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Xia Z, Chen Y, Xie J, Zhang W, Tan L, Shi Y, Liu J, Wang X, Tan G, Zeng A. Faster Return to Daily Activities and Better Pain Control: A Prospective Study of Enhanced Recovery After Surgery Protocol in Breast Augmentation. Aesthetic Plast Surg 2023; 47:2261-2267. [PMID: 37488312 DOI: 10.1007/s00266-023-03504-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/30/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) has been proven to decrease the amount of opioid use and reduce postoperative pain for a variety of surgeries, including breast reconstruction. However, data on ERAS in breast augmentation is lacking. OBJECTIVES This study aims to investigate the effectiveness and safety of ERAS for breast augmentation. METHODS A standardized ERAS protocol was established with full consideration of all aspects of perioperative care. Patients undergoing implant-based breast augmentation were prospectively recruited between December 2020 and January 2023, and assigned to either the ERAS or non-ERAS group randomly. The primary outcome was the activity of daily living after surgery. The secondary was postoperative pain and other outcomes included time to freely elevation, vomiting frequency, the use of analgesics, and complications. RESULTS A total of 122 patients were included, with 70 in the ERAS group and 52 in the non-ERAS group. Compared to non-ERAS patients, ERAS patients had a shorter time to freely elevation of upper limbs (2.3 d vs. 5.5 d, P < 0.001). For ERAS patients, the pain scores were significantly lower on postoperative days 1 to 3, the activity of daily living index was significantly higher on postoperative days 1 to 3 and the opioids consumption was decreased (7.1 mg vs. 46.2 mg, P = 0.018). No difference was observed in complication and hospital costs between the two groups. CONCLUSION The ERAS protocol significantly reduced postoperative pain and the use of opioids and promoted a return to daily activities without increasing complications in breast augmentation. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Zenan Xia
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1#, Dongcheng District, Beijing, 100730, P. R. China
| | - Yuliang Chen
- Department of Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1#, Dongcheng District, Beijing, 100730, P. R. China
| | - Jiangmiao Xie
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1#, Dongcheng District, Beijing, 100730, P. R. China
| | - Wenchao Zhang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1#, Dongcheng District, Beijing, 100730, P. R. China
| | - Linjuan Tan
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1#, Dongcheng District, Beijing, 100730, P. R. China
| | - Yanping Shi
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1#, Dongcheng District, Beijing, 100730, P. R. China
| | - Jie Liu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1#, Dongcheng District, Beijing, 100730, P. R. China
| | - Xiaojun Wang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1#, Dongcheng District, Beijing, 100730, P. R. China
| | - Gang Tan
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1#, Dongcheng District, Beijing, 100730, P. R. China
| | - Ang Zeng
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1#, Dongcheng District, Beijing, 100730, P. R. China.
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da Silva FG, Podestá MHMC, Silva TC, de Barros CM, de Carvalho BFV, Dos Reis TM, Espósito MC, Marrafon DAFDO, Nogueira DA, Diwan S, Ceron CS, Torres LH. Oral pregabalin is effective as preemptive analgesia in abdominal hysterectomy-A randomized controlled trial. Clin Exp Pharmacol Physiol 2023; 50:256-263. [PMID: 36440985 DOI: 10.1111/1440-1681.13742] [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: 09/28/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022]
Abstract
Postoperative pain is one of the main negative symptoms resulting from surgery and the use of new methods to control this symptom is of ever-increasing relevance. Opioid-sparing strategies, such as multimodal analgesia, are trends in this scenario. Pregabalin is a well-established treatment for neuropathic pain; however, it is still controversial in the surgical context for postoperative analgesia. This study investigated the effect of pregabalin on postoperative analgesia in patients undergoing abdominal hysterectomy. It is a prospective, randomised, double-blind, placebo-controlled clinical trial. Female patients undergoing abdominal hysterectomy were randomised to use pregabalin (group P1), 300 mg orally 2 h before surgery, or identical placebo pills (group P0). The main outcome includes the postoperative pain index by visual analogue scale (VAS) and McGill's pain questionnaire. Secondary outcomes include opioid consumption and the presence of adverse effects. A value of p < 0.05 was used to reject type I error. Fifty-five patients were randomised amongst the groups. Patients in group P1 had lower pain rates by VAS scale, both at rest and in active motion, than group P0. In McGill's questionnaire, patients from group P1 also had lower pain rates (12 × 28.5). There was approximately twice as much opioid consumption amongst patients in group P0. Regarding side effects, there was a difference between the two groups only for dizziness, being more incident in group P1. This study suggests that pregabalin is an important adjuvant drug in treating postoperative pain in patients with abdominal hysterectomy.
