remains present more than 2 years after CS in 17%. The reported incidence of PPP during the first 6 months after CS increased in recent years. Globally, approximately half of the patients with PPPCS reported moderate to severe pain. Chest is the main location of PPPCS followed by the leg; neuropathic pain is present in the majority of the patients. This is the first systematic review and meta-analysis to provide estimates regarding incidence and intensity of PPPCS, which elucidates its relevance. There is an urgent need for adequate treatment and follow-up in patients with PPPCS.
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Nezafati P, Shomali A, Kahrom M, Omidvar Tehrani S, Dianatkhah M, Nezafati MH. ZipFix Versus Conventional Sternal Closure: One-Year Follow-Up. Heart Lung Circ 2018; 28:443-449. [PMID: 29548913 DOI: 10.1016/j.hlc.2018.01.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 12/22/2017] [Accepted: 01/26/2018] [Indexed: 01/29/2023]
Abstract
BACKGROUND The present study aimed to compare postoperative complications commonly revealed after sternotomy closure by new sternal ZipFix™ (Synthes GmbH, Oberdorf, Switzerland) implant and conventional steel wire. METHODS Among the initial 360 subjects, 326 patients enrolled in this randomised control trial who were candidates for cardiac surgery from April 2014 to March 2015. After the surgery, the sternal closure was randomly done with poly-ether-ether-ketone (PEEK) based sternal ZipFix (ZF) on the sternal body (n=168) or with conventional wires (CWs) (n=158). Patients were followed postoperatively as well as 1, 3, 6, and 12 months after discharge regarding postoperative complications such as pain severity, dehiscence, and infection including incisional infections (superficial or deep), and organ/space infection (mediastinitis or osteomyelitis). RESULTS The mean age of the ZF and CW groups were 63.58±10.9 and 62.42±7.1years, respectively (p=0.262). In addition, there was no significant difference between the two groups' baseline characteristics (p>0.05). Our study showed higher mean pain severity score in the conventional closure group compared with ZipFix closure group at all study time points (p<0.001). Infection was seen in 2.76% of the overall participants with no significant difference of incisional and organ infection between the two groups throughout the study. After 1-month follow-up, five patients in the CW group had sternal dehiscence whereas no patients in ZF had dehiscence (p<0.001). CONCLUSIONS Our trial demonstrates greater clinical advantages in terms of pain and sternal dehiscence post surgery by using sternal ZipFix compared to conventional steel wire.
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Affiliation(s)
- Pouya Nezafati
- Cardiac Rehabilitation Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
| | | | - Mahdi Kahrom
- Cardiac Surgery, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
| | | | - Minoo Dianatkhah
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
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Vierck CJ, Chapman CR. Prospective evaluation of chronic pain disorders and treatments. J Neurosci Methods 2018; 295:104-110. [PMID: 29198951 DOI: 10.1016/j.jneumeth.2017.11.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 10/23/2017] [Accepted: 11/29/2017] [Indexed: 01/30/2023]
Abstract
BACKGROUND The incidence of chronic pain is variable among individuals who have sustained traumatic or surgical injury. Also, treatments for pain rarely are effective consistently for a procedure or agent, and no therapies are considered effective for pain that is chronic. NEW METHOD Difficulties with standard methods for conducting clinical trials call attention to a need for protocols that provide a new understanding of the development of and control over chronic pain. Prospective single-subject research designs can document varieties of pain progression over time for individuals. Subsequent grouping of individuals with common characteristics directs a mechanism-based approach to therapy. RESULTS Tracking of individuals' pain and associated influences over time is consistent with clinical practice, noting and adapting to changes that occur. COMPARISON WITH EXISTING METHODS Grouping patients with diverse characteristics and variable effects of therapy is problematic. Conventional evaluation of pain assesses patients with similar injuries or surgery without characterizations of individuals who develop chronic pain or recover over time. Also, classical evaluation of therapies involves comparison of groups receiving treatment or a placebo without characterization of patients with successful and unsuccessful results. CONCLUSIONS Single-subject prospective studies can inform clinical trials according to individual differences that would be obscured by comparison of groups with unknown variation in characteristics that influence pain and therapeutic effectiveness.
