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Zhao Y, Guo Y, Pan X, Zhang X, Yu F, Cao X. The Impact of Different Regional Anesthesia Techniques on the Incidence of Chronic Post-surgical Pain in Patients Undergoing Video-Assisted Thoracoscopic Surgery: A Network Meta-analysis. Pain Ther 2024:10.1007/s40122-024-00648-9. [PMID: 39240480 DOI: 10.1007/s40122-024-00648-9] [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: 07/20/2024] [Accepted: 08/16/2024] [Indexed: 09/07/2024] Open
Abstract
INTRODUCTION Chronic post-surgical pain (CPSP) remains a prevalent issue following video-assisted thoracic surgery (VATS), despite advancements in surgical techniques. Various regional anesthesia techniques, including thoracic paravertebral block (PVB), intercostal nerve block (ICNB), serratus anterior plane block (SAPB), erector spinae plane block (ESPB), and thoracic epidural anesthesia (TEA), have been employed in VATS procedures to mitigate this issue. This study aims to compare the efficacy of these analgesia methods in reducing the incidence of CPSP in VATS patients through a network meta-analysis. METHODS A systematic search was conducted in PubMed, the Cochrane Library, and EMBASE for randomized controlled trials (RCTs) comparing the incidence of CPSP associated with PVB, ICNB, SAPB, ESPB, and TEA. The occurrence of CPSP was evaluated at both 2-3 months and 6 months post-surgery. RESULTS Six RCTs, involving 652 patients, were included in the analysis of CPSP incidence at 2-3 months, while seven RCTs, involving 715 patients, were included for 6 months analysis. PVB, ICNB, or TEA reduced CPSP incidence compared with control group (without regional anesthesia techniques) at both 2-3 months and 6 months post-surgery. However, SAPB was found less effective in reducing CPSP incidence at 2-3 months post-VATS compared to PVB, ICNB, or TEA. CONCLUSIONS PVB, ICNB, and TEA exhibit significant effects on reducing CPSP incidence following VATS. Conversely, SAPB is not recommended for reducing CPSP incidence post-VATS. Nonetheless, considering the limitation of a small sample size in this network meta-analysis, additional RCTs are necessary to validate these conclusions and enhance the management of CPSP after VATS.
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Affiliation(s)
- Yue Zhao
- Department of Anesthesiology, The First Hospital of China Medical University, Shenyang, 110001, China
| | - Yaming Guo
- Department of General Surgery, Hepatobiliary and Splenic Surgery Ward, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xue Pan
- Department of Anesthesiology, The First Hospital of China Medical University, Shenyang, 110001, China
| | - Xinyue Zhang
- Department of Anesthesiology, The First Hospital of China Medical University, Shenyang, 110001, China
| | - Fang Yu
- Department of Anesthesiology, The First Hospital of China Medical University, Shenyang, 110001, China
| | - Xuezhao Cao
- Department of Anesthesiology, The First Hospital of China Medical University, Shenyang, 110001, China.
