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Pompeu BF, Almiron da Rocha Soares G, Pereira Silva M, Ponte Farias AG, Oliveira de Sousa Silva R, Mazzola Poli de Figueiredo S. Suture versus tacks in minimally invasive transabdominal preperitoneal inguinal repair: a meta-analysis of randomized controlled trials. Surg Endosc 2024; 38:4858-4868. [PMID: 39160308 DOI: 10.1007/s00464-024-11138-6] [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: 01/30/2024] [Accepted: 08/01/2024] [Indexed: 08/21/2024]
Abstract
INTRODUCTION There is uncertainty regarding the method of mesh fixation and peritoneal closure during transabdominal preperitoneal (TAPP) repair for inguinal hernias, with no definitive guidelines to guide surgeon choice. METHODS MEDLINE, Cochrane, Central Register of Clinical Trials, and Web of Science were searched for RCTs published until November 2023. Risk ratios (RRs) and mean differences (MD) with 95% confidence intervals (CIs) were pooled with a random-effects model. Statistical significance was defined as p < 0.05. Heterogeneity was assessed using the Cochran Q test and I2 statistics, with p values inferior to 0.10 and I2 > 25% considered significant. Statistical analyses were conducted using Review Manager version 5.4 and RStudio version 4.1.2 (R Foundation for Statistical Computing). RESULTS Eight randomized controlled trials (RCTs) were included, comprising 624 patients, of whom 309 (49.5%) patients were submitted to TAPP with the use of tacks, and 315 (50.5%) received suture fixation. The use of tacker fixation was associated with a significant increase in postoperative pain at 24 h (MD 0.79 [VAS score]; 95% CI 0.38 to 1.19; p < 0.0002; I2 = 87%) and one week (MD 0.42 [VAS score]; 95% CI 0.05 to 0.79; p < 0.03, I2 = 84%). The use of tacks was associated with shorter operative time (MD-25.80 [min]; 95% - 34.31- - 17.28; P < 0.00001; I2 = 94%). No significant differences were found in overall complications, chronic pain, seromas, hematomas, and urinary retention rates. CONCLUSION In patients who underwent TAPP hernia repair, tacks are associated with decreased operative time but increased postoperative pain at 24 h and one week.
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Affiliation(s)
- Bernardo Fontel Pompeu
- Department of Surgery, Heliopolis Hospital, São Paulo, Brazil.
- USCS-Universidade Municipal de São Caetano do Sul, Rua Santo Antônio, 50-Centro, São Caetano do Sul, SP, 09521-160, Brazil.
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Chen M, Huang Y, Zhang J, Wu Z, Lin C, Zheng B, Chen C, Li W. Impact of preoperative anxiety on postoperative outcomes in patients undergoing minimally invasive thoracoscopic surgery: A prospective cohort study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108605. [PMID: 39151308 DOI: 10.1016/j.ejso.2024.108605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Revised: 08/05/2024] [Accepted: 08/12/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND Preoperative anxiety is a common preoperative psychological state in patients with cancer and associated with worsening perioperative outcomes. However, high-quality prospective studies on preoperative anxiety in patients undergoing lung surgery are scarce. METHODS We conducted a prospective cohort study, enrolling a total of 540 patients. Preoperative anxiety in patients undergoing thoracic surgery was measured using the Hospitalization Anxiety Scale. Patients were grouped according to the Hospitalization Anxiety Scale scores as follows: no anxiety (score <8) and anxiety (score ≥8). The association of preoperative anxiety with postoperative complications and non-complicated adverse events was determined by univariate regression and polynomial regression analyses. RESULTS A total of 121 patients (22.4 %) experienced preoperative anxiety. The anxiety group had a longer average hospital stay (4.33 vs. 3.85 days). Postoperative complications were similar between groups, but the anxiety group reported worse sleep quality (measured by the Athens Insomnia Scale). Regarding postoperative pain, both groups had comparable rates of mild and severe pain on postoperative day 1. However, the anxiety group experienced significantly higher rates of severe pain on postoperative day 2 and mild pain on postoperative day 3. Additionally, the incidence of postoperative nausea and vomiting was significantly higher in the anxiety group on postoperative day 1. CONCLUSIONS Preoperative anxiety may not increase the rates of postoperative complications in patients undergoing lung surgery. However, it may be associated with postoperative sleep disturbances, pain, nausea, and vomiting, as well as prolong the length of postoperative hospitalization.
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Affiliation(s)
- Maohui Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, China; National Key Clinical Specialty of Thoracic Surgery, Fuzhou, China
| | - Yizhou Huang
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, China; National Key Clinical Specialty of Thoracic Surgery, Fuzhou, China
| | - Jiaoxia Zhang
- Department of Thoracic Surgery Nursing, Fujian Medical University Union Hospital, Fuzhou, China
| | - Zhihui Wu
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, China; National Key Clinical Specialty of Thoracic Surgery, Fuzhou, China
| | - Chuanquan Lin
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, China; National Key Clinical Specialty of Thoracic Surgery, Fuzhou, China
| | - Bin Zheng
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, China; National Key Clinical Specialty of Thoracic Surgery, Fuzhou, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, China; National Key Clinical Specialty of Thoracic Surgery, Fuzhou, China.
| | - Wei Li
- Department of Thoracic Surgery Nursing, Fujian Medical University Union Hospital, Fuzhou, China.
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Chowdhury NS, Taseen K, Chiang A, Chang WJ, Millard SK, Seminowicz DA, Schabrun SM. A 5-day course of rTMS before pain onset ameliorates future pain and increases sensorimotor peak alpha frequency. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.06.11.598596. [PMID: 38915700 PMCID: PMC11195234 DOI: 10.1101/2024.06.11.598596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) has shown promise as an intervention for pain. An unexplored research question is whether the delivery of rTMS prior to pain onset might protect against a future episode of prolonged pain. The present study aimed to determine i) whether 5 consecutive days of rTMS delivered prior to experimentally-induced prolonged jaw pain could reduce future pain intensity and ii) whether any effects of rTMS on pain were mediated by changes in corticomotor excitability (CME) and/or sensorimotor peak alpha frequency (PAF). On each day from Day 0-4, forty healthy individuals received a single session of active (n = 21) or sham (n = 19) rTMS over the left primary motor cortex. PAF and CME were assessed on Day 0 (before rTMS) and Day 4 (after rTMS). Prolonged pain was induced via intramuscular injection of nerve growth factor (NGF) in the right masseter muscle after the final rTMS session. From Days 5-25, participants completed twice-daily electronic dairies including pain on chewing and yawning (primary outcomes), as well as pain during other activities (e.g. talking), functional limitation in jaw function and muscle soreness (secondary outcomes). Compared to sham, individuals who received active rTMS subsequently experienced lower pain on chewing and yawning. Although active rTMS increased PAF, the effects of rTMS on pain were not mediated by changes in PAF or CME. This study is the first to show that rTMS delivered prior to pain onset can protect against future pain and associated functional impairment. Thus, rTMS may hold promise as a prophylactic intervention for persistent pain.
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Affiliation(s)
- Nahian S Chowdhury
- Center for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Khandoker Taseen
- Center for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Alan Chiang
- Center for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Wei-Ju Chang
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Samantha K Millard
- Center for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - David A Seminowicz
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada
| | - Siobhan M Schabrun
- The Gray Centre for Mobility and Activity, Parkwood Institute, St. Joseph's Healthcare, London, Canada
- School of Physical Therapy, University of Western Ontario, London, Canada
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McAuliffe M, Pillay T, Jaber K, Sterling M, O'Leary S. Pre-operative pain pressure threshold association with patient satisfaction following Total Knee Arthroplasty. J Orthop 2024; 52:21-27. [PMID: 38404700 PMCID: PMC10881419 DOI: 10.1016/j.jor.2024.02.017] [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: 01/07/2024] [Accepted: 02/09/2024] [Indexed: 02/27/2024] Open
Abstract
Background Total knee arthroplasty (TKA) is commonly performed for the treatment of knee osteoarthritis (KOA). Poor satisfaction continues to be seen after TKA. Whilst reasons for poor patient satisfaction are multifactorial, there is a strong correlation with persistent pain following TKA. Studies have shown an association between local and remote mechanical hypersensitivity, measured using pressure pain thresholds (PPTs), and severity of knee osteoarthritis and functional status. We aimed to determine if the pre-operative PPTs were associated with patient satisfaction following TKA. Methods A prospective longitudinal study of 77 individuals was undertaken. Regression modelling assessed the relationship between Patient Satisfaction using the Knee Society Score (satisfaction subscale) following TKA for KOA, and PPTs recorded pre-operatively locally and remote to the affected knee, while accounting for potentially confounding patient demographic and psychosocial factors. Results Lower PPTs (indicating increased mechanical hypersensitivity) locally and remote to the operative knee were modestly associated with lower patient satisfaction in the short-term (six weeks) following TKA (β 0.25-0.28, adjR2 = 0.14-0.15), independent of demographic or psychosocial influences. However, this relationship progressively diminished in the intermediate and long-term post TKA. Conclusion While pre-operative PPT measures may provide some foresight to patient satisfaction post TKA in the short term, these measures appear to provide little insight to patient satisfaction in the intermediate and longer term.
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Affiliation(s)
- Michael McAuliffe
- Ipswich General Hospital, Queensland Health, Ipswich, QLD, 4305, Australia
- The CJM Centre, Ipswich, QLD, 4305, Australia
- The Mater Private Hospital, Springfield Lakes, QLD, 4300, Australia
- St Andrew's Ipswich Private Hospital, Ipswich, QLD, 4305, Australia
| | - Tristan Pillay
- The CJM Centre, Ipswich, QLD, 4305, Australia
- The Mater Private Hospital, Springfield Lakes, QLD, 4300, Australia
- St Andrew's Ipswich Private Hospital, Ipswich, QLD, 4305, Australia
| | - Khalid Jaber
- Ipswich General Hospital, Queensland Health, Ipswich, QLD, 4305, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Michele Sterling
- RECOVER Injury Research Centre, NHMRC Centre of Research Excellence: Better Health Outcomes for Compensable Injury, The University of Qld, Herston, 4006, Australia
| | - Shaun O'Leary
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, 4072, Australia
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, 4029, Australia
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Pu D, Zhang S, Hu S, Zhang Y, Xiong X, Du S. Orthodontic Patients with Poor Oral Health-Related Quality of Life are More Likely to Have Emotional Distress: A Cross-Sectional Study. Patient Prefer Adherence 2023; 17:3047-3056. [PMID: 38027074 PMCID: PMC10676641 DOI: 10.2147/ppa.s433076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 11/14/2023] [Indexed: 12/01/2023] Open
Abstract
Objective This study aims to investigate the relationship between oral health-related quality of life (OHRQoL) and emotional distress (ED), including anxiety and depression, in orthodontic patients. Methods A cross-sectional study was conducted involving 603 orthodontic patients, consisting of 401 females (66.5%) with a mean age of 24.15 ± 7.72 and 202 males (33.5%) with a mean age of 24.16 ± 7.72. A questionnaire containing questions of demographic information, the Oral Health Impact Profile (OHIP-14) and the Huaxi emotional-distress index (HEI) was employed to assess OHRQoL and ED. According to the HEI score, the respondents were divided into ED group (HEI > 8) and non-ED group (HEI ≤ 8). Data were analyzed using Kolmogorov-Smirnov test, Mann-Whitney test and logistic regression analysis with the significance level set at p < 0.05. Results The prevalence of poor OHRQoL and ED of the study sample was 28.4% and 19.57%, respectively. There was a significantly higher prevalence of ED among poor OHRQoL patients (35.67%) compared to those with good OHRQoL (13.19%) (p < 0.001). Poor OHRQoL and risky drinking behavior addressed higher significant correlation with ED patients than non-ED patients (p < 0.05). There were no statistical differences in other factors such as gender, age, and appliance type (p > 0.05). Poor OHRQoL orthodontic patients were at a higher risk of suffering from anxiety and depression compared to those with good OHRQoL (age-risky drinking behavior-sex-adjusted: OR = 4.00; all p < 0.001). Conclusion Oral health-related quality of life (OHRQoL) is related to emotional stress. Namely, patients with poor OHRQoL are more likely to experience anxiety and depression. As a result, orthodontists should consistently assess the emotional well-being and OHROoL of patients over the treatment course for better treatment outcomes.
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Affiliation(s)
- Dan Pu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, People’s Republic of China
| | - Shiyong Zhang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, People’s Republic of China
| | - Shoushan Hu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, People’s Republic of China
| | - Yuyao Zhang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, People’s Republic of China
| | - Xin Xiong
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, People’s Republic of China
| | - Shufang Du
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, People’s Republic of China
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Angadi SP, Ramachandran K, Shetty AP, Kanna RM, Shanmuganathan R. Preoperative pain sensitivity predicts postoperative pain severity and analgesics requirement in lumbar fusion surgery - a prospective observational study. Spine J 2023; 23:1306-1313. [PMID: 37220813 DOI: 10.1016/j.spinee.2023.05.010] [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: 01/17/2023] [Revised: 04/18/2023] [Accepted: 05/18/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND CONTENT The goal of postoperative pain management is to facilitate the patient's return to normal activity and decrease the detrimental effects of acute postsurgical pain. In order to provide more tailored and successful pain treatment, it is necessary to identify individuals who are at a high risk of experiencing severe postoperative pain. The most precise way to assess pain sensitivity is by determining the pressure pain threshold and heat pain threshold by objective methods using a digital algometer and neurotouch respectively. PURPOSE The primary aim of the study is to assess the preoperative pain threshold and its influence on postoperative pain severity and analgesics requirements in patients undergoing lumbar fusion surgeries. STUDY DESIGN Prospective, observational study. PATIENT SAMPLE Sixty patients requiring a single-level lumbar fusion surgery. OUTCOME MEASURES Postoperative pain intensity and the amount of postoperative analgesics consumption. METHODS In our patients, preoperative pain sensitivity was assessed by pressure pain threshold measurements with the help of a digital algometer, and heat pain threshold using a neurotouch instrument. In addition, pain sensitivity questionnaires (PSQ) were used in all our patients to determine pain sensitivity. Preoperative psychosocial and functional assessments were performed by Hospital anxiety-depression scores (HADS), and Oswestry disability index (ODI) respectively. Preoperative visual analog scale (VAS) score was determined at three instances of needle prick (phlebotomy, glucometer blood sugar, and intradermal antibiotic test dose) and during the range of movements of the lumbar spine region. Postoperative VAS score and postoperative breakthrough analgesic requirements were recorded in all of these patients from day 0 to day 3. RESULTS The average age of the patients was 51.11±13.467 years and 70% were females. Females had lower mean algometry values (72.14±7.56) compared to males (77.34±6.33). Patients with higher HADS (p<.0016), higher PSQ (p<.001), higher ODI scores(p<.001), and female gender significantly correlated with a lower algometer average indicating high pain sensitivity. Patients with lower preoperative VAS scores and with higher neurotouch scores showed lower postoperative VAS scores at different time periods. Preoperative VAS scores, algometer average scores, neurotouch scores, and HADS scores were considered as independent variables (predictors) for postoperative VAS at 6 hours period. By the multivariate analysis, factors like preoperative VAS scores, algometer average scores, and HADS scores were statistically significant (p<.05). There was a significant correlation between algometer average scores (p<.001) with the breakthrough analgesics. CONCLUSION Preoperative assessment of pain sensitivity can predict postoperative analgesic requirements and aid in recovery. Patients with a lower pain threshold should be counseled preoperatively and also receive a better titration of analgesics perioperatively.