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Affiliation(s)
- Fabrício Gomes da Silva
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Alfenas, Brazil.,Department of Anesthesiology, pain and palliative care, Santa Casa of Alfenas, Alfenas, Brazil
| | | | - Thayná Coelho Silva
- Department of Anesthesiology, pain and palliative care, Santa Casa of Alfenas, Alfenas, Brazil
| | - Carlos Marcelo de Barros
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Alfenas, Brazil.,Department of Anesthesiology, pain and palliative care, Santa Casa of Alfenas, Alfenas, Brazil
| | | | - Tiago Marques Dos Reis
- Department of Clinical and Toxicological Analysis, School of Pharmaceutical Sciences, Federal University of Alfenas, Alfenas, Brazil
| | - Milena Carla Espósito
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Alfenas, Brazil
| | | | - Denismar Alves Nogueira
- Department of Statistics, Institute of Exact Sciences, Federal University of Alfenas, Alfenas, Brazil
| | - Sudhir Diwan
- Department of Anesthesiology and Pain Medicine, Lenox Hill Hospital, New York, USA
| | - Carla Speroni Ceron
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Alfenas, Brazil
| | - Larissa Helena Torres
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Alfenas, Brazil
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Wang Q, Dong J, Ye X, Ren YF. A Meta-Analysis Showing the Quantitative Evidence Base of Preemptive Pregabalin for Postoperative Pain from Cancer-Related Surgery. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020280. [PMID: 36837482 PMCID: PMC9965191 DOI: 10.3390/medicina59020280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/14/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023]
Abstract
Background and Objectives: As an adjunct to postoperative multimodal analgesic regimens, pregabalin has been reported in reducing postoperative acute pain and opioid consumption. However, there is only a small amount of evidence for preemptive pregabalin in patients undergoing cancer-related surgery. This systematic review was conducted to integrate high-quality evidence to evaluate the preemptive analgesic effects of pregabalin in cancer-related surgery. Materials and Methods: Seven electronic databases were searched in a combination of subject terms and free words. Efficacy and safety of preemptive pregabalin on postoperative pain for cancer-related surgery were evaluated by assessing resting and dynamic pain scores postoperatively, cumulative morphine equivalent consumption, time to first analgesic request, hemodynamic parameters, and the safety indicators. Results: Thirteen trials were incorporated for quantitative synthesis. The pooled results showed administration of pregabalin preoperatively is clinically significant for improving resting (weighted mean difference (WMD), -1.53 cm; 95% CI, -2.30 to -0.77) and dynamic (WMD, -1.16 cm; 95% CI, -2.22 to -0.11) pain severity scores at 2 h postoperatively and prolonging time to first analgesic request (WMD, 2.28 h; 95% CI, 0.79 to 3.77) in cancer-related surgery. Preemptive pregabalin was also statistically effective in some other pain indicators but would increase the risk of pregabalin-related side effects after surgery. Conclusions: Our findings do not support the administration of pregabalin in doses larger than 300 mg when put in cancer-related surgery. Taken together, more high-quality research particularly focused on the optimal dosages and timing of pregabalin in cancer-related surgery is needed in the future to establish stronger evidence for therapeutic effects.
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Affiliation(s)
| | | | - Xin Ye
- Correspondence: (X.Y.); (Y.-F.R.); Tel.: +86-15828461815 (X.Y.); +86-19130860334 (Y.-F.R.)
| | - Yi-Feng Ren
- Correspondence: (X.Y.); (Y.-F.R.); Tel.: +86-15828461815 (X.Y.); +86-19130860334 (Y.-F.R.)
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Maniker RB, Damiano J, Ivie RMJ, Pavelic M, Woodworth GE. Perioperative Breast Analgesia: a Systematic Review of the Evidence for Perioperative Analgesic Medications. Curr Pain Headache Rep 2022; 26:299-321. [PMID: 35195851 DOI: 10.1007/s11916-022-01031-z] [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] [Accepted: 01/26/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Breast surgery is common and may result in significant acute as well as chronic pain. A wide range of pharmacologic interventions is available including opioids, non-steroidal anti-inflammatory drugs (NSAIDs), N-methyl-D-aspartate (NMDA) receptor antagonists, anticonvulsants, and other non-opioids with analgesic properties. We present a review of the evidence for these pharmacologic interventions. A literature search of the MEDLINE database was performed via PubMed with combined terms related to breast surgery, anesthesia, and analgesia. Articles were limited to randomized controlled trial (RCT) design, adult patients undergoing elective surgery on the breast (not including biopsy), and pharmacologic interventions only. Article titles and abstracts were screened, and risk of bias assessments were performed. RECENT FINDINGS The search strategy initially captured 7254 articles of which 60 articles met the full inclusion criteria. Articles were organized according to intervention: 6 opioid agonists, 14 NSAIDs and acetaminophen, 4 alpha-2 agonists, 7 NMDA receptor antagonists, 6 local anesthetics, 7 steroids, 15 anticonvulsants (one of which also discussed an NMDA antagonist), 1 antiarrhythmic, and 2 serotonin reuptake inhibitors (one of which also studied an anticonvulsant). A wide variety of medications is effective for perioperative breast analgesia, but results vary by agent and dose. The most efficacious are likely NSAIDs and anticonvulsants. Some agents may also decrease the incidence of chronic postoperative pain, including flurbiprofen, gabapentin, venlafaxine, and memantine. While many individual agents are well studied, optimal combinations of analgesic medications remain unclear.