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Affiliation(s)
- Charles J Vierck
- Department of Neuroscience, College of Medicine and McKnight Brain Institute, University of Florida, Gainesville, FL, 2610, United States.
| | - C Richard Chapman
- Department of Anesthesiology, School of Medicine, University of Utah, Salt Lake City, UT, 84108, United States
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Turan A, Karimi N, Zimmerman NM, Mick SL, Sessler DI, Mamoun N. Intravenous Acetaminophen Does Not Decrease Persistent Surgical Pain After Cardiac Surgery. J Cardiothorac Vasc Anesth 2017; 31:2058-2064. [DOI: 10.1053/j.jvca.2017.05.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Indexed: 11/11/2022]
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Forsberg A, Claëson M, Dahlman GB, Lennerling A. Pain, fatigue and well-being one to five years after lung transplantation - a nationwide cross-sectional study. Scand J Caring Sci 2017; 32:971-978. [PMID: 28976009 DOI: 10.1111/scs.12537] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 09/18/2017] [Indexed: 12/29/2022]
Abstract
RATIONALE AND AIM Little is known about persistent pain after lung transplantation. Therefore, the aim was to present a multidimensional assessment of self-reported pain 1-5 years after lung transplantation and its relationship with fatigue and transplant-specific well-being. METHODS This nationwide, cross-sectional cohort study is part of the self-management after thoracic transplantation study. A total of 117 lung recipients, all White, who were due for their annual follow-up at one (n = 35), two (n = 28), three (n = 23), four (n = 20) and 5 years (n = 11) after lung transplantation were included. We used three instruments; the Pain-O-Meter (POM), which provides information about pain intensity, sensation, location and duration, the MFI-19 fatigue instrument and the Organ Transplant Symptom and Well-being Instrument (OTSWI). Permission to carry out this study was granted by the Regional Ethical Review Board in southern Sweden (D-nr 2014-124). RESULTS The prevalence of pain was 51% after 1 year, 68% after 2 years, 69.5% after 3 years, 75% after 4 years and 54.5% after 5 years. Women experienced more pain than men. Lung recipients with pain reported lower well-being and higher symptom distress but were not more fatigued than those without pain. STUDY LIMITATIONS The limitations of this study are due to the cross-sectional design. The recruitment of patients during the study period was probably affected by the different conditions regarding staffing at the outpatient lung transplant clinic in the two thoracic transplant centres in Sweden. The slightly different approach to the care of these patients in the pre, peri and postoperative setting contributes to the heterogeneity of the study population. CONCLUSION Chronic bodily pain up to 5 years after lung transplantation reduces perceived well-being. Lung recipients with pain report higher symptom distress than those without pain.
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Affiliation(s)
- Anna Forsberg
- Institute of Health Sciences at Lund University, Lund, Sweden.,Department of Thoracic Transplantation and Cardiology, Skåne University Hospital, Lund, Sweden
| | - Matilda Claëson
- Department of Thoracic Transplantation and Cardiology, Skåne University Hospital, Lund, Sweden
| | | | - Annette Lennerling
- The Transplant Centre at Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Health and Care Sciences, Gothenburg University, Gothenburg, Sweden
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Han C, Ge Z, Jiang W, Zhao H, Ma T. Incidence and risk factors of chronic pain following hysterectomy among Southern Jiangsu Chinese Women. BMC Anesthesiol 2017; 17:103. [PMID: 28800726 PMCID: PMC5553861 DOI: 10.1186/s12871-017-0394-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 07/31/2017] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Chronic post-surgical pain (CPSP) after hysterectomy has been recognized as a major clinical problem in the Western World. Reports on post-hysterectomy pain are relatively scarce in China. The aim of the current study was to prospectively investigate the incidence and the potential risk factors of CPSP at 3 months following hysterectomy in Chinese population. METHODS We assessed and collected data on preoperative socio-demographic characteristics, preexisting pain, anxiety and depression, sexual satisfaction, intra-operative variables, and acute postoperative pain intensity in a cohort of 870 women undergoing hysterectomy. The participants were interviewed to determine their suitability to diagnostic criteria of CPSP 3 months later. Logistic regression analyses were subsequently performed to identify predictors for CPSP. RESULTS The incidence of CPSP at 3 months after hysterectomy was 27.7%. Most of the women with CPSP suffered from mild pain and had a slight impact on daily life with sleep and emotion functional limitation. Risk factors for CPSP after hysterectomy were preoperative anxiety, depression, pelvic pain, preexisting pain, very-moderate sexual dissatisfaction, and acute postoperative pain at movement. Intra-operative dexmedetomidine infusion with 0.5 μg/kg/h was associated with a decreased incidence rate of chronic post-hysterectomy pain. CONCLUSION Twenty-eight percent of patients after hysterectomy in southern Jiangsu china had CPSP with 92% of those women describing it as mild with sleep and emotion functional limitation. Patients with preoperative anxiety and depression, poor sexual satisfaction, preexisting pain, and acute postoperative pain on movement have been identified to be at risk to develop CPSP.