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Affiliation(s)
- Sachin P Angadi
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Road, Coimbatore, 641043, Tamilnadu, India
| | - Karthik Ramachandran
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Road, Coimbatore, 641043, Tamilnadu, India
| | - Ajoy P Shetty
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Road, Coimbatore, 641043, Tamilnadu, India.
| | - Rishi M Kanna
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Road, Coimbatore, 641043, Tamilnadu, India
| | - Rajasekaran Shanmuganathan
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Road, Coimbatore, 641043, Tamilnadu, India
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Aoyama N, Izumi M, Morimoto T, Wada H, Dan J, Kasai Y, Satake Y, Aso K, Ikeuchi M. A Novel Rat Model to Study Postsurgical Pain After Joint Replacement Surgery. J Pain Res 2022; 15:2911-2918. [PMID: 36132997 PMCID: PMC9482957 DOI: 10.2147/jpr.s368130] [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] [Received: 04/04/2022] [Accepted: 09/08/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The mechanisms underlying chronic postsurgical pain after joint replacement (JR) are complex, and it has been suggested that chronic postsurgical pain can develop as a result of inadequate acute pain management. Few studies have addressed acute pain after JR using specific animal models. This study aimed to develop a novel JR model focused on postsurgical pain assessment and the time course of pain recovery. Materials and Methods Rats were allocated to the following three groups: sham (joint exposure), joint destruction (JD; resection of the femoral head), and JR (femoral head replacement using an originally developed implant). The time course of postsurgical pain behavior was measured using a dynamic weight-bearing apparatus, along with radiological assessments. The expression of calcitonin gene-related peptide-immunoreactive (CGRP-IR) neurons in the dorsal root ganglion (DRG) was evaluated by immunohistochemistry on days 28 and 42. Results The ratio of weight-bearing distribution in the JR group gradually recovered from day 14 and reached the same level as that in the sham group on day 42, which was significantly greater than that in the JD group after day 7 (p<0.05). Radiologically, no significant issues were found, except for transient central migration of the implant in the JR group. The percentage of CGRP-IR DRG neurons in the JR group was significantly lower than that in the JD group on day 28 (mean, 37.4 vs 58.1%, p<0.05) and day 42 (mean, 32.3 vs 50.0%, p<0.05). Conclusion Our novel JR model presented acute postsurgical pain behavior that was successfully recovered to the baseline level at day 42 after surgery. Difference of the pain manifestation between the JR and JD groups could be supported by the expression of CGRP-IR in DRG neurons. This model is the first step toward understanding detailed mechanisms of post-JR pain.
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Affiliation(s)
- Naoki Aoyama
- Department of Orthopedic Surgery, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Masashi Izumi
- Department of Orthopedic Surgery, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Toru Morimoto
- Department of Orthopedic Surgery, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Hiroyuki Wada
- Department of Orthopedic Surgery, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Junpei Dan
- Department of Orthopedic Surgery, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Yusuke Kasai
- Department of Orthopedic Surgery, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Yoshinori Satake
- Department of Orthopedic Surgery, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Koji Aso
- Department of Orthopedic Surgery, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Masahiko Ikeuchi
- Department of Orthopedic Surgery, Kochi Medical School, Kochi University, Nankoku, Japan
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Othow CO, Ferede YA, Tawuye HY, Aytolign HA. The magnitude and associated factors of post-operative pain among adult patients. Ann Med Surg (Lond) 2022; 81:104406. [PMID: 36147180 PMCID: PMC9486549 DOI: 10.1016/j.amsu.2022.104406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 11/22/2022] Open
Abstract
Background Postoperative pain continues to be a serious consequence of surgical intervention. Several factors may contribute to the development of postoperative pain; these could be preoperative factors, demographic factors, anesthetic factors, and surgical factors. Objective The aim of this study was to assess the magnitude and factors associated with postoperative pain among surgical patients. Methods An institutional-based prospective longitudinal study included 265 postoperative patients from the surgical wards of Gambella General Hospital from April 15, 2021, to June 30, 2021. A consecutive sampling technique was used to recruit study participants. The patients were followed up for 24 h postoperatively. A numerical rating scale (NRS-11) is used for the assessment of pain. Data analysis was done using the Statistical Package for Social Science (SPSS) 25. Logistic regression analysis was used to calculate the association between dependent and independent variables with a 95% confidence interval and a p-value<0.05 was considered statistically significant. Results A total of 270 data points were collected. Of these, a total of 265 with a 98.1% response rate were analyzed. The incidence of postoperative pain was 69%, 74%, and 77.0% at 2 h, 12 h, and 24 h, respectively. The following factors were strongly associated with the dependent variable: patient age, 18–45 years old [AOR = 2.8; (95%CI: 1.13, 6.74, p = 0.026)], skin incision length, 10 cm [AOR = 2.5; (95%CI: 1.30, 5.13, p = 0.007)], preoperative pain [AOR = 2.4, (95%CI: 1.02, 5.60, p = 0.045)], and surgeon experience [AOR = 2.1, (95%CI: Conclusion and Recommendation: In the current study the magnitude of postoperative pain was high, 220 patients were complaining POP (83%). Age of the patient, length of skin incision, preoperative pain, and experience of surgeons were the independent associated factors for the experience of postoperative pain. Preoperative pain management should exercise among adult surgical patients in order to reduce the incidence of postoperative pain, and the length of surgical skin incisions should be minimized. The overall prevalence rate of post-operative pain (POP) was high (83%). The magnitude of POP was 69%, 74% and 77.0% at 2hr, 12hr and 24hr respectively. Age of the patient, length of skin incision and significantly associated with POP. Preoperative pain and work experience of surgeons were also associated with POP.
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Hasabo EA, Assar A, Mahmoud MM, Abdalrahman HA, Ibrahim EA, Hasanin MA, Emam AK, AbdelQadir YH, AbdelAzim AA, Ali AS. Adductor canal block versus femoral nerve block for pain control after total knee arthroplasty: A systematic review and Meta-analysis. Medicine (Baltimore) 2022; 101:e30110. [PMID: 36042669 PMCID: PMC9410636 DOI: 10.1097/md.0000000000030110] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Femoral nerve block is a widely accepted nerve block method with evident reduction in consumption of opioid painkiller and minimization of the duration of hospital stay but may cause weakness of quadriceps muscle strength. Adductor canal block is another nerve block technique that attracts the attention of scientific community nowadays because of its possible superiority over Femoral nerve block regarding mobility and muscle strength. METHODS This is a systematic review and meta-analysis of 33 studies, aiming to compare femoral nerve block with adductor canal block following total knee arthroplasty regarding pain control and mobilization. RESULTS Adductor canal block showed better preservation of quadriceps muscle strength (MD = 0.28, 95% CI [0.11, 0.46], P = .002), and better mobilization up to 2 days postoperatively. However, no significant difference was found between the 2 interventions regarding pain control (MD = 0.06, 95% CI [-0.06, 0.17], P = .33) or opioid consumption (SMD = 0.08, 95% CI [-0.06, 0.22], P = .28) up to 2 days postoperatively. The better mobilization results of adductor canal block did not translate into a significant difference in the risk of falls or patients' satisfaction; however, adductor canal block patients had less mean length of hospital stay than the patients with femoral nerve block. CONCLUSION Both femoral nerve block and adductor canal block provide similar results regarding pain control and opioid consumption, however adductor canal block provides better preservation of quadriceps strength and mobilization, giving it more advantage over femoral nerve block.
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Affiliation(s)
- Elfatih A. Hasabo
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
- International Medical Research Association (IMedRA)
| | - Ahmed Assar
- International Medical Research Association (IMedRA)
- Faculty of Medicine, Menofia University, Shebin El kom, Menofia, Egypt
| | - Maysa Madny Mahmoud
- International Medical Research Association (IMedRA)
- Faculty of Medicine, South Valley University, Qena, Egypt
| | - Hamid Ali Abdalrahman
- International Medical Research Association (IMedRA)
- Faculty of Medicine, University of Gezira, Wad Madani, Sudan
| | - EzzElDien A. Ibrahim
- International Medical Research Association (IMedRA)
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Menna Allah Hasanin
- International Medical Research Association (IMedRA)
- Faculty of Medicine, Al-Azhar University of Cairo, Cairo, Egypt
| | - Amr Khaled Emam
- International Medical Research Association (IMedRA)
- Faculty of Medicine, South Valley University, Qena, Egypt
| | - Yossef Hassan AbdelQadir
- International Medical Research Association (IMedRA)
- Faculty of Medicine, Beni Suef university, Egypt
| | - Ahmed Alaa AbdelAzim
- International Medical Research Association (IMedRA)
- Faculty of Medicine, Beni Suef university, Egypt
| | - Ahmed Said Ali
- International Medical Research Association (IMedRA)
- Faculty of Medicine, Al-Azhar University of Cairo, Cairo, Egypt
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The Role of Regional Anesthesia in the Development of Chronic Pain: a Review of Literature. CURRENT ANESTHESIOLOGY REPORTS 2022. [DOI: 10.1007/s40140-022-00536-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Abstract
Purpose of Review
The acute management of pain using regional anesthesia techniques may prevent the development of persistent postsurgical pain (PPP), ultimately improving patient outcomes and enhancing overall quality of life in postsurgical patients. The purpose of this review is to describe the current literature regarding the role of regional anesthesia techniques in the perioperative setting to address and prevent PPP.
Recent Findings
Data was collected and analyzed using results from randomized controlled studies stratified into categories based on different surgical subspecialties. Conclusions were drawn from each surgical category regarding the role of regional anesthesia and/or local analgesia in acute and chronic pain management on the long-term results seen in the studies analyzed.
Summary
Preoperative consultations and optimized perioperative analgesia using regional anesthesia and local analgesia play a fundamental role preventing and treating postoperative pain after many types of surgery by managing pain in the acute setting to mitigate the future development of PPP. Additional studies in different surgical subspecialties are needed to confirm the role regional anesthesia plays in chronic postsurgical pain (CPSP) prevention.
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Similar outcomes and satisfaction after transtibial versus transportal femoral drilling for anterior cruciate ligament reconstruction in young adult recreational athletes. Knee Surg Sports Traumatol Arthrosc 2022; 30:1197-1203. [PMID: 33386427 DOI: 10.1007/s00167-020-06393-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 11/24/2020] [Indexed: 01/30/2023]
Abstract
PURPOSE Controversy continues regarding whether the transtibial (TT) and transportal (TP) methods for anterior cruciate ligament (ACL) reconstruction provide similar or different outcomes, and the evidence on patient satisfaction is very limited. The objective of this study was to compare functional outcomes and patient satisfaction in young adult recreational athletes who underwent arthroscopic hamstring ACL reconstruction using either the TT or the TP femoral tunnel drilling method. METHODS A nonrandomized prospective study was designed to compare the outcomes of arthroscopic hamstring ACL reconstruction using TT or TP method. Functional outcome was assessed with the Lyshom score, and patient satisfaction with a 5-point Likert scale. Knee stability was measured with the KT-1000 arthrometer. RESULTS 42 patients in the TT group and 41 in TP group, with age ranged 18-40 years, were compared with a mean follow-up of 42 (range 24-60) months. There were no significant differences between groups in the Lysholm score (n.s.), sport return rate (n.s.) or patient satisfaction with the surgery (n.s.). Satisfaction was only significantly associated with the Lysholm score (OR 1.3; IC 95% 1.06-1.6; p = 0.012), but not with the return to sports (n.s.) or knee anterior laxity (n.s.). CONCLUSION This study showed no statistical differences between the TT and the TP method in functional outcomes or patient satisfaction in young adult recreational athletes. In those patients, satisfaction with the surgery was not influenced by the return to sport activities. This study can guide surgeons in the decision-making for ACL reconstruction in recreational athletes. LEVEL OF EVIDENCE Level II.
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Predictive factors of postoperative fentanyl consumption in patients with inflammatory bowel disease: a retrospective cohort study. BMC Anesthesiol 2022; 22:70. [PMID: 35277136 PMCID: PMC8915481 DOI: 10.1186/s12871-022-01606-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/25/2022] [Indexed: 12/02/2022] Open
Abstract
Background Patients with inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis, might present difficulties in achieving postoperative analgesia. Prior studies have suggested that patients with IBD undergoing major abdominal surgery require higher doses of perioperative opioids than do patients without IBD. Considering patients with IBD potentially require high-dose opioids, identifying those requiring higher opioid doses will allow clinicians to optimize the perioperative opioid dose and avoid insufficient pain management or complications of opioid overdose. Therefore, we conducted this study to identify predictive factors that might influence postoperative opioid consumption in patients with IBD. Methods This single-center, historical cohort study reviewed the medical records of all patients admitted to the IBD center of our institution for surgery and who used intravenous fentanyl patient-controlled analgesia (PCA) after open abdominal surgery between June 2013 and April 2017. Ultimately, 179 patients were enrolled in the analysis. Variables expected to influence and/or represent pain, analgesia, inflammation, disease condition, and extent of surgery were selected as potential explanatory variables for predicting postoperative opioid consumption. Multivariable linear regression analysis was used to examine the effect of independent variables on postoperative fentanyl consumption. Results Of the nine predictive variables selected using the stepwise-selection method, eight were significant. Intraoperative fentanyl consumption, current smoking, ulcerative colitis, administration of biologics during the month before surgery, and the use of supplementary analgesics had a significant increasing effect on postoperative fentanyl consumption, whereas droperidol concentration in the PCA solution, age, and diabetes mellitus had a significant decreasing effect. Preoperative use of opioids was a non-significant variable. The adjusted coefficient of determination was 0.302. Conclusions Intraoperative fentanyl consumption, current smoking, ulcerative colitis, administration of biologics during the month before surgery, and the use of supplementary analgesics had a significant increasing effect, whereas droperidol concentration in the PCA solution, age, and diabetes mellitus had a significant decreasing effect on postoperative fentanyl consumption. These factors should be considered when adopting postoperative intravenous fentanyl PCA administration for patients with IBD. Trial registration Registry: UMIN Clinical Trials Registry. Clinical Trial Number: UMIN000031198. Date of registration: February 8, 2018.