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Affiliation(s)
- Robert B Maniker
- Department of Anesthesiology, Columbia University, 622 West 168th Street, PH505, NY, 10032, New York, USA.
| | | | - Ryan M J Ivie
- Oregon Health and Science University, Portland, OR, USA
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Li X, Li Y. Nerve Block on Pain After Mammaplasty: A Meta-Analysis of randomized controlled studies. Plast Surg (Oakv) 2022; 30:32-38. [PMID: 35096690 PMCID: PMC8793749 DOI: 10.1177/2292550320969648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Nerve block showed some potential in alleviating pain after mammaplasty. This systematic review and meta-analysis was conducted to investigate the efficacy of nerve block for pain control after mammaplasty. METHODS The databases including PubMed, Embase, Web of Science, EBSCO, and Cochrane library databases were systematically searched for collecting the randomized controlled trials (RCTs) regarding the impact of nerve block on pain intensity after mammaplasty. RESULTS This meta-analysis included 4 RCTs. Compared with control group after mammaplasty, nerve block resulted in remarkably reduced pain scores at 1 hour (mean difference [MD] = -1.84; 95% CI = -2.49 to -1.20; P < .00001), 3 hours (MD = -1.04; 95% CI = -1.47 to -0.62; P < .00001), 6 hours (MD = -0.96; 95% CI = -1.48 to -0.43; P = .0004), and analgesic consumption (standard mean difference = -1.27; 95% CI = -1.73 to -0.82; P < .00001), but showed no significant impact on pain scores within 24 hours (MD = -0.31; 95% CI = -1.05 to 0.43; P = .41). CONCLUSIONS Nerve block was associated with substantially reduced pain intensity after mammaplasty.
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Affiliation(s)
- Xiaoxia Li
- Burn Plastic and Cosmetic Surgery Department, Bayannur City Hospital, Inner Mongolia, People’s Republic of China,Xiaoxia Li, Burn Plastic and Cosmetic Surgery Department, Bayannur City Hospital, No.98, Wulanbuhe Road, Bayannur city, Inner Mongolia 015000, People’s Republic of China.
| | - Ying Li
- Burn Plastic and Cosmetic Surgery Department, Bayannur City Hospital, Inner Mongolia, People’s Republic of China
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Afshan G, Khan RI, Ahmed A, Siddiqui AS, Rehman A, Raza SA, Kerai R, Mustafa K. Post-operative pain management modalities employed in clinical trials for adult patients in LMIC; a systematic review. BMC Anesthesiol 2021; 21:160. [PMID: 34034672 PMCID: PMC8152022 DOI: 10.1186/s12871-021-01375-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 05/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unrelieved postoperative pain afflicts millions each year in low and middle income countries (LMIC). Despite substantial advances in the study of pain, this area remains neglected. Current systematic review was designed to ascertain the types of clinical trials conducted in LMIC on postoperative pain management modalities over the last decade. METHODS A comprehensive search was performed in June 2019 on PubMed, Cochrane Library, CINAHL Plus, and Web of Science databases to identify relevant trials on the management of postoperative pain in LMIC. Out of 1450 RCTs, 108 studies were reviewed for quality evidence using structured form of critical appraisal skill program. Total of 51 clinical trials were included after applying inclusion/exclusion criteria. RESULTS Results are charted according to the type of surgery. Eleven trials on laparoscopic cholecystectomy used multimodal analgesia including some form of regional analgesia. Different analgesic modalities were studied in 4 trials on thoracotomy, but none used multimodal approach. In 11 trials on laparotomy, multimodal analgesia was employed along with the studied modalities. In 2 trials on hysterectomy, preemptive pregabalin or gabapentin were used for reduction in rescue analgesia. In 13 trials on breast surgical procedures and 10 on orthopaedic surgery, multimodal analgesia was used with some form of regional analgesia. CONCLUSION We found that over the past 10 years, clinical trials for postoperative pain modalities have evolved in LMIC according to the current postoperative pain management guidelines i.e. multi-modal approach with some form of regional analgesia. The current review shows that clinical trials were conducted using multimodal analgesia including but not limited to some form of regional analgesia for postoperative pain in LMIC however this research snapshot (of only three countries) may not exactly reflect the clinical practices in all 47 countries. Post Operative Pain Management Modalities Employed in Clinical Trials for Adult Patients in LMIC; A Systematic Review.