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Affiliation(s)
- Chao Han
- The Affiliated Yixing Hospital of Jiangsu University, 75 Tongzhenguan Road, Yixing, Jiangsu 214200 People’s Republic of China
| | - Zhijun Ge
- The Affiliated Yixing Hospital of Jiangsu University, 75 Tongzhenguan Road, Yixing, Jiangsu 214200 People’s Republic of China
| | - Wenjie Jiang
- The Affiliated Yixing Hospital of Jiangsu University, 75 Tongzhenguan Road, Yixing, Jiangsu 214200 People’s Republic of China
| | - Hailong Zhao
- The Affiliated Yixing Hospital of Jiangsu University, 75 Tongzhenguan Road, Yixing, Jiangsu 214200 People’s Republic of China
| | - Tieliang Ma
- The Affiliated Yixing Hospital of Jiangsu University, 75 Tongzhenguan Road, Yixing, Jiangsu 214200 People’s Republic of China
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Cogan J, Eipe N, Vargas-Schaffer G, Ouimette MF, Belisle S. “CAPS” Cardiac Acute Pain Services—A Nationwide Survey From Canada. J Cardiothorac Vasc Anesth 2017; 31:1235-1240. [DOI: 10.1053/j.jvca.2016.10.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Indexed: 11/11/2022]
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The Transition of Acute Postoperative Pain to Chronic Pain: An Integrative Overview of Research on Mechanisms. THE JOURNAL OF PAIN 2017; 18:359.e1-359.e38. [DOI: 10.1016/j.jpain.2016.11.004] [Citation(s) in RCA: 180] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 10/15/2016] [Accepted: 11/16/2016] [Indexed: 01/01/2023]
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Olsson A, Sandblom G, Fränneby U, Sondén A, Gunnarsson U, Dahlstrand U. Impact of postoperative complications on the risk for chronic groin pain after open inguinal hernia repair. Surgery 2016; 161:509-516. [PMID: 27838103 DOI: 10.1016/j.surg.2016.08.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 06/18/2016] [Accepted: 08/02/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Chronic pain is common after inguinal hernia repair and has become one of the most important outcome measures for this procedure. The purpose of this study was to determine whether or not there is a relationship between specific postoperative complications and risk for chronic pain after open inguinal hernia repair. METHODS A prospective cohort study was designed in which participants responded to the Inguinal Pain Questionnaire regarding postoperative groin pain 8 years after inguinal hernia repair. Responses to the questionnaire were matched with data from a previous study regarding reported postoperative complications after open inguinal hernia repair. Participants were recruited originally from the Swedish Hernia Register. Response rate was 82.4% (952/1,155). The primary outcome was chronic pain in the operated groin at follow-up. Grading of pain was performed using the Inguinal Pain Questionnaire. RESULTS A total of 170 patients (17.9%) reported groin pain and 29 patients (3.0%) reported severe groin pain. The risk for developing chronic groin pain was greater in patients with severe pain in the preoperative or immediate postoperative period (odds ratio 2.09; 95% confidence interval 1.28-3.41). Risk for chronic pain decreased for every 1-year increase in age at the time of operation (odds ratio 0.99, 95% confidence interval 0.98-1.00). CONCLUSION Both preoperative pain and pain in the immediate postoperative period are strong risk factors for chronic groin pain. Risk factor patterns should be considered before operative repair of presumed symptomatic inguinal hernias. The problem of postoperative pain must be addressed regarding both pre-emptive and postoperative analgesia.