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13
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Hazewinkel MH, Berendsen RR, van Klink RC, Dik H, Wink J, Braun J, de Lind van Wijngaarden RA. Incidence and risk factors of unplanned emergency department visits following thoracic surgery. JTCVS OPEN 2021; 8:668-676. [PMID: 36004175 PMCID: PMC9390480 DOI: 10.1016/j.xjon.2021.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 08/16/2021] [Indexed: 11/24/2022]
Abstract
Background Unplanned visits for care following a surgical procedure can represent a lapse in quality of care. The purpose of this study was to define the proportion of patients undergoing thoracic surgery who return to the emergency department (ED) within 6 months after discharge and the reasons for the returns. In addition, the risk factors for ED visits after thoracic surgery were identified. Methods All adult patients undergoing thoracic surgery at the Leiden University Medical Center between January 1, 2016, and December 31, 2017, were reviewed. To identify potential risk factors for ED return visits, a multivariate regression analysis was performed. A subgroup analysis of patients who reported pain during the ED visit was performed to identify the risk factors for pain-related return to the ED. Results Of 277 patients who underwent thoracic surgery, 27.4% (n = 76) returned to the ED within 6 months after discharge. Among these patients, 41 (53.9%) presented with postoperative pain. Younger patients (odds ratio [OR], 0.98; P = .04), those who were operated on through a thoracotomy (OR, 2.92; P = .04), and those reporting a high pain score on the ward (OR, 1.98; P < .001) were at increased risk of returning to the ED. Conclusions The rate of patients returning to the ED after thoracic surgery was high. Pain was the most frequently reported reason for unplanned ED visits. The results of this study highlight the need to optimize the postoperative care and the follow-up of patients undergoing thoracic surgery.
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Affiliation(s)
- Merel H.J. Hazewinkel
- Department of Cardio-Thoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Remco R. Berendsen
- Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Rik C.J. van Klink
- Department of Pulmonology, Alrijne Hospital, Leiderdorp, The Netherlands
| | - Hans Dik
- Department of Pulmonology, Alrijne Hospital, Leiderdorp, The Netherlands
| | - Jeroen Wink
- Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jerry Braun
- Department of Cardio-Thoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Robert A.F. de Lind van Wijngaarden
- Department of Cardio-Thoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
- Department of Cardio-Thoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
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Early Postoperative Pain After Total Knee Arthroplasty Is Associated With Subsequent Poorer Functional Outcomes and Lower Satisfaction. J Arthroplasty 2021; 36:2466-2472. [PMID: 33744080 DOI: 10.1016/j.arth.2021.02.044] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 02/12/2021] [Accepted: 02/15/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND There are few studies investigating the effects of acute postoperative pain on functional outcomes after total knee arthroplasty (TKA). The aims of this study are to identify perioperative factors associated with increased early postoperative pain and investigate the effects of acute postoperative day 1 and 2 pain on outcomes at 6 months and 2 years post-TKA. METHODS 1041 unilateral TKA patients were included in this retrospective cohort study. Patients were categorized into minor (visual analog scale: VAS <5) and major (VAS ≥5) pain groups based on postoperative day 1/2 VAS scores. Patients were assessed preoperatively, at 6 months and 2 years using Knee Society Knee Score and Function Scores (KSFS), Oxford Knee Score (OKS), SF-36 physical and mental component score (SF-36 PCS), expectation and satisfaction scores. Perioperative variables including age, gender, race, body mass index, American Society of Anesthesiologist status, type of anesthesia, and presence of caregiver were analyzed as predictors of postoperative acute pain. Wilcoxon two-sample test was used to analyze outcomes significantly associated with "major pain." Multiple logistic regression was used to identify predictors of "major pain." RESULTS Patients with "minor pain" had significantly better KSFS, Knee Society Knee Score, OKS, and SF-36 PCS scores at 6 months and significantly better KSFS, OKS, SF-36 PCS, and satisfaction at 2 years (P < .05). A significantly higher percentage of patients with "minor pain" met the minimal clinically important difference for SF-36 PCS at 6 months and KSFS at 2 years (P < .05). Women, Indian/Malay race, higher BMI, and use of general over regional anesthesia were independent predictors of getting "major pain" (P < .05). CONCLUSION Patients should be counseled about risk factors of postoperative pain to manage preoperative expectations of surgery. Patients should be managed adequately using multimodal pain protocols to improve subsequent functional outcomes while avoiding unnecessary opioid use.
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15
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Barry GS, Bailey JG, Sardinha J, Brousseau P, Uppal V. Factors associated with rebound pain after peripheral nerve block for ambulatory surgery. Br J Anaesth 2020; 126:862-871. [PMID: 33390261 DOI: 10.1016/j.bja.2020.10.035] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 10/07/2020] [Accepted: 10/23/2020] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Rebound pain is a common, yet under-recognised acute increase in pain severity after a peripheral nerve block (PNB) has receded, typically manifesting within 24 h after the block was performed. This retrospective cohort study investigated the incidence and factors associated with rebound pain in patients who received a PNB for ambulatory surgery. METHODS Ambulatory surgery patients who received a preoperative PNB between March 2017 and February 2019 were included. Rebound pain was defined as the transition from well-controlled pain (numerical rating scale [NRS] ≤3) while the block is working to severe pain (NRS ≥7) within 24 h of block performance. Patient, surgical, and anaesthetic factors were analysed for association with rebound pain by univariate, multivariable, and machine learning methods. RESULTS Four hundred and eighty-two (49.6%) of 972 included patients experienced rebound pain as per the definition. Multivariable analysis showed that the factors independently associated with rebound pain were younger age (odds ratio [OR] 0.98; 95% confidence interval [CI] 0.97-0.99), female gender (OR 1.52 [1.15-2.02]), surgery involving bone (OR 1.82 [1.38-2.40]), and absence of perioperative i.v. dexamethasone (OR 1.78 [1.12-2.83]). Despite a high incidence of rebound pain, there were high rates of patient satisfaction (83.2%) and return to daily activities (96.5%). CONCLUSIONS Rebound pain occurred in half of the patients and showed independent associations with age, female gender, bone surgery, and absence of intraoperative use of i.v. dexamethasone. Until further research is available, clinicians should continue to use preventative strategies, especially for patients at higher risk of experiencing rebound pain.
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Affiliation(s)
- Garrett S Barry
- Department of Anesthesia, Perioperative Medicine and Pain Management, Dalhousie University, Nova Scotia Health Authority and IWK Health Centre, Halifax, NS, Canada
| | - Jonathan G Bailey
- Department of Anesthesia, Perioperative Medicine and Pain Management, Dalhousie University, Nova Scotia Health Authority and IWK Health Centre, Halifax, NS, Canada
| | - Joel Sardinha
- Department of Anesthesia, Perioperative Medicine and Pain Management, Dalhousie University, Nova Scotia Health Authority and IWK Health Centre, Halifax, NS, Canada; Department of Anesthesiology and Pain Management, University of Toronto, Toronto, ON, Canada
| | - Paul Brousseau
- Department of Anesthesia, Perioperative Medicine and Pain Management, Dalhousie University, Nova Scotia Health Authority and IWK Health Centre, Halifax, NS, Canada
| | - Vishal Uppal
- Department of Anesthesia, Perioperative Medicine and Pain Management, Dalhousie University, Nova Scotia Health Authority and IWK Health Centre, Halifax, NS, Canada.
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Exploring Internal Benefits of Medical Tourism Facilitators' Satisfaction: Customer Orientation, Job Satisfaction, and Work Performance. J Healthc Manag 2020; 65:90-105. [PMID: 32168184 DOI: 10.1097/jhm-d-18-00168] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
EXECUTIVE SUMMARY This study examined the impact of employee satisfaction with management and coworkers on their performance as medical tourism facilitators. The proposed hypotheses were tested with structural equation modeling based on data collected from major hospitals in South Korea. Results supported assumptions that satisfaction with management is positively correlated with customer orientation and job satisfaction of medical tourism facilitators, as well as with the assumption that satisfaction with coworkers has a direct impact on customer orientation. This study has practical implications as organizations develop effective internal marketing (i.e., communication) strategies to improve the performance of medical tourism facilitators.
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Nadarajah V, Glazier E, Miller K, Jauregui JJ, Smuda MP, Bennett CH, Packer JD, Henn RF. Evaluation of Preoperative Pain Using PROMIS Pain Interference in Knee Surgery Patients. J Knee Surg 2020; 33:875-883. [PMID: 31096280 DOI: 10.1055/s-0039-1688769] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Given that pain relief is often the primary goal of orthopaedic surgery, an accurate assessment of pain is paramount. The objectives of this cross-sectional analytical study were to (1) compare how the Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference (PI) computer adaptive test (CT) performs against the Numeric Pain Scale (NPS) measure in evaluating pain, and (2) to determine demographic, clinical, and psychosocial correlates of PI in an urban population undergoing a variety of knee surgeries. We hypothesized that there would be a strong correlation between PI and NPS, with minimal floor and ceiling effects; and that a worse PI score would be associated with a worse general health profile. The sample consisted of 412 patients undergoing knee surgery at an urban academic center. Patients were preoperatively administered measures of health-related quality of life (HRQOL). Bivariate and multivariable statistical analyses were performed to identify significant independent predictors. The mean PI score was 60.3 ± 7.2 and had no floor or ceiling effects, whereas NPS demonstrated a greater percentage of patients scoring at the extremes of the measure. Worse PI scores were associated with older age, higher body mass index (BMI), greater comorbidity, lower income, smoking, female gender, Hispanic ethnicity, Black race, unemployment, opioid use, lower expectations, and greater American Society of Anesthesiologists score (p < 0.05). Compared with other procedures, total knee arthroplasty was associated with worse PI scores and anterior cruciate ligament reconstruction was associated with better PI scores. Furthermore, PI demonstrated significant associations with a wide range of HRQOL measures. After controlling for confounding variables, worse PI was independently associated with older age, lower income, higher BMI, and smoking.
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Affiliation(s)
- Vidushan Nadarajah
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland.,Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, New York
| | - Elizabeth Glazier
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Kenneth Miller
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Julio J Jauregui
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Michael P Smuda
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Craig H Bennett
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jonathan D Packer
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
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Park HY, Park YW, Hwang JW, Do SH, Na HS. The influence of preoperative epidural labor analgesia on postoperative pain in parturients undergoing emergency cesarean section : A retrospective analysis. Anaesthesist 2020; 69:352-358. [PMID: 32152737 DOI: 10.1007/s00101-020-00753-2] [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: 07/03/2019] [Revised: 02/04/2020] [Accepted: 02/22/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Intense noxious input from the periphery may result in central sensitization and hyperexcitability, thus accentuating subsequent postoperative pain. Parturients who undergo emergency cesarean section (C-sec) after experiencing labor pain often develop labor pain-induced sensitization. OBJECTIVE This retrospective study evaluated whether parturients without epidural labor analgesia (ELA) who underwent emergency C‑sec, experienced more severe postoperative pain and required more rescue analgesics during the postoperative period. METHODS The institution's medical database was searched for parturients who underwent emergency C‑sec under spinal anesthesia for any reason between January 2013 and December 2016. Those who underwent elective C‑sec under spinal anesthesia were included as the reference arm. Parturients were divided into three groups: ELA, no-ELA and elective. Characteristics of patients and perioperative outcomes were evaluated. As primary outcomes, numerical rating scale (NRS) for postoperative pain (0-10) was recorded up to 96 h postoperatively, and use of rescue analgesics was evaluated at 6, 24, and 48 h postoperatively. RESULTS In the ELA, no-ELA, and elective groups, 61, 73, and 88 parturients, respectively, were ultimately enrolled. The NRS for pain were similar among the three groups, except at 6 h postoperatively. Parturients in the no-ELA group demonstrated significantly higher NRS at 6 h postoperatively than those in the ELA group (P = 0.01).More patients in the no-ELA group required rescue analgesics than in the ELA (P = 0.001) and elective groups (P < 0.001) at 6-24 h postoperatively. Moreover, the proportion of patients requiring rescue analgesics ≥2 times was also significantly higher in the no-ELA group (vs. the ELA group, P = 0.004; vs. the elective group, P < 0.001). CONCLUSION Parturients undergoing emergency C‑sec without ELA management during labor experienced greater postoperative pain and a greater use of rescue analgesics during the postoperative period. The findings suggest that administration of ELA before emergency C‑sec may act as pre-emptive analgesia against postoperative pain.
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Affiliation(s)
- H-Y Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seoul, Korea (Republic of).,Department of Anesthesiology and Pain Medicine, Gachon University Gil Medical Center, Gachon, Korea (Republic of)
| | - Y-W Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seoul, Korea (Republic of)
| | - J-W Hwang
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seoul, Korea (Republic of)
| | - S-H Do
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seoul, Korea (Republic of)
| | - H-S Na
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seoul, Korea (Republic of).