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Affiliation(s)
- Gauhar Afshan
- Department of Anaesthesiology, 2nd floor Private Wing, Aga Khan University, P.O. Box 3500, Stadium Road, Karachi, 74800, Pakistan.
| | - Robyna Irshad Khan
- Department of Anaesthesiology, 2nd floor Private Wing, Aga Khan University, P.O. Box 3500, Stadium Road, Karachi, 74800, Pakistan
| | - Aliya Ahmed
- Department of Anaesthesiology, 2nd floor Private Wing, Aga Khan University, P.O. Box 3500, Stadium Road, Karachi, 74800, Pakistan
| | - Ali Sarfraz Siddiqui
- Faculty of Health Sciences, Aga Khan University, P.O. Box 3500, Stadium Road, Karachi, Pakistan
| | - Azhar Rehman
- Faculty of Health Sciences, Aga Khan University, P.O. Box 3500, Stadium Road, Karachi, Pakistan
| | - Syed Amir Raza
- Faculty of Health Sciences, Aga Khan University, P.O. Box 3500, Stadium Road, Karachi, Pakistan
| | - Rozina Kerai
- Department of Anaesthesiology, 2nd floor Private Wing, Aga Khan University, P.O. Box 3500, Stadium Road, Karachi, 74800, Pakistan
| | - Khawaja Mustafa
- Department of Anaesthesiology, 2nd floor Private Wing, Aga Khan University, P.O. Box 3500, Stadium Road, Karachi, 74800, Pakistan
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Perioperative Pregabalin for Preventive Analgesia in Breast Cancer Surgery: A Meta-analysis of Randomized Controlled Trials. Clin J Pain 2020; 36:968-977. [PMID: 32960823 DOI: 10.1097/ajp.0000000000000883] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Pregabalin is a drug for neuropathic pain. Antipronociceptive properties of pregabalin have led to its recent use as an adjuvant to the multimodal postoperative pain regimen. This meta-analysis was conducted to evaluate the efficacy of perioperative pregabalin on acute and chronic postsurgical pain (CPSP) after breast cancer surgery. METHODS A meta-analysis including 8 randomized controlled trials searched from MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials was conducted. Subgroup analysis was performed according to doses and timecourse of pregabalin administration. Review Manager 5.3 was selected to conduct the meta-analysis. RESULTS Preoperative pregabalin in breast cancer surgery alleviated acute postoperative pain at rest 24 hours after surgery by 0.31 points on an 0 to 10 Numerical Rating Scale (95% confidence interval [CI] -0.57 to -0.05). Morphine consumption showed a decrease in postoperative use by 1.09 mg (95% CI: -1.61 to -0.57). The incidence of CPSP 3 months after surgery was reduced to 46% (95% CI: 0.25-0.85). Postoperative nausea and vomiting, dizziness, and sedation showed no overall significant reductions. However, a decrease in the incidence of postoperative nausea and vomiting and an increase in the incidence of dizziness were noted when patients received 300 mg of pregabalin before surgery. DISCUSSION This study demonstrated that pregabalin showed more efficacy on chronic pain than acute pain after a breast cancer surgery. Further study based on doses and treatment course of pregabalin should be conducted to establish stronger evidence of treatment effects.
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Zhang L, Ding W, Ji Y. Analgesic effect of pulsed electromagnetic fields for mammaplasty: A meta-analysis of randomized controlled studies. Medicine (Baltimore) 2020; 99:e21449. [PMID: 32871867 PMCID: PMC7458251 DOI: 10.1097/md.0000000000021449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/18/2020] [Accepted: 06/24/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Pulsed electromagnetic fields shows some potential in alleviating pain after mammaplasty. This systematic review and meta-analysis is conducted to investigate the analgesic efficacy of pulsed electromagnetic fields for pain control after mammaplasty. METHODS The databases including PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases are systematically searched for collecting the randomized controlled trials regarding the impact of pulsed electromagnetic fields on pain intensity after mammaplasty. RESULTS This meta-analysis has included 4 randomized controlled trials. Compared with control group after mammaplasty, pulsed electromagnetic fields results in remarkably reduced pain scores on 1 day (MD = -1.34; 95% confidence interval [CI] = -2.23 to -0.45; P = .003) and 3 days (MD = -1.86; 95% CI = -3.23 to -0.49; P = .008), as well as analgesic consumption (Std. MD = -5.64; 95% CI = -7.26 to -4.02; P < .00001). CONCLUSIONS Pulsed electromagnetic fields is associated with substantially reduced pain intensity after mammaplasty.