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Affiliation(s)
- Anders Olsson
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Södersjukhuset, Stockholm, Sweden.
| | - Gabriel Sandblom
- Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Ulf Fränneby
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Sondén
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - Ulf Gunnarsson
- Department of Surgical and Perioperative Sciences, Division of Surgery, Umeå University, Umeå, Sweden
| | - Ursula Dahlstrand
- Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
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Boitor M, Martorella G, Laizner AM, Maheu C, Gélinas C. The Effectiveness of Hand Massage on Pain in Critically Ill Patients After Cardiac Surgery: A Randomized Controlled Trial Protocol. JMIR Res Protoc 2016; 5:e203. [PMID: 27821384 PMCID: PMC5118583 DOI: 10.2196/resprot.6277] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 09/19/2016] [Accepted: 09/19/2016] [Indexed: 01/20/2023] Open
Abstract
Background Postoperative pain is common in the intensive care unit despite the administration of analgesia. Some trials suggest that massage can be effective at reducing postoperative pain in acute care units; however, its effects on pain relief in the intensive care unit and when pain severity is highest remain unknown. Objective The objective is to evaluate the effectiveness of hand massage on the pain intensity (primary outcome), unpleasantness and interference, muscle tension, anxiety, and vital signs of critically ill patients after cardiac surgery. Methods A 3-arm randomized controlled trial will be conducted. A total of 79 patients who are 18 years or older, able to speak French or English and self-report symptoms, have undergone elective cardiac surgery, and do not have a high risk of postoperative complications and contraindications to hand massage will be recruited. They will be randomly allocated (1:1:1) to standard care plus either 3 20-minute hand massages (experimental), 3 20-minute hand holdings (active control), or 3 20-minute rest periods (passive control). Pain intensity, unpleasantness, anxiety, muscle tension, and vital signs will be evaluated before, immediately after, and 30 minutes later for each intervention administered within 24 hours postoperatively. Peer-reviewed competitive funding was received from the Quebec Nursing Intervention Research Network and McGill University in December 2015, and research ethics approval was obtained February 2016. Results Recruitment started in April 2016, and data collection is expected to be complete by January 2017. To date, 24 patients were randomized and had data collection done. Conclusions This study will be one of the first randomized controlled trials to examine the effect of hand massage on the pain levels of critically ill patients after cardiac surgery and to provide empirical evidence for the use of massage among this population. ClinicalTrial ClinicalTrials.gov NCT02679534; https://clinicaltrials.gov/ct2/show/NCT02679534 (Archived by WebCite at http://www.webcitation.org/6l8Ly5eHS)
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Affiliation(s)
- Madalina Boitor
- Ingram School of Nursing, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | | | - Andréa Maria Laizner
- Ingram School of Nursing, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Christine Maheu
- Ingram School of Nursing, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Céline Gélinas
- Ingram School of Nursing, Faculty of Medicine, McGill University, Montreal, QC, Canada
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Gjeilo KH, Stenseth R, Wahba A, Lydersen S, Klepstad P. Chronic postsurgical pain in patients 5 years after cardiac surgery: A prospective cohort study. Eur J Pain 2016; 21:425-433. [PMID: 27461370 DOI: 10.1002/ejp.918] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Chronic postsurgical pain (CPSP) is a common complication after many surgical procedures, including cardiac surgery. The prevalence of CPSP after cardiac surgery ranges from 9.5% to 56%. Most studies on CPSP after cardiac surgery are retrospective and long-term prospective studies are scarce. The aim of this study was to follow CPSP and health-related quality of life (HRQOL) prospectively in a cohort of patients, emphasizing the prevalence from 12 months to 5 years. METHODS A total of 534 patients (23% ≥75 years, 67% men) were consecutively included before surgery. Study-specific questionnaires and the Brief Pain Inventory (BPI) were used to measure CPSP at baseline, 12 months and 5-year follow-up. Short-Form Health Survey (SF-36) was used to measure HRQOL. RESULTS Among 458 patients who were alive after 5 years, 82% responded (n = 373). The majority, 89.8% (335/373), did not report CPSP, neither 12 months nor 5 years after surgery. Among the 38 patients who reported CPSP after 12 months, 24 (63%) patients did not report CPSP after 5 years. The overall prevalence of CPSP after 5 years was 3.8% (14/373). Patients reporting CPSP and resolved CPSP had lower scores on HRQOL and more pain preoperatively than patients who did not report CPSP. CONCLUSIONS The prevalence of CPSP was lower in this study than previously reported. Among the patients reporting CPSP at 12 months, 63% did not report CPSP after 5 years. Hence, the observed decline in CPSP is in line with studies evaluating CPSP in noncardiac surgery. SIGNIFICANCE The prevalence of chronic postsurgical pain (CPSP) at 5 years after surgery of 3.8% is lower than previously reported. The majority of patients reporting CPSP after 12 months did not report CPSP after 5 years.