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Baek W, Jang Y, Park CG, Moon M. Factors Influencing Satisfaction with Patient-Controlled Analgesia Among Postoperative Patients Using a Generalized Ordinal Logistic Regression Model. Asian Nurs Res (Korean Soc Nurs Sci) 2020; 14:73-81. [PMID: 32165329 DOI: 10.1016/j.anr.2020.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/27/2020] [Accepted: 03/01/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The purpose of this study was to identify the factors affecting the satisfaction with patient-controlled analgesia (PCA) of patients using a generalized ordinal logistic regression model and to evaluate the difference in results of the ordinal regression from those of binary regression. METHODS The study design involved secondary analysis of electronic medical records from a single tertiary care hospital in Seoul, Korea. It included 2,409 patients treated with PCA for postoperative pain management after open or laparoscopic abdominal surgery. Binary logistic regression and generalized ordinal logistic regression were used to identify factors affecting satisfaction. RESULTS Binary logistic regression analysis showed that there was insufficient information for analysis. Generalized ordinal logistic regression revealed that sex, age, pain, PCA usage, and side-effects were common factors affecting PCA satisfaction. However, the effect of some factors affecting PCA satisfaction differed with the level of satisfaction. In open surgery patients, the effect of pain at 6 hours after surgery was significantly greater in the group with lower satisfaction. While, in the laparoscopic surgery patients, the effect of pain at 6-24 hours after surgery was significantly greater in the group with lower satisfaction. CONCLUSION Generalized logistic regression may be an appropriate statistical method for analyzing ordinal data. Degree of postoperative pain and assessment interval are the most important factors associated with PCA satisfaction. Because the factors affecting PCA satisfaction were different for the two types of abdominal surgeries, customizing PCA to individual patients may potentially improve pain management and consequently increase PCA satisfaction.
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Affiliation(s)
- Wonhee Baek
- College of Nursing, Yonsei University, Seoul, Republic of Korea; Acute Pain Service Team, Severance Hospital, Seoul, Republic of Korea
| | - Yeonsoo Jang
- College of Nursing, Yonsei University, Seoul, Republic of Korea; Mo-Im Kim Nursing Research Institute, Seoul, Republic of Korea.
| | - Chang Gi Park
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Mir Moon
- College of Nursing, Yonsei University, Seoul, Republic of Korea; Acute Pain Service Team, Severance Hospital, Seoul, Republic of Korea
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Horn A, Kaneshiro K, Tsui BCH. Preemptive and Preventive Pain Psychoeducation and Its Potential Application as a Multimodal Perioperative Pain Control Option. Anesth Analg 2020; 130:559-573. [DOI: 10.1213/ane.0000000000004319] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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21
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Kavak Akelma F, Altınsoy S, Arslan MT, Ergil J. Effect of favorite music on postoperative anxiety and pain. Anaesthesist 2020; 69:198-204. [DOI: 10.1007/s00101-020-00731-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/22/2019] [Accepted: 12/28/2019] [Indexed: 10/25/2022]
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22
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Krall C, Glass S, Dancourt G, Adams M, Koenig K, Hutchinson EK. Behavioural anxiety predisposes rabbits to intra-operative apnoea and cardiorespiratory instability. Appl Anim Behav Sci 2019. [DOI: 10.1016/j.applanim.2019.104875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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23
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Okunrintemi V, Valero-Elizondo J, Patrick B, Salami J, Tibuakuu M, Ahmad S, Ogunmoroti O, Mahajan S, Khan SU, Gulati M, Nasir K, Michos ED. Gender Differences in Patient-Reported Outcomes Among Adults With Atherosclerotic Cardiovascular Disease. J Am Heart Assoc 2019; 7:e010498. [PMID: 30561253 PMCID: PMC6405598 DOI: 10.1161/jaha.118.010498] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Atherosclerotic cardiovascular disease (ASCVD) accounts for approximately one third of deaths in women. Although there is an established relationship between positive patient experiences, health‐related quality of life, and improved health outcomes, little is known about gender differences in patient‐reported outcomes among ASCVD patients. We therefore compared gender differences in patient‐centered outcomes among individuals with ASCVD. Methods and Results Data from the 2006 to 2015 Medical Expenditure Panel Survey, a nationally representative US sample, were used for this study. Adults ≥18 years with a diagnosis of ASCVD, ascertained by International Classification of Diseases, Ninth Revision (ICD‐9) codes and/or self‐reported data, were included. Linear and logistic regression were used to compare self‐reported patient experience, perception of health, and health‐related quality of life by gender. Models adjusted for demographics, socioeconomic status, and comorbidities. There were 21 353 participants included, with >10 000 (47%‐weighted) of the participants being women, representing ≈11 million female adults with ASCVD nationwide. Compared with men, women with ASCVD were more likely to experience poor patient–provider communication (odds ratio 1.25 [95% confidence interval 1.11–1.41]), lower healthcare satisfaction (1.12 [1.02–1.24]), poor perception of health status (1.15 [1.04–1.28]), and lower health‐related quality of life scores. Women with ASCVD also had lower use of aspirin and statins, and greater odds of ≥2 Emergency Department visits/y. Conclusions Women with ASCVD were more likely to report poorer patient experience, lower health‐related quality of life, and poorer perception of their health when compared with men. These findings have important public health implications and require more research towards understanding the gender‐specific differences in healthcare quality, delivery, and ultimately health outcomes among individuals with ASCVD.
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Affiliation(s)
- Victor Okunrintemi
- 1 Department of Internal Medicine East Carolina University Greenville NC
| | | | | | | | - Martin Tibuakuu
- 5 Department of Medicine St. Luke's Hospital Chesterfield MO.,6 Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins School of Medicine Baltimore MD
| | - Saba Ahmad
- 7 Department of Cardiology Lankenau Medical Center Wynnewood PA
| | - Oluseye Ogunmoroti
- 6 Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins School of Medicine Baltimore MD
| | - Shiwani Mahajan
- 2 Center for Outcomes Research and Evaluation Yale New Haven Hospital New Haven CT
| | | | - Martha Gulati
- 9 Division of Cardiology University of Arizona College of Medicine Phoenix AZ
| | - Khurram Nasir
- 2 Center for Outcomes Research and Evaluation Yale New Haven Hospital New Haven CT.,10 Division of Cardiology Yale School of Medicine New Haven CT
| | - Erin D Michos
- 6 Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins School of Medicine Baltimore MD.,11 Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
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Behman R, Cleary S, McHardy P, Kiss A, Sawyer J, Ladak SSJ, McCluskey SA, Srinivas C, Katz J, Coburn N, Law C, Wei AC, Greig P, Hallet J, Clarke H, Karanicolas PJ. Predictors of Post-operative Pain and Opioid Consumption in Patients Undergoing Liver Surgery. World J Surg 2019; 43:2579-2586. [PMID: 31187246 DOI: 10.1007/s00268-019-05050-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Post-operative pain management is a critical component of perioperative care. Patients at risk of poorly controlled post-operative pain may benefit from early measures to optimize pain management. We sought to identify risk factors for post-operative pain and opioid consumption in patients undergoing liver resection. METHODS This is a multi-institutional prospective nested cohort study of patients undergoing open liver resection. Opioid consumption and pain scores were collected following surgery. To estimate the effects of patient factors on opioid consumption (oral morphine equivalents-OME) and on pain scores (NRS-11), we used generalized linear models and multivariable linear regression model, respectively. RESULTS One hundred and fifty-three patients who underwent open liver resection between 2013 and 2016 were included in the study. The mean patient age was 62.2 years, and 43.3% were female. Younger patients were significantly more likely to use more opioids in the early post-operative period (16.7 OME/10 years, p < 0.001). Patient factors that were significantly associated with increased NRS-11 pain scores also included younger patient age (difference in pain score of 0.3/10 years with cough and 0.2/10 years at rest, p < 0.01 for both) as well as a history of analgesic use (difference in pain score of 0.9 with cough and 0.6 at rest, p < 0.01 and p = 0.07, respectively). CONCLUSION Younger patients and those with a history of analgesic use are more likely to report higher post-operative pain and require higher doses of opioids. Early identification of these patients, and measures to better manage their pain, may contribute to optimal perioperative care.
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Affiliation(s)
- R Behman
- Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, T2-016, Toronto, ON, M4N3M5, Canada
| | - S Cleary
- Department of Surgery, University Health Network, University of Toronto, Toronto, Canada
- Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, USA
| | - P McHardy
- Department of Anaesthesia, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - A Kiss
- Department of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - J Sawyer
- Department of Anaesthesia, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - S S J Ladak
- Department of Anaesthesia and Pain Management, University Health Network, University of Toronto, Toronto, Canada
| | - S A McCluskey
- Pain Research Unit, Toronto General Hospital, University Health Network, Toronto, Canada
| | - C Srinivas
- Pain Research Unit, Toronto General Hospital, University Health Network, Toronto, Canada
| | - J Katz
- Department of Anaesthesia and Pain Management, University Health Network, University of Toronto, Toronto, Canada
- Pain Research Unit, Toronto General Hospital, University Health Network, Toronto, Canada
| | - N Coburn
- Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, T2-016, Toronto, ON, M4N3M5, Canada
- Department of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - C Law
- Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, T2-016, Toronto, ON, M4N3M5, Canada
- Department of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - A C Wei
- Department of Surgery, University Health Network, University of Toronto, Toronto, Canada
| | - P Greig
- Department of Surgery, University Health Network, University of Toronto, Toronto, Canada
| | - J Hallet
- Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, T2-016, Toronto, ON, M4N3M5, Canada
| | - H Clarke
- Department of Anaesthesia and Pain Management, University Health Network, University of Toronto, Toronto, Canada
- Pain Research Unit, Toronto General Hospital, University Health Network, Toronto, Canada
| | - P J Karanicolas
- Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, T2-016, Toronto, ON, M4N3M5, Canada.
- Department of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.
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Torres LM, Sánchez-del-Águila MJ, Salazar R, Failde I, Leal A, Villoria J. A Patient-Based National Survey and Prospective Evaluation of Postoperative Pain Management in Spain: Prevalent but Possibly Preventable. PAIN MEDICINE 2019; 21:1039-1048. [DOI: 10.1093/pm/pnz149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Objective
To evaluate the national general prevalence of postoperative pain and the associated organizational/structural factors related to the provision of health care services.
Design and Setting
Observational prospective cohort study performed in 46 tertiary hospitals that were randomly selected from the Spanish National Inventory of Hospitals through a two-stage balanced and stratified procedure.
Subjects and Methods
Nine-hundred surgical patients representing a wide spectrum of surgical procedures and anesthetic methods were recruited. Those suffering moderate or worse pain while in the postanesthesia care unit/surgery ward (PACU/SW) were followed for 72 hours. Site characteristics were also surveyed. Multilevel models were used to evaluate center- and patient-level factors associated with pain and quality of recovery (QoR). Weighted generalized estimating equations were used to analyze the evolution of pain intensity.
Results
The prevalence while in and at discharge from the PACU/SW was 48.7% (cluster-adjusted 95% confidence interval [CI] = 38.1–59.2%) and 21.6% (95% CI = 15.4–27.8%), respectively. Pain intensity decreased significantly over time. Less than 20% of the patients received systemic patient-controlled analgesia (PCA) or regional analgesic techniques. Age, preexisting pain, type of surgery, use of general anesthesia, and postoperative potent opioids were associated with pain risk and intensity, as were center-level factors such as patient information, protocol availability, and coordination of care. In turn, QoR was related to pain intensity and patient satisfaction with analgesia and side effects.
Conclusions
Compared with previous reports, the prevalence of moderate/severe postoperative pain has decreased but remains excessive. Organizational improvements to deploy procedure-specific, opioid-sparing analgesic strategies including regional techniques are recommended.
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Affiliation(s)
- Luis M Torres
- Anesthesia Department, Hospital Puerta del Mar, University of Cádiz, Cádiz, Spain
| | - Manuel J Sánchez-del-Águila
- Department of Anesthesia, Reanimation and Pain Therapeutics, Hospital Costa del Sol, Marbella (Málaga), Spain
| | - Rafael Salazar
- Anesthesia Department, Hospital Comarcal de Inca, Inca (Mallorca), Spain
| | - Inmaculada Failde
- Preventive Medicine and Public Health Area, University of Cádiz, Cádiz, Spain
- The Observatory of Pain, Grünenthal Foundation-University, Cádiz, Spain
- Institute of Research and Innovation in Biomedical Sciences (INiBICA), Cádiz, Spain
| | - Ana Leal
- Medical Department, Grünenthal Pharma, S.A., Madrid, Spain
| | - Jesús Villoria
- Department of Design and Biometrics, Medicxact, S.L., Alpedrete (Madrid), Spain
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S PK, Aafaque S, S S, N N. Effect of Aromatherapy on Dental Anxiety Among Orthodontic Patients: A Randomized Controlled Trial. Cureus 2019; 11:e5306. [PMID: 31592362 PMCID: PMC6773455 DOI: 10.7759/cureus.5306] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction: Dental anxiety is a distressing challenge faced by both the patients and the dental care provider, particularly in the Department of Orthodontics. The goal of this study was to assess the effect of aromatherapy (oils) on dental anxiety level among orthodontic patients and to compare the effect on anxiety levels between lavender oil, rose oil, and a placebo. Materials and methods: A total of 72 patients (36 men and 36 women) who reported to the Department of Orthodontics were selected and randomly allocated into three groups: lavender oil, rose oil, and placebo. The ambient odor of those oils or placebo was maintained with a candle warmer, and the patients were made to wait in their respective rooms for 15 minutes. Participants' heart rate and blood pressure, being reliable and objective indicators of anxiety, were measured using pulse oximeter and sphygmomanometer, respectively. Additionally, a questionnaire, comprising demographic data and questions representing a modified Dental Anxiety Scale, was given to the patients to measure subjective anxiety levels before and after aromatic therapy. Paired t-test, analysis of variance, and the Wilcoxon signed-rank test were used for both subjective and objective analyses. Results: Lavender oil and rose oil produced a significant reduction of dental anxiety level among orthodontic patients in both objective and subjective method (P ≤ .05); lavender oil demonstrated a greater significance in reducing the anxiety level when compared to rose oil. Conclusion: Our findings indicate that aromatherapy offers promising effect against dental anxiety among orthodontic patients. Aromatherapy can be recommended as an easy alternative to reduce anxiety in patients before orthodontic treatment.