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Affiliation(s)
- Li Zhang
- Department of Plastic Surgery, The First people's Hospital of Xiaoshan
| | - Wei Ding
- Department of Plastic Surgery, The First people's Hospital of Xiaoshan
| | - Yu Ji
- Department of Plastic Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou; Zhejiang Province, P.R. China
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Lepot A, Elia N, Tramèr MR, Rehberg B. Preventing pain after breast surgery: A systematic review with meta-analyses and trial-sequential analyses. Eur J Pain 2020; 25:5-22. [PMID: 32816362 DOI: 10.1002/ejp.1648] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 08/03/2020] [Accepted: 08/13/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVE The aim of this systematic review was to indirectly compare the efficacy of any intervention, administered perioperatively, on acute and persistent pain after breast surgery. DATABASES AND DATA TREATMENT We searched for randomized trials comparing analgesic interventions with placebo or no treatment in patients undergoing breast surgery under general anaesthesia. Primary outcome was intensity of acute pain (up to 6 hr postoperatively). Secondary outcomes were cumulative 24-hr morphine consumption, incidence of postoperative nausea and vomiting (PONV), and chronic pain. We used an original three-step approach. First, meta-analyses were performed when data from at least three trials could be combined; secondly, trial sequential analyses were used to separate conclusive from unclear evidence. And thirdly, the quality of evidence was rated with GRADE. RESULTS Seventy-three trials (5,512 patients) tested loco-regional blocks (paravertebral, pectoralis), local anaesthetic infiltrations, oral gabapentinoids or intravenous administration of glucocorticoids, lidocaine, N-methyl-D-aspartate antagonists or alpha2 agonists. With paravertebral blocks, pectoralis blocks and glucocorticoids, there was conclusive evidence of a clinically relevant reduction in acute pain (visual analogue scale > 1.0 cm). With pectoralis blocks, and gabapentinoids, there was conclusive evidence of a reduction in the cumulative 24-hr morphine consumption (> 30%). With paravertebral blocks and glucocorticoids, there was conclusive evidence of a relative reduction in the incidence of PONV of 70%. For chronic pain, insufficient data were available. CONCLUSIONS Mainly with loco-regional blocks, there is conclusive evidence of a reduction in acute pain intensity, morphine consumption and PONV incidence after breast surgery. For rational decision making, data on chronic pain are needed. SIGNIFICANCE This quantitative systematic review compares eight interventions, published across 73 trials, to prevent pain after breast surgery, and grades their degree of efficacy. The most efficient interventions are paravertebral blocks, pectoralis blocks and glucocorticoids, with moderate to low evidence for the blocks. Intravenous lidocaine and alpha2 agonists are efficacious to a lesser extent, but with a higher level of evidence. Data for chronic pain are lacking.
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Affiliation(s)
- Ariane Lepot
- Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Nadia Elia
- Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, Institute of Global Health, University of Geneva, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Martin Richard Tramèr
- Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Benno Rehberg
- Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
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10
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Cai L, Li Z, Liu L, Cao D, Li K, Li Y, Wang D. The efficacy of nerve block for pain control after mammaplasty: a meta-analysis of randomized controlled studies. J Plast Surg Hand Surg 2020; 54:195-199. [PMID: 32530351 DOI: 10.1080/2000656x.2019.1661847] [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] [Indexed: 10/24/2022]
Abstract
Background: Nerve block shows some potential in alleviating pain after mammaplasty. This systematic review and meta-analysis aims to investigate the efficacy of nerve block for pain control after mammaplasty.Methods: The databases including PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases are systematically searched for collecting the randomized controlled trials (RCTs) regarding the impact of nerve block on pain intensity after mammaplasty.Results: This meta-analysis has included four RCTs. Compared with the control group after mammaplasty, nerve block results in remarkably reduced pain scores. At 1, 3, and 6 h, the scores are -1.84; -2.49 to -1.20 (mean difference (MD; 95% confidence interval (CI)); p < .00001, -1.04; -1.47 to -0.62; p < .00001; and -0.96; -1.48 to -0.43; p = .0004, respectively. At 24 h, nerve block shows no significant impact on pain scores: 0.31; -1.05 to 0.43; p = .41. The standard MD of analgesic consumption is significantly reduced after nerve block: -1.27; -1.73 to -0.82; p < .00001.Conclusions: Nerve block is associated with substantially reduced pain intensity at 1 h, 3 h, and 6 h, as well as decreased analgesic consumption after mammaplasty. Therefore, a nerve block is a valuable tool for postoperative care after mammaplasty and should be recommended for the surgery.