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Affiliation(s)
- K H Gjeilo
- Department of Cardiothoracic Surgery, St. Olavs Hospital, Trondheim University Hospital, Norway.,Department of Cardiology, St. Olavs Hospital, Trondheim University Hospital, Norway.,National Competence Centre for Complex Symptom Disorders, St. Olavs Hospital, Trondheim University Hospital, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - R Stenseth
- Department of Circulation and Medical Imaging, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Cardiothoracic Anaesthesiology, St. Olavs Hospital, Trondheim University Hospital, Norway
| | - A Wahba
- Department of Cardiothoracic Surgery, St. Olavs Hospital, Trondheim University Hospital, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - S Lydersen
- Regional Centre for Child and Youth Mental Health and Child Welfare-Central Norway, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - P Klepstad
- Department of Circulation and Medical Imaging, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Intensive Care Medicine, St. Olavs Hospital, Trondheim University Hospital, Norway
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Guimarães-Pereira L, Farinha F, Azevedo L, Abelha F, Castro-Lopes J. Persistent Postoperative Pain after Cardiac Surgery: Incidence, Characterization, Associated Factors and its impact in Quality of Life. Eur J Pain 2016; 20:1433-42. [PMID: 26988335 DOI: 10.1002/ejp.866] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cardiac surgery (CS) ranks among the most frequently performed interventions worldwide and persistent postoperative pain (PPP) has been recognized as a relevant clinical outcome in this context. We aimed to evaluate its incidence, characteristics, associated factors and patient's quality of life (QoL). METHODS Observational prospective study conducted in patients undergoing CS in a tertiary university hospital. PPP was defined as persistent pain after surgery with higher than 3 months' duration, after excluding other causes of pain. We used a set of questionnaires for data collection: Pain Catastrophizing Scale, Duke Health Profile, Brief Pain Inventory Short Form, McGill Pain Questionnaire Short Form, Douleur Neuropathique en 4 Questions and standardized questions regarding pain periodicity. RESULTS A total of 288 patients have completed the study and 43% presented PPP assessed at 3 months (PPP3M); out of which 84% were not under any treatment. PPP patients reported significantly lower QoL, and a neuropathic pain (NP) component was present in 50% of them. Younger age, female gender, higher body mass index, catastrophizing, coronary artery bypass graft, osteoarthritis, history of previous surgery (excluding sternotomy) and moderate to severe acute postoperative pain were independent predictors of PPP3M. CONCLUSION This is the first study comprehensively describing PPP after CS and identifying NP in half of them. Our results support the important role that PPP plays after CS in considering its interference in patients' daily life and their lower QoL, which deserves the attention of health care professionals in order to improve prevention, assessment and treatment of these patients. WHAT DOES THIS STUDY ADD?: This study comprehensively describes persistent postoperative pain (PPP) after cardiac surgery (CS) and identifies neuropathic pain (NP) in half of them. Our results support the important role that PPP plays after CS in considering its interference in patients' daily life and their lower quality of life.