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Affiliation(s)
- Premkumar K S
- Department of Orthodontics and Dentofacial Orthopaedics, Best Dental Science College and Hospital, Madurai, IND
| | - Syed Aafaque
- Department of Orthodontics and Dentofacial Orthopaedics, Best Dental Science College and Hospital, Madurai, IND
| | - Sumalatha S
- Department of Orthodontics and Dentofacial Orthopaedics, Best Dental Science College and Hospital, Madurai, IND
| | - Narendran N
- Department of Orthodontics and Dentofacial Orthopaedics, Best Dental Science College and Hospital, Madurai, IND
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Clarke H, Rai A, Bao J, Poon M, Rao V, Djaiani G, Beattie S, Page G, Choiniere M, McGillion M, Parry M, Hunter J, Watt-Watson J, Martin L, Grosman-Rimon L, Kumbhare D, Hanlon J, Seltzer Z, Katz J. Toward a phenomic analysis of chronic postsurgical pain following cardiac surgery. Can J Pain 2019; 3:58-69. [PMID: 35005394 PMCID: PMC8730663 DOI: 10.1080/24740527.2019.1580142] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background: Despite the same surgical approach, up to 40% of patients develop chronic postsurgical pain (CPSP) following cardiac surgery, whereas the rest are chronic pain free. This variability suggests that CPSP is controlled partially through genetics, but the genes for CPSP are largely unknown. Aims: The aim of this study was to identify potential CPSP phenotypes by comparing patients who developed CPSP following cardiac surgery vs. those who did not. Methods: A research ethics board–approved, cross-sectional study of post–cardiac surgery pain was conducted at Toronto General Hospital from 2011 to 2015. Patients were recruited to complete a short survey of chronic pain scores and the Short-Form McGill Pain Questionnaire–2. A subset of patients completed a longer survey of eight validated pain phenotyping questionnaires and/or four psychophysical assessments. All surveys and psychophysical testing were conducted after surgery. Patients were stratified by presence of chronic pain and groups were compared using descriptive statistics. Results: Six hundred forty-three patients completed the short form survey. The mean postsurgery assessment time was 41.5 (SD = ±25.1) months. Over a quarter (27.8%) reported CPSP at the chest as a consequence of their surgery. Of patients reporting CPSP, 46.6% reported mild pain (0–3), 35.8% reported moderate pain (4–7), and 17.6% reported severe pain (7–10) in accordance with the numerical rating scale. Patients with moderate and/or severe CPSP were younger, had a greater body mass index, and had higher anxiety sensitivity, pain catastrophizing, and somatization scores. Conclusions: Chronic pain levels after cardiac surgery are associated with anxiety, catastrophizing, and sensory abnormalities in body parts outside the field innervated by injured nerves, indicating the presence of widespread central sensitization to incoming sensory inputs from intact nerves.
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Affiliation(s)
- Hance Clarke
- Department of Anaesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada.,Transitional Pain Service, Department of Anaesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada.,Department of Anaesthesia, University of Toronto, Toronto, Ontario, Canada.,University of Toronto Centre for the Study of Pain, University of Toronto, Toronto, Ontario, Canada
| | - Ajit Rai
- Department of Anaesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
| | - James Bao
- Department of Anaesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
| | - Michael Poon
- Department of Anaesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
| | - Vivek Rao
- Department of Cardiovascular Surgery, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - George Djaiani
- Department of Anaesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada.,Department of Anaesthesia, University of Toronto, Toronto, Ontario, Canada
| | - Scott Beattie
- Department of Anaesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada.,Department of Anaesthesia, University of Toronto, Toronto, Ontario, Canada
| | - Gabrielle Page
- Département d'anesthésiologie et médecine de la douleur, Université de Montréal, Montreal, Quebec, Canada
| | - Manon Choiniere
- Département d'anesthésiologie et médecine de la douleur, Université de Montréal, Montreal, Quebec, Canada
| | | | - Monica Parry
- Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Judith Hunter
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Judy Watt-Watson
- Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Loren Martin
- Department of Psychology, University of Toronto Mississauga, Toronto, Ontario, Canada
| | - Liza Grosman-Rimon
- Department of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
| | - Dinesh Kumbhare
- Department of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
| | - John Hanlon
- Department of Anaesthesia, University of Toronto, Toronto, Ontario, Canada.,University of Toronto Centre for the Study of Pain, University of Toronto, Toronto, Ontario, Canada.,Department of Anaesthesia, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Ze'ev Seltzer
- Department of Anaesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada.,Department of Anaesthesia, University of Toronto, Toronto, Ontario, Canada.,University of Toronto Centre for the Study of Pain, University of Toronto, Toronto, Ontario, Canada.,University of Toronto Faculties of Dentistry and Medicine, University of Toronto, Toronto, Ontario, Canada.,Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Joel Katz
- Department of Anaesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada.,Transitional Pain Service, Department of Anaesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada.,Department of Anaesthesia, University of Toronto, Toronto, Ontario, Canada.,University of Toronto Centre for the Study of Pain, University of Toronto, Toronto, Ontario, Canada.,Department of Psychology, York University, Toronto, Ontario, Canada
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The Effect of Preoperative Medications on Length of Stay, Inpatient Pain, and Narcotics Consumption After Minimally Invasive Transforaminal Lumbar Interbody Fusion. Clin Spine Surg 2019; 32:E37-E42. [PMID: 30234567 DOI: 10.1097/bsd.0000000000000713] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
STUDY DESIGN This is a retrospective cohort study. OBJECTIVE To determine the association between preoperative medications and length of stay, inpatient pain, and narcotics consumption after a minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). SUMMARY OF BACKGROUND DATA Previous studies have identified risk factors for increased length of hospital stay, inpatient pain, and narcotics consumption. However, little is known regarding the effects of preoperative medications on outcomes after spine surgery. METHODS A prospectively maintained surgical database of patients undergoing primary, single-level MIS TLIF was retrospectively reviewed. Preoperative medications taken within 30 days before surgery were recorded for each patient and categorized by medication type. Poisson regression with robust error variance was used to determine the association between preoperative medications and length of stay, pain scores, and narcotics consumption. Multivariate analysis was performed using a backwards, stepwise regression to identify independent risk factors. RESULTS In total, 138 patients were included in this analysis. On bivariate analysis, benzodiazepines were associated with longer hospital stays [relative risk (RR)=2.03; P=0.031]. Benzodiazepines (RR=3.71; P<0.001) and preoperative narcotics (RR=2.60; P=0.012) were risk factors for pain ≥7 on postoperative day 0. On multivariate analysis, benzodiazepines were an independent risk factor for prolonged stay. Benzodiazepines, narcotics, and nonsteroidal anti-inflammatories were identified as independent risk factors for increased postoperative pain. CONCLUSIONS These results suggest that benzodiazepines are a risk factor for increased length of stay and postoperative pain after MIS TLIF. Preoperative narcotics and nonsteroidal anti-inflammatories were also identified as risk factors for postoperative pain though this did not lead to increases in narcotics consumption. Patients taking these medications should undergo more vigilant perioperative monitoring for adequate pain management. More work must be done to further elucidate the association between preoperative medications and postoperative outcomes after MIS TLIF.
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29
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Ogurlu M, Sari S, Küçük M, Bakiş M, Uğur B, Eshraghi YE, Galimberti F, Turan A. Comparison of the Effect of Propofol and Sevoflurane Anaesthesia on Acute and Chronic Postoperative Pain after Hysterectomy. Anaesth Intensive Care 2019; 42:365-70. [DOI: 10.1177/0310057x1404200314] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- M. Ogurlu
- Department of Anesthesiology and Reanimation, Adnan Menderes University, Aydin, Turkey
| | - S. Sari
- Department of Anesthesiology and Reanimation, Adnan Menderes University, Aydin, Turkey
| | - M. Küçük
- Department of Anesthesiology and Reanimation, Adnan Menderes University, Aydin, Turkey
| | - M. Bakiş
- Department of Anesthesiology and Reanimation, Adnan Menderes University, Aydin, Turkey
| | - B. Uğur
- Department of Anesthesiology and Reanimation, Adnan Menderes University, Aydin, Turkey
| | - Y. E. Eshraghi
- Department of Anesthesiology and Reanimation, Adnan Menderes University, Aydin, Turkey
- Department of Anesthesiology, Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - F. Galimberti
- Department of Anesthesiology and Reanimation, Adnan Menderes University, Aydin, Turkey
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
| | - A. Turan
- Department of Anesthesiology and Reanimation, Adnan Menderes University, Aydin, Turkey
- Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA
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31
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Tulloch I, Rubin JS. Assessment and Management of Preoperative Anxiety. J Voice 2018; 33:691-696. [PMID: 29753446 DOI: 10.1016/j.jvoice.2018.02.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 02/13/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Preoperative anxiety has the potential to alter the dynamics of an elective procedure and has been shown to detrimentally affect patients both cognitively and physiologically. If mismanaged, it can lead to essential procedures being postponed or canceled, delay postoperative recovery, and increase patients' requirements for medical intervention postoperatively. These outcomes have harmful implications both clinically and economically. Our primary objective was to evaluate the levels of anxiety patients experience immediately before elective otorhinolaryngologic procedures. Our secondary outcome was to assess the subjects' views on potential management strategies to tackle their anxiety. METHODS This is an observational cross-sectional project evaluating 53 patients who were selected consecutively from a list of elective otorhinolaryngologic procedures. All procedures were to be completed under general anesthetic, and all patients had received the same preoperative assessment preparation. 29 male and 24 female patients were included, aged between 19 and 76 years (mean 45). The Spielberger State-Trait Anxiety Inventory was used to assess preoperative anxiety directly before the otorhinolaryngologic procedure. The Service Improvement questionnaire was used to assess whether patients would favor the introduction of anxiety-reduction measures. RESULTS There was neither a significant increase in patient anxiety levels preoperatively (P = 0.37) nor a significant increase in anxiety levels preoperatively when results were stratified according to patient gender and age (P = 0.45 and P = 0.27). 54% of the patients felt that their anxiety would have been reduced if they had read a procedural information leaflet, and 22% felt it would have been reduced if they had received preoperative behavioral training. 17% of the patients wanted more information from the surgical team. However, 12% of the patients would have liked less information from the surgical team preoperatively. CONCLUSIONS Patients did not have a significant increase in their anxiety levels preoperatively. On the basis of our findings, we will work to improve the information we provide to patients preoperatively and to identify patient subgroups that require additional preoperative support.
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Affiliation(s)
- Isabel Tulloch
- Neurosurgery, King's College Hospital, London, United Kingdom.
| | - John S Rubin
- The University College London Hospital, University of London, London, United Kingdom
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32
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Sjamsudin E, Maulina T, Cipta A, Iskandarsyah A, Hardianto A, Nandini M, Kasim A, Yusuf HY. Assessment of oral cancer pain, anxiety, and quality of life of oral squamous cell carcinoma patients with invasive treatment procedure. Oral Maxillofac Surg 2018; 22:83-90. [PMID: 29332186 DOI: 10.1007/s10006-018-0672-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 01/03/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE Depending on its stage on diagnosis, oral squamous cell carcinoma (OSCC) might cause excruciating pain and decreased quality of life. As for treatment, the treatment of OSCC might vary from chemotherapy to surgery. The objective of the current study was to assess the preoperative and postoperative oral cancer pain, anxiety, and quality of life of OSCC patients with invasive treatment procedure. METHODS The current study was conducted by interviewing 21 (10 males; 11 females) patients who had been diagnosed with stage 3 and stage 4 OSCC and about to go through surgery at the inpatient ward of Surgical Oncology Department, Hasan Sadikin Hospital, Bandung, Indonesia. A preoperative and interview was conducted by using the Hospital Anxiety and Depression Scale (HADS), the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QOL)-C30, the shortened EORTC QOL Questionnaire for Oesophageal Cancer (OES)18, the visual analog scale (VAS), and the University of California San Francisco (UCSF) Oral Cancer Pain Questionnaire. All data were analyzed to evaluate the preoperative and postoperative effect. RESULTS The current study showed a significant decrease of the postoperative oral pain (p < 0.01) and anxiety level (p < 0.01), while postoperative patient' quality of life was significantly (p < 0.01) increased. CONCLUSION Despite of the invasive procedure that might cause postoperative effect, OSCC patients in the current study showed a better quality of life after cancer removal.
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Affiliation(s)
- Endang Sjamsudin
- Oral Surgery Department, Faculty of Dentistry, Universitas Padjadjaran, Jl. Sekeloa Selatan no. 1, Bandung, West Java, 40132, Indonesia
| | - Tantry Maulina
- Oral Surgery Department, Faculty of Dentistry, Universitas Padjadjaran, Jl. Sekeloa Selatan no. 1, Bandung, West Java, 40132, Indonesia.
| | - Ahmad Cipta
- Oral Surgery Department, Faculty of Dentistry, Universitas Padjadjaran, Jl. Sekeloa Selatan no. 1, Bandung, West Java, 40132, Indonesia
| | - Aulia Iskandarsyah
- Clinical Psychology Department, Faculty of Psychology, Universitas Padjadjaran, Bandung, Indonesia
| | - Andri Hardianto
- Oral Surgery Department, Faculty of Dentistry, Universitas Padjadjaran, Jl. Sekeloa Selatan no. 1, Bandung, West Java, 40132, Indonesia
| | - Mantra Nandini
- Oral Surgery Department, Faculty of Dentistry, Universitas Padjadjaran, Jl. Sekeloa Selatan no. 1, Bandung, West Java, 40132, Indonesia
| | - Alwin Kasim
- Oral Surgery Department, Faculty of Dentistry, Universitas Padjadjaran, Jl. Sekeloa Selatan no. 1, Bandung, West Java, 40132, Indonesia
| | - Harmas Yazid Yusuf
- Oral Surgery Department, Faculty of Dentistry, Universitas Padjadjaran, Jl. Sekeloa Selatan no. 1, Bandung, West Java, 40132, Indonesia
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Stevenson KL, Neuwirth AL, Sheth N. Perioperative pain management following total joint arthroplasty: A review and update to an institutional pain protocol. J Clin Orthop Trauma 2018; 9:40-45. [PMID: 29628682 PMCID: PMC5884049 DOI: 10.1016/j.jcot.2017.09.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 09/26/2017] [Indexed: 10/18/2022] Open
Abstract
As the rate of total joint arthroplasty increases with the aging population of the United States, new focus on decreasing opioid use through the development of multimodal pain regimens (MPRs) is becoming an important area of research. MPRs use different agents and modes of delivery in order to synergistically address pain at many levels of the pain pathway. MPRs include a combination of acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), gabapentinoids, opioids (short- and long-acting), spinal/epidural analgesia, regional nerve blocks, and local anesthetics. This review summarizes the available literature on major components of MPRs shown to be effective in the total joint arthroplasty population. Finally, the authors' preferred method for pain control in the TJA population is reviewed.