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Affiliation(s)
- Limin Cai
- Department of Anesthesiology, The First Hospital of Jilin University, Changchun, China
| | - Zhiwen Li
- Department of Anesthesiology, The First Hospital of Jilin University, Changchun, China
| | - Lingyun Liu
- Department of Andrology, The First Hospital of Jilin University, Changchun, China
| | - Dongdong Cao
- Department of Anesthesiology, The First Hospital of Jilin University, Changchun, China
| | - Kuiliang Li
- Department of Anesthesiology, The First Hospital of Jilin University, Changchun, China
| | - Ying Li
- Department of Andrology, The First Hospital of Jilin University, Changchun, China
| | - Dunwei Wang
- Department of Anesthesiology, The First Hospital of Jilin University, Changchun, China
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Kavak Akelma F, Baran Akkuş I, Altinsoy S, Özkan D, Ergil J. The effects of pregabalin and adductor canal block on postoperative pain in arthroscopic anterior cruciate ligament reconstruction. Turk J Med Sci 2020; 50:195-204. [PMID: 31887853 PMCID: PMC7080358 DOI: 10.3906/sag-1906-66] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 12/29/2019] [Indexed: 01/09/2023] Open
Abstract
Background/aim To determine the effectiveness of pregabalin and adductor canal block on opioid consumption, postoperative pain, and fast-tracking. Materials and methods A total of 51 American Society of Anaesthesiologists (ASA) classification I–II patients aged 18–70 years who were scheduled to undergo elective anterior cruciate ligament reconstruction were included in the study. Patients were randomized into groups P, A, and C. Patients in group P (n = 16), received 150 mg of preoperative oral pregabalin, patients in group A (n = 17) received postoperative adductor canal blockade, and patients in group C (n = 18) received neither adductor canal block nor pregabalin. Surgeries were performed under spinal anaesthesia with hyperbaric bupivacaine following monitorization. Demographic data along with block features, hemodynamic data, mean opioid consumption, numerical rating scale score, White’s fast-track score, and postoperative adverse effects were recorded. Results Fifty-seven patients were enrolled in the study, and 6 patients were excluded from the study; the data of 51 patients were included in the final analyses. Demographic characteristics and hemodynamic data were similar between the 3groups. Postoperative opioid consumption was significantly lower in groups A and P compared with group C (group P = 178.75 mg, group C = 318.61 mg, group A = 236.47 mg; P < 0.05). The regression of sensory block was significantly slower in group P (P < 0.05). The first analgesic requirement was earlier in group C than in groups P and A (P < 0.05). Patients in group P had higher fast-track scores at 8 h and 12 h compared with group C (P < 0.05); however, group A fast-track scores were similar to those of the other 2groups (P > 0.05). The rate of postoperative adverse effects was similar between the groups (P > 0.05). Conclusion Preoperative pregabalin (150 mg) reduced postoperative opioid consumption as much as adductor canal block in patients undergoing anterior cruciate ligament reconstruction. The first analgesic requirement was earlier in group C than in groups P and A. In addition, pregabalin can prolong the duration of spinal sensory block and shorten the time required to achieve high fast-tracking scores. We recommend the use of both methods as a part of multimodal analgesia.
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Affiliation(s)
- Fatma Kavak Akelma
- University of Health Sciences, Anaesthesiology and Reanimation Clinic, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Ilkay Baran Akkuş
- University of Health Sciences, Anaesthesiology and Reanimation Clinic, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Savaş Altinsoy
- University of Health Sciences, Anaesthesiology and Reanimation Clinic, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Derya Özkan
- University of Health Sciences, Anaesthesiology and Reanimation Clinic, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Jülide Ergil
- University of Health Sciences, Anaesthesiology and Reanimation Clinic, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
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El-Refai NA, Shehata JH, Lotfy A, Elbadawy AM, Abdel Rahman RA, Gamaleldin TM, Dobal NM, Mohamed AA, Farrag TA, Shafik YM, Kamal AF. Role of preoperative pregabalin in reducing inhalational anesthetic requirements in abdominal hysterectomy: randomized controlled trial. Minerva Anestesiol 2020; 86:56-63. [DOI: 10.23736/s0375-9393.19.13734-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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13
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Vig S, Kumar V, Deo S, Bhan S, Mishra S, Bhatnagar S. Effect of Perioperative Pregabalin on Incidence of Chronic Postmastectomy Pain Syndrome: A Prospective Randomized Placebo-Controlled Pilot Study. Indian J Palliat Care 2019; 25:508-513. [PMID: 31673203 PMCID: PMC6812425 DOI: 10.4103/ijpc.ijpc_85_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background: Breast cancer is the most common malignancy among women. Chronic pain after breast surgeries is a well-known entity and is mainly neuropathic in nature. The primary aim of this study was to assess the effect of pregabalin given as preventive analgesic on the incidence of chronic postmastectomy pain. Methods: A randomized control trial (RCT) was performed on 80 patients. Patients were allocated into two groups. Group 1 received pregabalin (Lyrica, Pfizer) 75 mg. BD starting from the morning of surgery and continued for 1 week. Group 2 received placebo capsules at identical time intervals. Patients were followed up for 3 months postoperatively. Incidence, severity, and location of chronic pain were recorded. The primary objective was to evaluate the effect of perioperative oral pregabalin on the incidence of chronic postmastectomy pain (at 3 months postoperatively). Results: Of the 80 patients enrolled, 71 patients completed the study and were assessed for final outcomes. Incidence of chronic pain was comparable in both groups, with 16 out of 35 patients in Group 1 (44.7%) and 20 out of 36 patients in Group 2 (55.6%) reported chronic pain (P = 0.407). There was no difference between the severity of chronic pain (numeric rating scale ≥ 4) in both groups (P = 0.307). Incidence of adverse effects was comparable in both groups. Conclusion: This RCT shows that perioperative pregabalin may not have a role in the prevention of chronic pain after breast surgeries.