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Affiliation(s)
- Luís Guimarães-Pereira
- Department of Anesthesiology, Centro Hospitalar São João, Oporto, Portugal. .,Department of Health Information and Decision Sciences & Center for Health Technology and Services Research, Faculty of Medicine of the University of Porto, Oporto, Portugal.
| | - Filomena Farinha
- Department of Anesthesiology, Centro Hospitalar São João, Oporto, Portugal
| | - Luís Azevedo
- Department of Health Information and Decision Sciences & Center for Health Technology and Services Research, Faculty of Medicine of the University of Porto, Oporto, Portugal
| | - Fernando Abelha
- Department of Anesthesiology, Centro Hospitalar São João, Oporto, Portugal.,Department of Surgery, Faculty of Medicine of the University of Porto, Oporto, Portugal
| | - José Castro-Lopes
- Department of Experimental Biology, Faculty of Medicine of the University of Porto, Oporto, Portugal
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Abstract
Abstract
Background
Persistent incisional pain is common after cardiac surgery and is believed to be in part related to inflammation and poorly controlled acute pain. Methylprednisolone is a corticosteroid with substantial antiinflammatory and analgesic properties and is thus likely to ameliorate persistent surgical pain. Therefore, the authors tested the primary hypothesis that patients randomized to methylprednisolone have less persistent incisional pain than those given placebo.
Methods
One thousand forty-three patients having cardiopulmonary bypass for cardiac surgery via a median sternotomy were included in this substudy of Steroids in Cardiac Surgery (SIRS) trial. Patients were randomized to 500 mg intraoperative methylprednisolone or placebo. Incisional pain was assessed at 30 days and 6 months after surgery, and the potential risk factors were also evaluated.
Results
Methylprednisolone administration did not reduce pain at 30 days or persistent incisional pain at 6 months, which occurred in 78 of 520 patients (15.7%) in the methylprednisolone group and in 88 of 523 patients (17.8%) in the placebo group. The odds ratio for methylprednisolone was 0.93 (95% CI, 0.79 to 1.09, P = 0.37). Furthermore, there was no difference in worst pain and average pain in the last 24 h, pain interference with daily life, or use of pain medicine at 6 months. Younger age, female sex, and surgical infections were associated with the development of persistent incisional pain.
Conclusions
Intraoperative methylprednisolone administration does not reduce persistent incisional pain at 6 months in patients recovering from cardiac surgery.
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Giménez-Milà M, Videla S, Jenkins D, Klein AA, Gerrard C, Nalpon J, Valchanov K. Acute Pain and Analgesic Requirements After Pulmonary Endarterectomy With Deep Hypothermic Circulatory Arrest. J Cardiothorac Vasc Anesth 2015; 30:993-6. [PMID: 26948465 DOI: 10.1053/j.jvca.2015.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To assess postoperative pain intensity and the analgesic requirements in the postoperative period in patients undergoing sternotomy for pulmonary endarterectomy involving deep hypothermic circulatory arrest. DESIGN Retrospective cohort study. SETTING Single-center hospital study. PARTICIPANTS Patients 18 years and older undergoing sternotomy for cardiac surgery between August 2012 and August 2014. INTERVENTIONS No modification to usual clinical practice. MEASUREMENTS AND MAIN RESULTS Intraoperative opioid and steroid administration, referral to the chronic pain unit, intensive care unit pain scores, and analgesic administration in the first 48 hours after the admission to the intensive care unit were recorded. Postoperative pain was evaluated by means of a categoric verbal scale from no pain (0) to severe pain (3); this is the routine analgesic scale used in the authors' intensive care unit. A total of 200 consecutive patients undergoing pulmonary endarterectomy (PEA group) were included in the study. No patient in the PEA group received morphine during surgery. The mean (standard deviation) postoperative pain intensity score at 24 hours was 0.30 (0.54) in the PEA group. Postoperative morphine was administered in 39% of patients. No PEA patient was referred to the chronic pain unit after hospital discharge. CONCLUSION The total analgesic requirements and pain score of patients undergoing sternotomy for pulmonary endarterectomy with deep hypothermic circulatory arrest seemed to be low.