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Affiliation(s)
- Kimberly L Stevenson
- Resident Department of Orthopaedic Surgery, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, United States
| | - Alexander L Neuwirth
- Resident Department of Orthopaedic Surgery, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, United States
| | - Neil Sheth
- Department of Orthopaedic Surgery, University of Pennsylvania, 800 Spruce Street − 8th Floor Preston Building, Philadelphia, PA 19107, United States
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Transient Receptor Potential Vanilloid 1 Antagonists Prevent Anesthesia-induced Hypothermia and Decrease Postincisional Opioid Dose Requirements in Rodents. Anesthesiology 2017; 127:813-823. [DOI: 10.1097/aln.0000000000001812] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Background
Intraoperative hypothermia and postoperative pain control are two important clinical challenges in anesthesiology. Transient receptor potential vanilloid 1 has been implicated both in thermoregulation and pain. Transient receptor potential vanilloid 1 antagonists were not advanced as analgesics in humans in part due to a side effect of hyperthermia. This study tested the hypothesis that a single, preincision injection of a transient receptor potential vanilloid 1 antagonist could prevent anesthesia-induced hypothermia and decrease the opioid requirement for postsurgical hypersensitivity.
Methods
General anesthesia was induced in rats and mice with either isoflurane or ketamine, and animals were treated with transient receptor potential vanilloid 1 antagonists (AMG 517 or ABT-102). The core body temperature and oxygen consumption were monitored during anesthesia and the postanesthesia period. The effect of preincision AMG 517 on morphine-induced reversal of postincision hyperalgesia was evaluated in rats.
Results
AMG 517 and ABT-102 dose-dependently prevented general anesthesia-induced hypothermia (mean ± SD; from 1.5° ± 0.1°C to 0.1° ± 0.1°C decrease; P < 0.001) without causing hyperthermia in the postanesthesia phase. Isoflurane-induced hypothermia was prevented by AMG 517 in wild-type but not in transient receptor potential vanilloid 1 knockout mice (n = 7 to 11 per group). The prevention of anesthesia-induced hypothermia by AMG 517 involved activation of brown fat thermogenesis with a possible contribution from changes in vasomotor tone. A single preincision dose of AMG 517 decreased the morphine dose requirement for the reduction of postincision thermal (12.6 ± 3.0 vs. 15.6 ± 1.0 s) and mechanical (6.8 ± 3.0 vs. 9.5 ± 3.0 g) withdrawal latencies.
Conclusions
These studies demonstrate that transient receptor potential vanilloid 1 antagonists prevent anesthesia-induced hypothermia and decrease opioid dose requirements for the reduction of postincisional hypersensitivity in rodents.
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Persson AKM, Pettersson FD, Åkeson J. Single Nucleotide Polymorphisms Associated with Pain Sensitivity After Laparoscopic Cholecystectomy. PAIN MEDICINE 2017; 19:1271-1279. [DOI: 10.1093/pm/pnx164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Anna K M Persson
- Department of Clinical Sciences Malmö, Anaesthesiology and Intensive Care Medicine, Lund University, Malmö, Sweden
- Department of Anaesthesiology and Intensive Care Medicine, Halland Hospital, Halmstad, Sweden
| | - Fatimah Dabo Pettersson
- Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, Sweden
| | - Jonas Åkeson
- Department of Clinical Sciences Malmö, Anaesthesiology and Intensive Care Medicine, Lund University, Malmö, Sweden
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Elsamadicy AA, Reddy GB, Nayar G, Sergesketter A, Zakare-Fagbamila R, Karikari IO, Gottfried ON. Impact of Gender Disparities on Short-Term and Long-Term Patient Reported Outcomes and Satisfaction Measures After Elective Lumbar Spine Surgery: A Single Institutional Study of 384 Patients. World Neurosurg 2017; 107:952-958. [PMID: 28743671 DOI: 10.1016/j.wneu.2017.07.082] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/14/2017] [Accepted: 07/15/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is a paucity of data determining the impact that gender disparities have on spine outcomes, particularly perception of health and satisfaction. The aim of this study was to determine whether there is a difference in 3-month and 1-year patient-reported outcomes and satisfaction after elective lumbar spine surgery. METHODS This was a retrospectively analyzed study from a maintained prospective database of 384 patients who underwent elective lumbar spine surgery. Patients were categorized by gender (men, n = 199; women, n = 185). Patient-reported outcome instruments (Oswestry disability index, visual analogue scale-back pain/leg pain, EuroQol visual analogue scale, and EuroQol 5 dimensions questionnaire) were completed before surgery, then at 3 and 12 months after surgery along with patient satisfaction measures. RESULTS Baseline patient demographics, comorbidities, and operative variables were similar between both cohorts. The female cohort had a slightly longer hospital stay than male cohort (P = 0.007). Baseline patient-reported outcome measures were different between both cohorts, with female patients having more Oswestry disability index (23.8 vs. 20.4; P ≤ 0.0001) and visual analogue scale-back pain (7.2 vs. 6.2; P = 0.0004), and a lower EuroQol 5 dimensions questionnaire (0.34 vs. 0.49; P = 0.0001) compared with the male cohort. At 1-year follow-up, the male cohort had a significantly more mean change in visual analogue scale-leg pain (-3.9 vs. -2.8; P = 0.04) and trended to have more mean change in visual analogue scale-back pain (-3.4 vs. -2.5; P = 0.06) and EuroQol visual analogue scale (8.6 vs. 3.4; P = 0.054) scores compared with the female cohort. At 1-year a significantly more portion in the male cohort found that surgery met their expectations compared with the female cohort (65.0% vs. 49.5%; P = 0.02). CONCLUSIONS Our study suggests that there may be differences in perception of health, pain, and disability between men and women at baseline, short-term and long-term follow-up that may influence overall patient satisfaction.
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Affiliation(s)
- Aladine A Elsamadicy
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Gireesh B Reddy
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Gautum Nayar
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Amanda Sergesketter
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Isaac O Karikari
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Oren N Gottfried
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
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Nakamoto K, Aizawa F, Miyagi K, Yamashita T, Mankura M, Koyama Y, Kasuya F, Hirasawa A, Kurihara T, Miyata A, Tokuyama S. Dysfunctional GPR40/FFAR1 signaling exacerbates pain behavior in mice. PLoS One 2017; 12:e0180610. [PMID: 28723961 PMCID: PMC5516985 DOI: 10.1371/journal.pone.0180610] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 06/19/2017] [Indexed: 11/22/2022] Open
Abstract
We previously showed that activation of G protein-coupled receptor 40/free fatty acid receptor 1 (GPR40/FFAR1) signaling modulates descending inhibition of pain. In this study, we investigated the involvement of fatty acid-GPR40/FFAR1 signaling in the transition from acute to chronic pain. We used GPR40/FFAR1-knockout (GPR40KO) mice and wild-type (WT) mice. A plantar incision was performed, and mechanical allodynia and thermal hyperalgesia were evaluated with a von Frey filament test and plantar test, respectively. Immunohistochemistry was used to localize GPR40/FFAR1, and the levels of free fatty acids in the hypothalamus were analyzed with liquid chromatography-tandem mass spectrometry. The repeated administration of GW1100, a GPR40/FFAR1 antagonist, exacerbated the incision-induced mechanical allodynia and significantly increased the levels of phosphorylated extracellular signal-regulated kinase in the spinal cord after low-threshold touch stimulation in the mice compared to vehicle-treated mice. The levels of long-chain free fatty acids, such as docosahexaenoic acid, oleic acid, and palmitate, which are GPR40/FFAR1 agonists, were significantly increased in the hypothalamus two days after the surgery compared to levels in the sham group. Furthermore, the incision-induced mechanical allodynia was exacerbated in the GPR40KO mice compared to the WT mice, while the response in the plantar test was not changed. These findings suggested that dysfunction of the GPR40/FFAR1 signaling pathway altered the endogenous pain control system and that this dysfunction might be associated with the development of chronic pain.
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Affiliation(s)
- Kazuo Nakamoto
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Kobe Gakuin University, Chuo-ku, Kobe, Japan
| | - Fuka Aizawa
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Kobe Gakuin University, Chuo-ku, Kobe, Japan
| | - Kei Miyagi
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Kobe Gakuin University, Chuo-ku, Kobe, Japan
| | - Takuya Yamashita
- Biochemical Toxicology Laboratory, Faculty of Pharmaceutical Sciences, Kobe Gakuin University, Chuo-ku, Kobe, Japan
| | - Mitsumasa Mankura
- Faculty of Food Culture, Kurashiki Sakuyo University, Kurashiki, Okayama, Japan
| | - Yutaka Koyama
- Laboratory of Pharmacology, Faculty of Pharmacy, Osaka Ohtani University, Tondabayashi, Osaka, Japan
| | - Fumiyo Kasuya
- Biochemical Toxicology Laboratory, Faculty of Pharmaceutical Sciences, Kobe Gakuin University, Chuo-ku, Kobe, Japan
| | - Akira Hirasawa
- Department of Genomic Drug Discovery Science, Graduate School of Pharmaceutical Sciences, Kyoto University, Kyoto, Japan
| | - Takashi Kurihara
- Department of Pharmacology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Atsuro Miyata
- Department of Pharmacology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Shogo Tokuyama
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Kobe Gakuin University, Chuo-ku, Kobe, Japan
- * E-mail:
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Zan P, Li G. Letter to the Editor on "Efficacy in Deep Vein Thrombosis Prevention With Extended Mechanical Compression Device Therapy and Prophylactic Aspirin Following Total Knee Arthroplasty: A Randomized Control Trial". J Arthroplasty 2017; 32:2316-2317. [PMID: 28413138 DOI: 10.1016/j.arth.2017.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 03/13/2017] [Indexed: 02/01/2023] Open
Affiliation(s)
- Pengfei Zan
- Department of Orthopedics, The Tenth People's Hospital Affiliated to Tongji University, Shanghai, People's Republic of China
| | - Guodong Li
- Department of Orthopedics, The Tenth People's Hospital Affiliated to Tongji University, Shanghai, People's Republic of China
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Si HB, Yang TM, Zeng Y, Zhou ZK, Pei FX, Lu YR, Cheng JQ, Shen B. Correlations between inflammatory cytokines, muscle damage markers and acute postoperative pain following primary total knee arthroplasty. BMC Musculoskelet Disord 2017. [PMID: 28623906 PMCID: PMC5473999 DOI: 10.1186/s12891-017-1597-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Despite the success of total knee arthroplasty (TKA) in reducing knee pain and improving functional disability, the management of acute postoperative pain is still unsatisfactory. This study was aimed to quantitatively analyze the possible correlations between inflammatory cytokines, muscle damage markers and acute postoperative pain following primary TKA. METHODS Patients scheduled for unilateral primary TKA were consecutively included, the serial changes of the numerical rating scale (NRS) at rest (NRSR) and at walking (NRSW), serum inflammatory cytokines and muscle damage markers were assessed before surgery (T0) and at postoperative day 1, 2, 3 and 5 (T1-T4, respectively); while pain disability questionnaire (PDQ) and synovial fluid inflammatory cytokines were evaluated at T0. The correlations between inflammatory cytokines, muscle damage markers and pain scores were examined, and Bonferroni correction was applied for multiple comparisons. RESULTS Ninety six patients were included for serum markers and pain evaluations at T0-T4, while 54 (56.25%) for synovial fluid cytokines at T0. The NRSR at T1 and T2 were positively correlated with preoperative NRSW, while the NRSW at T1 to T4 were positively correlated with preoperative NRSR, NRSW and PDQ (all p < 0.05). The NRSR was positively correlated with serum PGE2, IL-6, and CK at T1; the NRSW was positively correlated with serum CRP at T1, with PGE2 and IL-6 at T1 to T3, with CK at T2 and T4, and with Mb and LDH at T1 to T4 (all p < 0.003). Meanwhile, positive correlations were observed between preoperative NRSW and synovial fluid PGE2, IL-6, IL-8, or TNF-α, as well as between PDQ and PGE2 (all p < 0.003), but no associations between postoperative pain scores and preoperative synovial fluid cytokines was found (all p ≥ 0.003). Additionally, the NRSR at T1 and T2, and NRSW at T1 to T4 were positively correlated with body mass index (all p < 0.05). CONCLUSIONS Serum inflammatory cytokines and muscle damage markers are positively correlated with acute postoperative pain following primary TKA, and the key cytokines (CRP, PGE2, and IL-6) and markers (Mb, CK and LDH) may serve as the targets for developing novel analgesic strategies.
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Affiliation(s)
- Hai-Bo Si
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, 37th Guoxue Road, Chengdu, Sichuan, 610041, China.,Key Laboratory of Transplant Engineering and Immunology, West China Hospital, Sichuan University, No.1 Keyuan 4th Road, Chengdu, Sichuan, 610041, China
| | - Ti-Min Yang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, 37th Guoxue Road, Chengdu, Sichuan, 610041, China
| | - Yi Zeng
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, 37th Guoxue Road, Chengdu, Sichuan, 610041, China
| | - Zong-Ke Zhou
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, 37th Guoxue Road, Chengdu, Sichuan, 610041, China
| | - Fu-Xing Pei
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, 37th Guoxue Road, Chengdu, Sichuan, 610041, China
| | - Yan-Rong Lu
- Key Laboratory of Transplant Engineering and Immunology, West China Hospital, Sichuan University, No.1 Keyuan 4th Road, Chengdu, Sichuan, 610041, China
| | - Jing-Qiu Cheng
- Key Laboratory of Transplant Engineering and Immunology, West China Hospital, Sichuan University, No.1 Keyuan 4th Road, Chengdu, Sichuan, 610041, China.
| | - Bin Shen
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, 37th Guoxue Road, Chengdu, Sichuan, 610041, China.