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Affiliation(s)
- Saurabh Vig
- Department of Anaesthesia, Superspeciality Cancer Institute and Hospital, Lucknow, Uttar Pradesh, India
| | - Vinod Kumar
- Department of Onco-Anaesthesiology and Palliative Medicine, Dr. Bhim Rao Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Surayanarayana Deo
- Department of Surgical Oncology, Dr. Bhim Rao Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Swati Bhan
- Department of Onco-Anaesthesiology and Palliative Medicine, Dr. Bhim Rao Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Mishra
- Department of Onco-Anaesthesiology and Palliative Medicine, Dr. Bhim Rao Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Bhatnagar
- Department of Onco-Anaesthesiology and Palliative Medicine, Dr. Bhim Rao Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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14
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Reyad RM, Omran AF, Abbas DN, Kamel MA, Shaker EH, Tharwat J, Reyad EM, Hashem T. The Possible Preventive Role of Pregabalin in Postmastectomy Pain Syndrome: A Double-Blinded Randomized Controlled Trial. J Pain Symptom Manage 2019; 57:1-9. [PMID: 30359684 DOI: 10.1016/j.jpainsymman.2018.10.496] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 10/11/2018] [Accepted: 10/12/2018] [Indexed: 12/15/2022]
Abstract
CONTEXT Chronic postmastectomy pain syndrome (PMPS) has a considerable negative impact on the quality of life of breast cancer patients. OBJECTIVE The objective of this study was to assess the possible preventive role of perioperative pregabalin in PMPS. METHODS This randomized controlled study included 200 patients with breast cancer scheduled for elective breast cancer surgery. They were randomly assigned to one of two treatment groups. The pregabalin group received 75 mg of pregabalin twice daily for seven days and the control group received oral equivalent placebo capsules. The primary outcome was development of neuropathic PMPS. Neuropathic pain was assessed using the Grading System for Neuropathic Pain. Secondary outcome measures were safety and Visual Analogue Scale scores. RESULTS Neuropathic pain was significantly less frequent in the pregabalin group compared to the control group at four weeks (P = 0.005), 12 weeks (P = 0.002), and 24 weeks (P < 0.001) postoperatively. PMPS was diagnosed in 11 patients (11%) of the pregabalin group and 29 patients (29%) of the control group (P < 0.001, relative risk: 0.26, 95% CI: 0.12-0.56). At the three follow-up time points, Visual Analogue Scale scores during the first three postoperative weeks were comparable in both groups while they were significantly lower in the pregabalin group at 4, 12, and 24 weeks. These two groups were comparable in the frequency of adverse events (P = 0.552). CONCLUSION Perioperative oral pregabalin 75 mg twice daily, starting at the morning of surgery and continued for one week, could reduce the frequency of postmastectomy pain syndrome.
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Affiliation(s)
- Raafat M Reyad
- Department of Anesthesia and Pain Management, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Azza F Omran
- Department of Anesthesia and Pain Management, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Dina N Abbas
- Department of Anesthesia and Pain Management, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mahmoud A Kamel
- Department of Anesthesia and Pain Management, National Cancer Institute, Cairo University, Cairo, Egypt.
| | - Ehab H Shaker
- Department of Anesthesia and Pain Management, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Jhon Tharwat
- Department of Anesthesia and Pain Management, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ehab M Reyad
- Department of Clinical Pathology, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - Tarek Hashem
- Department of Surgical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
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15
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Hu J, Huang D, Li M, Wu C, Zhang J. Effects of a single dose of preoperative pregabalin and gabapentin for acute postoperative pain: a network meta-analysis of randomized controlled trials. J Pain Res 2018; 11:2633-2643. [PMID: 30519075 PMCID: PMC6233947 DOI: 10.2147/jpr.s170810] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Pregabalin (PGB) and gabapentin (GBP) are current and emerging drugs in the field of pre-emptive preoperative analgesia. However, the role of PGB or GBP in acute postoperative pain management still remains elusive. Materials and methods We conducted a comprehensive literature search of articles published by December 3, 2017. A total of 79 randomized controlled trials with 6,201 patients receiving single-dose premedication were included. Through a network meta-analysis (NMA), we validated the analgesic effect and incidence of adverse events by using various doses of PGB or GBP administration. Results NMA results suggested that the analgesic effect may be dose related. For 24-hour opioid consumption, a consistent decrease was found with the increase in the dose of PGB or GBP. For 24-hour pain score at rest, a high dose (≥150 mg) of PGB was more effective in decreasing pain score than a dose of 75 mg, and a high dose (≥900 mg) of GBP reduced pain intensity than doses of 300 or 600 mg. Moreover, the incidence of adverse reactions varied with varying doses of PGB or GBP. Conclusion A dose-response relationship was detected in opioid consumption and postoperative pain for a single-dose preoperative administration of PGB and GBP. Making reasonable choice of drugs and dosage may prevent the occurrence of adverse reactions.
