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Blanco R, Ansari T. Transitional pain services updates and a novel service for the obstetric population. Curr Opin Anaesthesiol 2024:00001503-990000000-00221. [PMID: 39087394 DOI: 10.1097/aco.0000000000001417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
PURPOSE OF THE REVIEW This paper is an update of the publications on Transitional Pain Services and explores the viability of a dedicated transitional pain service for women. RECENT FINDINGS We address common pain pathologies establishing referral criteria, pathways, and effective strategies to decrease chronification of pain during pregnancy. SUMMARY This review highlights the importance establishing transitional pain service models at every institution and in particular in obstetric population as pain is normalized by Society during pregnancy.
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Affiliation(s)
- Rafael Blanco
- Anesthesiology Department, Pain Division, Al Corniche Hospital: Corniche Hospital, Abu Dhabi, UAE
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Klimke R, Ott A, Romero CS, Berendes A, Urman RD, Luedi MM, Ashok V. Transitional Pain Service: An Update. Curr Pain Headache Rep 2024; 28:457-464. [PMID: 38530574 PMCID: PMC11156754 DOI: 10.1007/s11916-024-01239-1] [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] [Accepted: 03/12/2024] [Indexed: 03/28/2024]
Abstract
PURPOSE OF REVIEW Chronic Postsurgical Pain (CPSP) and the risk for long-term opioid dependency are known complications following major surgery. The idea of Transitional Pain Service (TPS) has been introduced as an interdisciplinary setting to manage pain in the perioperative continuum. We expand on the basic framework and principles of TPS and summarize the current evidence of the TPS and possible interventions to adress postoperative pain. Areas of future work in TPS-related research are discussed. RECENT FINDINGS Several studies support the effectiveness of TPS in reducing opioid consumption in the perioperative period and following discharge. Some studies also show an improvement in functional outcome with TPS with patients reporting lower pain severity and pain interference. The TPS aims to halt the progress of acute postoperative pain to CPSP by providing longitudinal support with patient-centered care. While some studies suggest a positive impact of TPS implementation in terms of reduction in postoperative opioid consumption and improvement of some functional outcomes, direct evidence in terms of reduction in the incidence of CPSP is still missing. The cost-effectiveness of TPS and the expansion of TPS through e-health services and digital applications also need to be evaluated.
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Affiliation(s)
- Ruben Klimke
- Department of Anaesthesiology Rescue- and Pain Medicine, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
| | - Alexander Ott
- Department of Anaesthesiology Rescue- and Pain Medicine, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
| | - Carolina S Romero
- Department of Anaesthesiology and Critical Care, Hospital General Universitario de Valencia, Valencia, Spain
- Research Methods Department, Universidad Europea de Valencia, Valencia, Spain
| | - Andrea Berendes
- Center for Palliative Care Medicine, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
| | - Richard D Urman
- Department of Anaesthesiology, College of Medicine, The Ohio State University, Columbus, OH, 43210, United States of America
| | - Markus M Luedi
- Department of Anaesthesiology Rescue- and Pain Medicine, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland.
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Vighnesh Ashok
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Admiraal M, van der Burg FAE, Hermanns H, Hermanides J, Hollmann MW, Benninga MA, de Jong J, Gorter RR, Stevens MF. Different Analgesia Techniques for Postoperative Pain in Children Undergoing Abdominal Surgery for Intractable Constipation: A Retrospective Cohort Study in a Single Tertiary Children's Hospital. J Clin Med 2024; 13:349. [PMID: 38256483 PMCID: PMC10816271 DOI: 10.3390/jcm13020349] [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: 12/01/2023] [Revised: 12/28/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
Functional constipation in the pediatric population is a prevalent issue that is usually well managed. However, in rare cases, conservative treatment fails, and surgical intervention is necessary. This retrospective cohort study aimed to describe and compare different perioperative analgesic techniques in children undergoing major abdominal surgery for intractable constipation. Conducted between 2011 and 2021, this study enrolled patients under 18 years old who underwent initial major abdominal surgery for intractable constipation (i.e., creation of ostomy or subtotal colectomy). Patients were categorized according to the perioperative analgesic technique (i.e., systemic, neuraxial, or truncal block). Of 65 patients, 46 (70.8%) were female, and the median age was 13.5 [8.8-16.1] years during initial major abdominal surgery. Systemic analgesia was used in 43 (66.2%), neuraxial in 17 (26.2%), and truncal blocks in 5 (7.7%) of the surgeries. Patients with neuraxial analgesia reported less postoperative pain (median [interquartile range] numeric rating scale (NRS) 2.0 [0-4.0]), compared to systemic analgesia (5.0 [2.0-7.0], p < 0.001) and to truncal blocks (5.0 [3.0-6.5], p < 0.001). In this preliminary investigation, neuraxial analgesia appears to be the most effective approach to reducing acute postoperative pain in pediatric patients undergoing major abdominal surgery for intractable functional constipation. However, well-designed studies are warranted.
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Affiliation(s)
- Manouk Admiraal
- Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.A.); (F.A.E.v.d.B.); (J.H.); (M.W.H.); (M.F.S.)
| | - Fleur A. E. van der Burg
- Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.A.); (F.A.E.v.d.B.); (J.H.); (M.W.H.); (M.F.S.)
| | - Henning Hermanns
- Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.A.); (F.A.E.v.d.B.); (J.H.); (M.W.H.); (M.F.S.)
| | - Jeroen Hermanides
- Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.A.); (F.A.E.v.d.B.); (J.H.); (M.W.H.); (M.F.S.)
| | - Markus W. Hollmann
- Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.A.); (F.A.E.v.d.B.); (J.H.); (M.W.H.); (M.F.S.)
| | - Marc A. Benninga
- Department of Pediatric Gastroenterology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands;
| | - Justin de Jong
- Department of Pediatric Surgery, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (J.d.J.); (R.R.G.)
| | - Ramon R. Gorter
- Department of Pediatric Surgery, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (J.d.J.); (R.R.G.)
| | - Markus F. Stevens
- Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.A.); (F.A.E.v.d.B.); (J.H.); (M.W.H.); (M.F.S.)
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