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Snyder MA, Sympson AN, Scheuerman CM, Gregg JL, Hussain LR. Efficacy in Deep Vein Thrombosis Prevention With Extended Mechanical Compression Device Therapy and Prophylactic Aspirin Following Total Knee Arthroplasty: A Randomized Control Trial. J Arthroplasty 2017; 32:1478-1482. [PMID: 28159420 DOI: 10.1016/j.arth.2016.12.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 12/13/2016] [Accepted: 12/14/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Aspirin at 325 mg twice daily is now included as a nationally approved venous thromboembolism (VTE) prophylaxis protocol for low-risk total knee arthroplasty (TKA) patients. The purpose of this study is to examine whether there is a difference in deep vein thrombosis (DVT) occurrence after a limited tourniquet TKA using aspirin-based prophylaxis with or without extended use of mechanical compression device (MCD) therapy. METHODS One hundred limited tourniquet TKA patients, whose DVT risk was managed with aspirin 325 mg twice daily for 3 weeks, were randomized to either using an MCD during hospitalization only or extended use at home up to 6 weeks postoperatively. Lower extremity duplex venous ultrasonography (LEDVU) was completed on the second postoperative day, 14 days postoperatively, and at 3 months postoperatively to confirm the absence of DVT after treatment. RESULTS The DVT rate for the postdischarge MCD therapy group was 0% and 23.1% for the inpatient MCD group (P < .001). All DVTs resolved by 3 months postoperatively. Patient satisfaction was 9.56 (±0.82) for postdischarge MCD patients vs 8.50 (±1.46) for inpatient MCD patients (P < .001). CONCLUSION Limited tourniquet TKA patients who were mobilized early, managed with aspirin for 3 weeks postoperatively, and on MCD therapy for up to 6 weeks postoperatively experienced superior DVT prophylaxis than patients receiving MCD therapy only as an inpatient (P < .05). The 0% incidence of nonsymptomatic DVTs prevented by aspirin and extended-use MCD further validates this type of prophylaxis in low DVT risk TKA patients.
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Affiliation(s)
- Mark A Snyder
- Trihealth Orthopaedic and Sports Institute, Cincinnati, Ohio
| | - Alexandra N Sympson
- Trihealth Hatton Research Institute, Good Samaritan Hospital, Cincinnati, Ohio
| | | | - Justin L Gregg
- Trihealth Hatton Research Institute, Good Samaritan Hospital, Cincinnati, Ohio
| | - Lala R Hussain
- Trihealth Hatton Research Institute, Good Samaritan Hospital, Cincinnati, Ohio
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Mokhtar AM, Elsakka AI, Ali HM. Premedication with midazolam prior to cesarean delivery in preeclamptic parturients: A randomized controlled trial. Anesth Essays Res 2016; 10:631-636. [PMID: 27746564 PMCID: PMC5062194 DOI: 10.4103/0259-1162.191117] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Anxiety is a concern in obstetrics, especially in preeclamptic mothers. Sedation is not commonly used in parturients for fear of adverse neonatal effect. We investigated maternal and neonatal outcome of midazolam as an adjuvant to spinal anesthesia for elective cesarean delivery. Methods: A prospective randomized controlled trial, in which eighty preeclamptic parturients received either an intravenous dose of 0.035 mg/kg of midazolam or an equal volume of normal saline, 30 min before spinal anesthesia. Maternal anxiety was assessed using Amsterdam Preoperative Anxiety and Information Scale (APAIS); postoperative maternal satisfaction was assessed using Maternal Satisfaction Scale for Cesarean Section (MSSCS). Newborns were assessed using Apgar score, Neonatal Neurologic and Adaptive Capacity Score (NACS), and umbilical artery blood gases. Results: Mothers premedicated with midazolam showed a lower level of preoperative anxiety and a higher degree of postoperative satisfaction than the control group. There were no between-group differences regarding the neonatal outcome. Conclusion: Preeclamptic parturients premedicated with midazolam (0.035 mg/kg) before spinal anesthesia have lower anxiety and higher postoperative satisfaction levels, with no adverse effects on the newborns.
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Affiliation(s)
- Ali M Mokhtar
- Department of Anesthesia, Cairo University, Cairo, Egypt
| | | | - Hassan M Ali
- Department of Anesthesia, Cairo University, Cairo, Egypt
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42
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Nakagawa S, Arai Y, Inoue H, Kan H, Hino M, Ichimaru S, Ikoma K, Fujiwara H, Amaya F, Sawa T, Kubo T. Comparative Effects of Periarticular Multimodal Drug Injection and Single-Shot Femoral Nerve Block on Pain Following Total Knee Arthroplasty and Factors Influencing Their Effectiveness. Knee Surg Relat Res 2016; 28:233-8. [PMID: 27595078 PMCID: PMC5009049 DOI: 10.5792/ksrr.2016.28.3.233] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 03/14/2016] [Accepted: 03/27/2016] [Indexed: 11/04/2022] Open
Abstract
Purpose This study compared the analgesic effects of local infiltration analgesia (LIA) and femoral nerve block (FNB) after total knee arthroplasty (TKA) and assessed factors associated with analgesia obtained by these two methods. Materials and Methods Study subjects included 66 patients (72 knees) who underwent TKA for osteoarthritis of the knee. Pain visual analogue scale (VAS), the amount of analgesics used, number of days to achieve 90° of flexion of the knee joint, date of initiating parallel-bar walking, range of motion of the knee joint at discharge, and adverse events were investigated. Results The VAS scores did not differ significantly between two groups, whereas the amount of analgesics used was significantly lower in the LIA group. Preoperative flexion contracture was significantly more severe in the LIA group with high VAS compared with low VAS. No serious adverse event occurred in the LIA or FNB group. Conclusions The lower analgesic usage in the LIA group than the FNB group indicates that the analgesic effect of LIA was greater than that of singleshot FNB after TKA. There were no serious complications in either group. The postoperative analgesic effect of LIA was smaller in patients with severe than less severe preoperative flexion contracture.
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Affiliation(s)
- Shuji Nakagawa
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuji Arai
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroaki Inoue
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroyuki Kan
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Manabu Hino
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shohei Ichimaru
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuya Ikoma
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroyoshi Fujiwara
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Fumimasa Amaya
- Department of Anesthesiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Teiji Sawa
- Department of Anesthesiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toshikazu Kubo
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Abstract
Because of its subjective nature, the assessment of pain requires the use of comprehensive practices that accurately reflect a patient’s experiences of pain. The purpose of this study was to determine how nurses make decisions in their assessment of patients’ pain in the postoperative clinical setting. An observational design was chosen as the means of examining pain activities in two surgical units of a metropolitan teaching hospital in Melbourne, Australia. Six fixed observation times were selected. Each 2-hour observation period was examined 12 times thus resulting in 74 observations. In total, 316 pain activities were determined. Five themes relating to assessment were identified from the data analysis: simple questioning, use of a pain scale, complex assessment, the lack of pain assessment, and physical examination for pain. The study identified how nurses’ prioritization of work demands created barriers in conducting timely and comprehensive pain assessment decisions.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Attitude of Health Personnel
- Communication
- Decision Making
- Female
- Health Knowledge, Attitudes, Practice
- Hospitals, Teaching
- Hospitals, Urban
- Humans
- Kinesics
- Male
- Middle Aged
- Nurse-Patient Relations
- Nursing Assessment/methods
- Nursing Evaluation Research
- Nursing Staff, Hospital/education
- Nursing Staff, Hospital/psychology
- Pain Measurement/methods
- Pain Measurement/nursing
- Pain, Postoperative/diagnosis
- Pain, Postoperative/nursing
- Pain, Postoperative/psychology
- Perioperative Nursing/education
- Perioperative Nursing/methods
- Physical Examination/methods
- Physical Examination/nursing
- Surveys and Questionnaires
- Victoria
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Pombo N, Garcia N, Bousson K, Spinsante S, Chorbev I. Pain Assessment--Can it be Done with a Computerised System? A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:415. [PMID: 27089351 PMCID: PMC4847077 DOI: 10.3390/ijerph13040415] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 03/29/2016] [Accepted: 04/07/2016] [Indexed: 01/17/2023]
Abstract
Background: Mobile and web technologies are becoming increasingly used to support the treatment of chronic pain conditions. However, the subjectivity of pain perception makes its management and evaluation very difficult. Pain treatment requires a multi-dimensional approach (e.g., sensory, affective, cognitive) whence the evidence of technology effects across dimensions is lacking. This study aims to describe computerised monitoring systems and to suggest a methodology, based on statistical analysis, to evaluate their effects on pain assessment. Methods: We conducted a review of the English-language literature about computerised systems related to chronic pain complaints that included data collected via mobile devices or Internet, published since 2000 in three relevant bibliographical databases such as BioMed Central, PubMed Central and ScienceDirect. The extracted data include: objective and duration of the study, age and condition of the participants, and type of collected information (e.g., questionnaires, scales). Results: Sixty-two studies were included, encompassing 13,338 participants. A total of 50 (81%) studies related to mobile systems, and 12 (19%) related to web-based systems. Technology and pen-and-paper approaches presented equivalent outcomes related with pain intensity. Conclusions: The adoption of technology was revealed as accurate and feasible as pen-and-paper methods. The proposed assessment model based on data fusion combined with a qualitative assessment method was revealed to be suitable. Data integration raises several concerns and challenges to the design, development and application of monitoring systems applied to pain.
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Affiliation(s)
- Nuno Pombo
- Instituto de Telecomunicações (Telecommunications Institute), University of Beira Interior, Covilhã 6200-001, Portugal.
- Department of Informatics, University of Beira Interior, Covilhã 6200-001, Portugal.
- ALLab-Assisted Living Computing and Telecommunications Laboratory, University of Beira Interior, Covilhã 6200-001, Portugal.
| | - Nuno Garcia
- Instituto de Telecomunicações (Telecommunications Institute), University of Beira Interior, Covilhã 6200-001, Portugal.
- Department of Informatics, University of Beira Interior, Covilhã 6200-001, Portugal.
- ALLab-Assisted Living Computing and Telecommunications Laboratory, University of Beira Interior, Covilhã 6200-001, Portugal.
| | - Kouamana Bousson
- Department of Aerospace Sciences, University of Beira Interior, Covilhã 6200-001, Portugal.
| | - Susanna Spinsante
- Dipartimento di Ingegneria dell'Informazione, Università Politecnica delle Marche, Ancona 60121, Italy.
| | - Ivan Chorbev
- Faculty of Computer Science and Engineering, Ss. Cyril and Methodius University Skopje, Skopje 1000, Macedonia.
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Persson AKM, Pettersson FD, Dyrehag LE, Åkeson J. Prediction of postoperative pain from assessment of pain induced by venous cannulation and propofol infusion. Acta Anaesthesiol Scand 2016; 60:166-76. [PMID: 26373922 DOI: 10.1111/aas.12634] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 08/17/2015] [Accepted: 08/21/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND Postoperative pain may lead to delayed mobilization, persisting pain, and psychosocial distress. There are no simple and reliable techniques for prediction of postoperative pain. This study was designed to evaluate if pain induced by venous cannulation or propofol injection can be used to predict postoperative pain. METHODS This prospective study included 180 patients scheduled for laparoscopic cholecystectomy. Pain intensity associated with peripheral venous cannulation and administration of propofol preoperatively and pain intensity, and use of opioid postoperatively was recorded. RESULTS Patients scoring cannulation-induced pain intensity > 2.0 VAS units were given postoperative opioid more often (65% vs. 36%; P < 0.001), earlier (12 min vs. 90 min; P < 0.001), and in higher doses (4.8 mg vs. 0 mg; P < 0.001), and also reported higher levels of postoperative pain intensity (5.8 vs. 2.9 VAS units; P < 0.001). There were also significant (P < 0.01) correlations with postoperative pain intensity (rs = 0.24), time to opioid administration (rs = -0.26), and total dose of opioid (rs = 0.25). Propofol-induced pain intensity correlated significantly (P < 0.05) with postoperative pain intensity (rs = 0.19). CONCLUSION Pain intensity associated with venous cannulation and propofol infusion can easily be evaluated at bedside before surgery without specific equipment or training. Patients scoring > 2.0 VAS units on venous cannulation were found to have 3.4 times higher risk of postoperative pain after laparoscopic cholecystectomy. Low pain intensity associated with venous cannulation and propofol infusion indicate lower risk of postoperative pain.
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Affiliation(s)
- A K M Persson
- Department of Clinical Sciences Malmö, Anesthesiology and Intensive Care Medicine, Lund University, Skåne University Hospital, Malmö, Sweden
- Department of Anesthesiology and Intensive Care Medicine, Hallands Sjukhus Halmstad, Halmstad, Sweden
| | - F D Pettersson
- Karolinska Institute, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Stockholm, Sweden
| | - L-E Dyrehag
- Department of Anesthesiology and Intensive Care Medicine, Hallands Sjukhus Halmstad, Halmstad, Sweden
| | - J Åkeson
- Department of Clinical Sciences Malmö, Anesthesiology and Intensive Care Medicine, Lund University, Skåne University Hospital, Malmö, Sweden
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Palmer JB, Lane D, Mayo D, Schluchter M, Leeming R. Effects of Music Therapy on Anesthesia Requirements and Anxiety in Women Undergoing Ambulatory Breast Surgery for Cancer Diagnosis and Treatment: A Randomized Controlled Trial. J Clin Oncol 2015; 33:3162-8. [PMID: 26282640 PMCID: PMC4979095 DOI: 10.1200/jco.2014.59.6049] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE To investigate the effect of live and recorded perioperative music therapy on anesthesia requirements, anxiety levels, recovery time, and patient satisfaction in women experiencing surgery for diagnosis or treatment of breast cancer. PATIENTS AND METHODS Between 2012 and 2014, 207 female patients undergoing surgery for potential or known breast cancer were randomly assigned to receive either patient-selected live music (LM) preoperatively with therapist-selected recorded music intraoperatively (n=69), patient-selected recorded music (RM) preoperatively with therapist-selected recorded music intraoperatively (n=70), or usual care (UC) preoperatively with noise-blocking earmuffs intraoperatively (n=68). RESULTS The LM and the RM groups did not differ significantly from the UC group in the amount of propofol required to reach moderate sedation. Compared with the UC group, both the LM and the RM groups had greater reductions (P<.001) in anxiety scores preoperatively (mean changes [and standard deviation: -30.9 [36.3], -26.8 [29.3], and 0.0 [22.7]), respectively. The LM and RM groups did not differ from the UC group with respect to recovery time; however, the LM group had a shorter recovery time compared with the RM group (a difference of 12.4 minutes; 95% CI, 2.2 to 22.5; P=.018). Satisfaction scores for the LM and RM groups did not differ from those of the UC group. CONCLUSION Including music therapy as a complementary modality with cancer surgery may help manage preoperative anxiety in a way that is safe, effective, time-efficient, and enjoyable.