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Affiliation(s)
- Jiaqi Hu
- Department of Anesthesiology, Zhejiang Chinese Medical University, Hangzhou, China.,Department of Anesthesiology, First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China,
| | - Dongdong Huang
- Department of Pathology, Key Laboratory of Disease Proteomics of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, China
| | - Minpu Li
- Department of Anesthesiology, Zhejiang Chinese Medical University, Hangzhou, China.,Department of Anesthesiology, First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China,
| | - Chao Wu
- Department of Anesthesiology, Zhejiang Chinese Medical University, Hangzhou, China.,Department of Anesthesiology, First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China,
| | - Juan Zhang
- Department of Anesthesiology, First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China,
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16
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Park CY, Park SH, Lim DG, Choi EK. Effect of preoperative pregabalin on postoperative pain after gastrectomy. Yeungnam Univ J Med 2018; 35:40-44. [PMID: 31620569 PMCID: PMC6784661 DOI: 10.12701/yujm.2018.35.1.40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 02/19/2018] [Accepted: 03/02/2018] [Indexed: 11/08/2022] Open
Abstract
Background Pregabalin has been studied as a single or multimodal analgesic drug for postoperative pain management in different types of surgeries. We evaluated the analgesic effect of 150 mg of pregabalin in resolving post-gastrectomy pain. Methods Forty-four patients were randomized into two groups: a pregabalin group that received oral pregabalin (150 mg) 2 h before anesthetic induction, and a control group that received placebo tablets at the same time. Data on postoperative pain intensity (visual analog scale [VAS], at 30 min, 2 h, 4 h, and 24 h), consumption of fentanyl in patient-controlled analgesia (PCA), and the proportion of patients requiring rescue analgesics at different time intervals (0-2 h, 2-4 h, and 4-24 h) were collected during the 24 h postoperative period. Results The VAS scores did not show significant differences at any time point and consumption of fentanyl in PCA and the proportion of patients requiring rescue analgesics did not differ between the two groups. The groups did not differ in the occurrence of dizziness, sedation, and dry mouth. Conclusion A preoperative 150 mg dose of pregabalin exerts no effect on acute pain after gastrectomy.
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Affiliation(s)
- Chan Yoon Park
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - Sol Hee Park
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - Dong Gun Lim
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - Eun Kyung Choi
- Department of Anesthesiology and Pain Medicine, Yeungnam University College of Medicine, Daegu, Korea
- Corresponding Author: Eun Kyung Choi, Department of Anesthesiology and Pain Medicine, Yeungnam University College of Medicine, 170, Hyeonchung-ro, Nam-gu, Daegu 42415, Korea Tel: +82-53-620-3361, Fax: +82-53-626-5275 E-mail:
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17
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Intraoperative Nerve Blocks Fail to Improve Quality of Recovery after Tissue Expander Breast Reconstruction. Plast Reconstr Surg 2018; 141:590-597. [DOI: 10.1097/prs.0000000000004104] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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18
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Elzohry AAM, Abd Elhamed MF, Mahran MH. Post Mastectomy Pain is No Longer Nightmare. JOURNAL OF FAMILY MEDICINE 2018; 1:1-11. [DOI: 10.14302/issn.2640-690x.jfm-17-1900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Background PMPS nowadays is common due to advances in both; diagnosis and treatment of cancer breast. Choosing proper treatments can improve the patients’ quality of life. Cancer breast is common and quite important disease and female in our family must be aware of it. Improvement of the diagnosis and treatment PMPS lead to increased patient’s satisfaction and decrease fear of cancer breast. Objective Discuss different methods for management of PMPS with less side effects, adequate analgesia, improvement of quality of life, and better patient satisfaction in the future. Methods Treatment approaches include both pharmacological interventions and non-pharmacological strategies. However, current treatments of the PMPS are near-optimal and prevention much better than treatment. Conclusion Continuous perioperative thoracic epidural Fentanyl–bupivacaine infusion was much better in pain relief, less sedating effect and shorter duration of hospital and ICU stay than continuous perioperative entanyl intravenous infusion in patients undergoing major upper gastrointestinal cancer surgery.
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Affiliation(s)
- Alaa Ali M Elzohry
- Department of Anesthesia, ICU and Pain Relief, South Egypt Cancer Institute, Assiut University
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19
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Kendall MC, McCormick ZL. Predicting Analgesic Use after Spinal Surgery. Pain Pract 2017; 18:814. [PMID: 29280594 DOI: 10.1111/papr.12675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Mark C Kendall
- Department of Anesthesiology, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, U.S.A
| | - Zachary L McCormick
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A
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Fabritius M, Strøm C, Koyuncu S, Jæger P, Petersen P, Geisler A, Wetterslev J, Dahl J, Mathiesen O. Benefit and harm of pregabalin in acute pain treatment: a systematic review with meta-analyses and trial sequential analyses. Br J Anaesth 2017; 119:775-791. [DOI: 10.1093/bja/aex227] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2017] [Indexed: 12/16/2022] Open
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22
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Conversion of Pregabalin to 4-Isobutylpyrrolidone-2. J Pharm Sci 2017; 106:3095-3102. [PMID: 28419825 DOI: 10.1016/j.xphs.2017.03.044] [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: 02/20/2017] [Accepted: 03/15/2017] [Indexed: 11/22/2022]
Abstract
Solid-state studies of C-butyl-resorcin[4]arene with pregabalin (Lyrica, Nervalin) in nitrobenzene yielded a cocrystal of C-butyl-resorcin[4]arene with 4-isobutylpyrrolidone-2. A combined experimental and quantum chemical investigation was implemented to further our understanding of the factors affecting the conversion process.
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