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Affiliation(s)
- Marc Giménez-Milà
- Department of Anaesthesia and Intensive Care, Papworth Hospital, Cambridge, United Kingdom;.
| | - Sebastian Videla
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
| | - David Jenkins
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, United Kingdom
| | - Andrew A Klein
- Department of Anaesthesia and Intensive Care, Papworth Hospital, Cambridge, United Kingdom
| | - Caroline Gerrard
- Department of Anaesthesia and Intensive Care, Papworth Hospital, Cambridge, United Kingdom
| | - Jacinta Nalpon
- Department of Anaesthesia and Intensive Care, Papworth Hospital, Cambridge, United Kingdom
| | - Kamen Valchanov
- Department of Anaesthesia and Intensive Care, Papworth Hospital, Cambridge, United Kingdom
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40
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Minimize the risk of chronic pain after cardiac surgery by treating acute postoperative pain. DRUGS & THERAPY PERSPECTIVES 2015. [DOI: 10.1007/s40267-015-0191-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Doering LV, McGuire A, Eastwood JA, Chen B, Bodán RC, Czer LS, Irwin MR. Cognitive behavioral therapy for depression improves pain and perceived control in cardiac surgery patients. Eur J Cardiovasc Nurs 2015; 15:417-24. [PMID: 26115954 DOI: 10.1177/1474515115592292] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 06/01/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Depression after cardiac surgery (CS) is associated with increased pain and decreased sleep quality. While cognitive behavioral therapy (CBT) aimed at depression is effective in relieving depressive symptoms after cardiac surgery, little is known about its ability to ameliorate other common postoperative problems that affect recovery and quality of life. AIMS The purpose of this study was to evaluate the effects of CBT for depression on pain severity, pain interference, sleep, and perceived control in patients recovering from CS. METHODS Depressed patients recovering from CS were randomized to receive either eight weeks of CBT or usual care. At baseline and post-intervention, patients completed questionnaires for depressive symptoms, pain, sleep, and perceived control. Group comparisons were conducted using t-tests or chi square analysis. Repeated measures analysis was used to assess the effect of the intervention in changes over time. RESULTS The sample (n=53) included 16.9% women and had a mean age of 67.8±9.2 years. CBT for depression increased perceived control (p<0.001) and decreased pain interference (p=0.02) and pain severity (p=0.03). Group effects remained significant (p<0.05) for perceived control and pain interference and a trend was observed for pain severity (p<0.10) after controlling for variables that differed at baseline. There were no group differences in sleep disturbance over time. CONCLUSIONS A depression-focused CBT intervention yields benefits in other common postoperative problems, specifically improved perceived control and decreased pain in depressed cardiac surgery patients.
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Affiliation(s)
| | - Anthony McGuire
- School of Nursing, California State University, Long Beach, USA
| | | | - Belinda Chen
- School of Nursing, University of California, USA
| | - Rebecca C Bodán
- School of Nursing, California State University, Fullerton, USA
| | | | - Michael R Irwin
- Cousins Center for Psychoneuroimmunology, University of California, USA
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Comparison of operant escape and reflex tests of nociceptive sensitivity. Neurosci Biobehav Rev 2015; 51:223-42. [PMID: 25660956 DOI: 10.1016/j.neubiorev.2015.01.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 01/17/2015] [Accepted: 01/27/2015] [Indexed: 01/17/2023]
Abstract
Testing of reflexes such as flexion/withdrawal or licking/guarding is well established as the standard for evaluating nociceptive sensitivity and its modulation in preclinical investigations of laboratory animals. Concerns about this approach have been dismissed for practical reasons - reflex testing requires no training of the animals; it is simple to instrument; and responses are characterized by observers as latencies or thresholds for evocation. In order to evaluate this method, the present review summarizes a series of experiments in which reflex and operant escape responding are compared in normal animals and following surgical models of neuropathic pain or pharmacological intervention for pain. Particular attention is paid to relationships between reflex and escape responding and information on the pain sensitivity of normal human subjects or patients with pain. Numerous disparities between results for reflex and operant escape measures are described, but the results of operant testing are consistent with evidence from humans. Objective reasons are given for experimenters to choose between these and other methods of evaluating the nociceptive sensitivity of laboratory animals.
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