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Affiliation(s)
- Jaclyn Bradley Palmer
- Jaclyn Bradley Palmer, Deforia Lane, and Diane Mayo, University Hospitals Case Medical Center; Mark Schluchter, Case Western Reserve University, Cleveland, OH; and Rosemary Leeming, Geisinger Health System, Danville, PA.
| | - Deforia Lane
- Jaclyn Bradley Palmer, Deforia Lane, and Diane Mayo, University Hospitals Case Medical Center; Mark Schluchter, Case Western Reserve University, Cleveland, OH; and Rosemary Leeming, Geisinger Health System, Danville, PA
| | - Diane Mayo
- Jaclyn Bradley Palmer, Deforia Lane, and Diane Mayo, University Hospitals Case Medical Center; Mark Schluchter, Case Western Reserve University, Cleveland, OH; and Rosemary Leeming, Geisinger Health System, Danville, PA
| | - Mark Schluchter
- Jaclyn Bradley Palmer, Deforia Lane, and Diane Mayo, University Hospitals Case Medical Center; Mark Schluchter, Case Western Reserve University, Cleveland, OH; and Rosemary Leeming, Geisinger Health System, Danville, PA
| | - Rosemary Leeming
- Jaclyn Bradley Palmer, Deforia Lane, and Diane Mayo, University Hospitals Case Medical Center; Mark Schluchter, Case Western Reserve University, Cleveland, OH; and Rosemary Leeming, Geisinger Health System, Danville, PA
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Ladha KS, Wanderer JP, Nanji KC. Age as a predictor of rescue opioid administration immediately after the emergence of general anesthesia. J Clin Anesth 2015; 27:537-42. [PMID: 26342632 DOI: 10.1016/j.jclinane.2015.07.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 07/22/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND OBJECTIVES While previous studies have shown that elderly patients require lower dosages of opioids, the literature suggests that pain is undertreated in the geriatric population, which may lead to postoperative pain and high rescue analgesia requirements. The purpose of this study is to determine whether elderly patients undergoing hip and knee arthroplasty require higher levels of postoperative rescue opioids than their younger counterparts early after emergence from anesthesia. METHODS Using a nonconcurrent retrospective cohort study design, patients who underwent hip or knee arthroplasty under general anesthesia at a tertiary academic hospital from 2007 to 2012 were identified. Demographic information and data regarding patients' anesthetic care were obtained from the institution's anesthesia information management system. To assess the presence of pain after the emergence of anesthesia, we used, as a proxy, opioid administration by the anesthesia provider after leaving the operating room and before the end of anesthesia care. RESULTS A total of 2731 patients met inclusion criteria, of which 487 (17.8%) received rescue opioids. Patients older than 80 years were less likely to receive opioids after leaving the operating room (odds ratio, 0.57; 95% confidence interval, 0.37-0.88; P = .01) and received 1.37 mg less of hydromorphone equivalent opioid compared to patients younger than the age of 50 years (95% confidence interval, 1.18-1.55; P < .001). The proportion of patients who received rescue opioids varied significantly between anesthesia providers from 0% to 38% (P < .001). CONCLUSIONS While elderly patients received lower doses of opioids intraoperatively, they were less likely to require rescue analgesia. The variability among providers in rescue opioid administration after emergence presents an opportunity for further research.
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Affiliation(s)
- Karim S Ladha
- Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA.
| | - Jonathan P Wanderer
- Departments of Anesthesiology and Biomedical Informatics, Vanderbilt University, Nashville, TN
| | - Karen C Nanji
- Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston MA
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Bedeutung präoperativer Angst für den postoperativen Verlauf bei urologischen Patienten. Schmerz 2015; 30:166-73. [DOI: 10.1007/s00482-015-0023-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Jules-Elysee KM, Goon AK, Westrich GH, Padgett DE, Mayman DJ, Ranawat AS, Ranawat CS, Lin Y, Kahn RL, Bhagat DD, Goytizolo EA, Ma Y, Reid SC, Curren J, YaDeau JT. Patient-controlled epidural analgesia or multimodal pain regimen with periarticular injection after total hip arthroplasty: a randomized, double-blind, placebo-controlled study. J Bone Joint Surg Am 2015; 97:789-98. [PMID: 25995489 PMCID: PMC4430099 DOI: 10.2106/jbjs.n.00698] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The optimal postoperative analgesia after primary total hip arthroplasty remains in question. This randomized, double-blind, placebo-controlled study compared the use of patient-controlled epidural analgesia (PCEA) with use of a multimodal pain regimen including periarticular injection (PAI). We hypothesized that PAI would lead to earlier readiness for discharge, decreased opioid consumption, and lower pain scores. METHODS Forty-one patients received PAI, and forty-three patients received PCEA. Preoperatively, both groups were administered dexamethasone (6 mg, orally). The PAI group received a clonidine patch and sustained-release oxycodone (10 mg), while the PCEA group had placebo. Both groups received combined spinal-epidural anesthesia and used an epidural pain pump postoperatively; the PAI group had normal saline solution, while the PCEA group had bupivacaine and hydromorphone. The primary outcome, readiness for discharge, required the discontinuation of the epidural, a pain score of <4 (numeric rating scale) without parenteral narcotics, normal eating, minimal nausea, urination without a catheter, a dry surgical wound, no acute medical problems, and the ability to independently transfer and walk 12.2 m (40 ft). RESULTS The mean time to readiness for discharge (and standard deviation) was 2.4 ± 0.7 days (PAI) compared with 2.3 ± 0.8 days (PCEA) (p = 0.86). The mean length of stay was 3.0 ± 0.8 days (PAI) compared with 3.1 ± 0.7 days (PCEA) (p = 0.46). A significant mean difference in pain score of 0.74 with ambulation (p = 0.01; 95% confidence interval [CI], 0.18 to 1.31) and 0.80 during physical therapy (p = 0.03; 95% CI, 0.09 to 1.51) favored the PCEA group. The mean opioid consumption (oral morphine equivalents in milligrams) was significantly higher in the PAI group on postoperative day 0 (43 ± 21 compared with 28 ± 23; p = 0.002) and postoperative days 0 through 2 (136 ± 59 compared with 90 ± 79; p = 0.004). Opioid-Related Symptom Distress Scale (ORSDS) composite scores for severity and bothersomeness as well as scores for nausea, vomiting, and itchiness were significantly higher in the PCEA group (p < 0.05). Quality of Recovery-40 scores and patient satisfaction were similar. CONCLUSIONS PAI did not decrease the time to discharge and was associated with higher pain scores and greater opioid consumption but lower ORSDS scores compared with PCEA. The choice for analgesic regimen may depend on a particular patient's threshold for pain and the potential side effects.
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Affiliation(s)
- Kethy M Jules-Elysee
- Departments of Anesthesiology (K.M.J.-E., A.K.G., Y.L., R.L.K., D.D.B., E.A.G., S.C.R., J.C., J.T.Y.) and Orthopedic Surgery (G.H.W., D.E.P., D.J.M., A.S.R., C.S.R.), Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for K.M. Jules-Elysee:
| | - Amanda K Goon
- Departments of Anesthesiology (K.M.J.-E., A.K.G., Y.L., R.L.K., D.D.B., E.A.G., S.C.R., J.C., J.T.Y.) and Orthopedic Surgery (G.H.W., D.E.P., D.J.M., A.S.R., C.S.R.), Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for K.M. Jules-Elysee:
| | - Geoffrey H Westrich
- Departments of Anesthesiology (K.M.J.-E., A.K.G., Y.L., R.L.K., D.D.B., E.A.G., S.C.R., J.C., J.T.Y.) and Orthopedic Surgery (G.H.W., D.E.P., D.J.M., A.S.R., C.S.R.), Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for K.M. Jules-Elysee:
| | - Douglas E Padgett
- Departments of Anesthesiology (K.M.J.-E., A.K.G., Y.L., R.L.K., D.D.B., E.A.G., S.C.R., J.C., J.T.Y.) and Orthopedic Surgery (G.H.W., D.E.P., D.J.M., A.S.R., C.S.R.), Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for K.M. Jules-Elysee:
| | - David J Mayman
- Departments of Anesthesiology (K.M.J.-E., A.K.G., Y.L., R.L.K., D.D.B., E.A.G., S.C.R., J.C., J.T.Y.) and Orthopedic Surgery (G.H.W., D.E.P., D.J.M., A.S.R., C.S.R.), Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for K.M. Jules-Elysee:
| | - Amar S Ranawat
- Departments of Anesthesiology (K.M.J.-E., A.K.G., Y.L., R.L.K., D.D.B., E.A.G., S.C.R., J.C., J.T.Y.) and Orthopedic Surgery (G.H.W., D.E.P., D.J.M., A.S.R., C.S.R.), Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for K.M. Jules-Elysee:
| | - Chitranjan S Ranawat
- Departments of Anesthesiology (K.M.J.-E., A.K.G., Y.L., R.L.K., D.D.B., E.A.G., S.C.R., J.C., J.T.Y.) and Orthopedic Surgery (G.H.W., D.E.P., D.J.M., A.S.R., C.S.R.), Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for K.M. Jules-Elysee:
| | - Yi Lin
- Departments of Anesthesiology (K.M.J.-E., A.K.G., Y.L., R.L.K., D.D.B., E.A.G., S.C.R., J.C., J.T.Y.) and Orthopedic Surgery (G.H.W., D.E.P., D.J.M., A.S.R., C.S.R.), Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for K.M. Jules-Elysee:
| | - Richard L Kahn
- Departments of Anesthesiology (K.M.J.-E., A.K.G., Y.L., R.L.K., D.D.B., E.A.G., S.C.R., J.C., J.T.Y.) and Orthopedic Surgery (G.H.W., D.E.P., D.J.M., A.S.R., C.S.R.), Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for K.M. Jules-Elysee:
| | - Devan D Bhagat
- Departments of Anesthesiology (K.M.J.-E., A.K.G., Y.L., R.L.K., D.D.B., E.A.G., S.C.R., J.C., J.T.Y.) and Orthopedic Surgery (G.H.W., D.E.P., D.J.M., A.S.R., C.S.R.), Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for K.M. Jules-Elysee:
| | - Enrique A Goytizolo
- Departments of Anesthesiology (K.M.J.-E., A.K.G., Y.L., R.L.K., D.D.B., E.A.G., S.C.R., J.C., J.T.Y.) and Orthopedic Surgery (G.H.W., D.E.P., D.J.M., A.S.R., C.S.R.), Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for K.M. Jules-Elysee:
| | - Yan Ma
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue, 5th Floor, Washington, DC 20052. E-mail address:
| | - Shane C Reid
- Departments of Anesthesiology (K.M.J.-E., A.K.G., Y.L., R.L.K., D.D.B., E.A.G., S.C.R., J.C., J.T.Y.) and Orthopedic Surgery (G.H.W., D.E.P., D.J.M., A.S.R., C.S.R.), Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for K.M. Jules-Elysee:
| | - Jodie Curren
- Departments of Anesthesiology (K.M.J.-E., A.K.G., Y.L., R.L.K., D.D.B., E.A.G., S.C.R., J.C., J.T.Y.) and Orthopedic Surgery (G.H.W., D.E.P., D.J.M., A.S.R., C.S.R.), Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for K.M. Jules-Elysee:
| | - Jacques T YaDeau
- Departments of Anesthesiology (K.M.J.-E., A.K.G., Y.L., R.L.K., D.D.B., E.A.G., S.C.R., J.C., J.T.Y.) and Orthopedic Surgery (G.H.W., D.E.P., D.J.M., A.S.R., C.S.R.), Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for K.M. Jules-Elysee:
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Ezenwa MO, Molokie RE, Wang ZJ, Suarez ML, Yao Y, Wilkie DJ. Satisfied or not satisfied: pain experiences of patients with sickle cell disease. J Adv Nurs 2015; 72:1398-408. [PMID: 25916256 DOI: 10.1111/jan.12678] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2015] [Indexed: 11/28/2022]
Abstract
AIMS To examine the relationship between pain and satisfaction in patients with sickle cell disease. BACKGROUND Frequency and severity of unrelieved sickle cell pain are positively associated with mortality. Yet, information is scarce on whether sickle cell patients are satisfied with their pain level. DESIGN A cross-sectional, correlational analysis of baseline data from a randomized clinical trial. METHODS A randomized sample of adult outpatients was recruited between February 2007-March 2011. Patients completed the PAINReportIt(®) , containing measures of pain, satisfaction and socio-demographics. We analysed data using Kendall's rank correlations, analysis of variance, Tukey-Kramer post hoc tests, Fisher's tests and proportional odds logistic regression. RESULTS There were statistically significant correlations between pain outcomes and satisfaction with pain level, but average pain intensity more strongly discriminated groups based on satisfaction with pain level. Among pain variables bivariately associated with patient satisfaction with pain level, only pain expectation maintained its significant relationship with satisfaction with pain level when average pain intensity was controlled. A smaller percentage of our sickle cell patients reported moderate to severe pain intensity (28%) or high composite pain index (39%), while reporting being satisfied with pain their level than reported in earlier studies using different measures and populations (70-94%). CONCLUSION Satisfaction with pain level was an unambiguous measure of patient satisfaction and a promising indicator of pain that did not show the paradoxical relationship between satisfaction and pain seen with past measures.
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Affiliation(s)
- Miriam O Ezenwa
- Department of Biobehavioral Health Science, University of Illinois at Chicago, College of Nursing, Illinois, USA
| | - Robert E Molokie
- College of Medicine, University of Illinois at Chicago, Illinois, USA
| | - Zaijie Jim Wang
- Department of Biopharmaceutical Sciences, University of Illinois at Chicago, Illinois, USA
| | - Marie L Suarez
- Department of Biobehavioral Health Science, University of Illinois at Chicago, College of Nursing, Illinois, USA
| | - Yingwei Yao
- Department of Biobehavioral Health Science, University of Illinois at Chicago, College of Nursing, Illinois, USA
| | - Diana J Wilkie
- Department of Biobehavioral Health Science, University of Illinois at Chicago, College of Nursing, Illinois, USA.,Center for End-of-Life Transition Research, Department of Biobehavioral Health Science, University of Illinois at Chicago, College of Nursing, Illinois, USA
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