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Alaverdyan H, Maeng J, Park PK, Reddy KN, Gaume MP, Yaeger L, Awad MM, Haroutounian S. Perioperative Risk Factors for Persistent Postsurgical Pain After Inguinal Hernia Repair: Systematic Review and Meta-Analysis. THE JOURNAL OF PAIN 2024; 25:104532. [PMID: 38599265 DOI: 10.1016/j.jpain.2024.104532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 04/04/2024] [Accepted: 04/04/2024] [Indexed: 04/12/2024]
Abstract
Persistent postsurgical pain (PPSP) is one of the most bothersome and disabling long-term complications after inguinal hernia repair surgery. Understanding perioperative risk factors that contribute to PPSP can help identify high-risk patients and develop risk-mitigation approaches. The objective of this study was to systematically review and meta-analyze risk factors that contribute to PPSP after inguinal hernia repair. The literature search resulted in 303 papers included in this review, 140 of which were used for meta-analyses. Our results suggest that younger age, female sex, preoperative pain, recurrent hernia, postoperative complications, and postoperative pain are associated with a higher risk of PPSP. Laparoscopic techniques reduce the PPSP occurrence compared to anterior techniques such as Lichtenstein repair, and tissue-suture techniques such as Shouldice repair. The use of fibrin glue for mesh fixation was consistently associated with lower PPSP rates compared to tacks, staples, and sutures. Considerable variability was observed with PPSP assessment and reporting methodology in terms of study design, follow-up timing, clarity of pain definition, as well as pain intensity or interference threshold. High or moderate risk of bias in at least one domain was noted in >75% of studies. These may limit the generalizability of our results. Future studies should assess and report comprehensive preoperative and perioperative risk factors for PPSP adjusted for confounding factors, and develop risk-prediction models to drive stratified PPSP-mitigation trials and personalized clinical decision-making. PERSPECTIVE: This systematic review and meta-analysis summarizes the current evidence on risk factors for persistent pain after inguinal hernia repair. The findings can help identify patients at risk and test personalized risk-mitigation approaches to prevent pain. PROSPERO REGISTRATION: htttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=154663.
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Affiliation(s)
- Harutyun Alaverdyan
- Department of Anesthesiology, Washington University in St Louis School of Medicine, St. Louis, Missouri
| | - Jooyoung Maeng
- Department of Anesthesiology, Washington University in St Louis School of Medicine, St. Louis, Missouri
| | - Peter K Park
- Department of Orthopaedic Surgery, Washington University in St Louis School of Medicine, St. Louis, Missouri
| | - Kavya Narayana Reddy
- Department of Anesthesiology and Pain Management, Arkansas Children Hospital, University of Arkansas Medical Science, Little Rock, Arkansas
| | - Michael P Gaume
- Department of Pain Management, University of Kansas Health System-St Francis Hospital, Topeka, Kansas
| | - Lauren Yaeger
- Bernard Becker Medical Library, Washington University in St Louis School of Medicine, St. Louis, Missouri
| | - Michael M Awad
- Department of Surgery, Washington University in St Louis School of Medicine, St. Louis, Missouri
| | - Simon Haroutounian
- Department of Anesthesiology, Washington University in St Louis School of Medicine, St. Louis, Missouri
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Görges M, Sujan J, West NC, Sreepada RS, Wood MD, Payne BA, Shetty S, Gelinas JP, Sutherland AM. Postsurgical Pain Risk Stratification to Enhance Pain Management Workflow in Adult Patients: Design, Implementation, and Pilot Evaluation. JMIR Perioper Med 2024; 7:e54926. [PMID: 38954808 PMCID: PMC11252618 DOI: 10.2196/54926] [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: 11/28/2023] [Revised: 03/15/2024] [Accepted: 05/13/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Exposure to opioids after surgery is the initial contact for some people who develop chronic opioid use disorder. Hence, effective postoperative pain management, with less reliance on opioids, is critical. The Perioperative Opioid Quality Improvement (POQI) program developed (1) a digital health platform leveraging patient-survey-reported risk factors and (2) a postsurgical pain risk stratification algorithm to personalize perioperative care by integrating several commercially available digital health solutions into a combined platform. Development was reduced in scope by the COVID-19 pandemic. OBJECTIVE This pilot study aims to assess the screening performance of the risk algorithm, quantify the use of the POQI platform, and evaluate clinicians' and patients' perceptions of its utility and benefit. METHODS A POQI platform prototype was implemented in a quality improvement initiative at a Canadian tertiary care center and evaluated from January to September 2022. After surgical booking, a preliminary risk stratification algorithm was applied to health history questionnaire responses. The estimated risk guided the patient assignment to a care pathway based on low or high risk for persistent pain and opioid use. Demographic, procedural, and medication administration data were extracted retrospectively from the electronic medical record. Postoperative inpatient opioid use of >90 morphine milligram equivalents per day was the outcome used to assess algorithm performance. Data were summarized and compared between the low- and high-risk groups. POQI use was assessed by completed surveys on postoperative days 7, 14, 30, 60, 90, and 120. Semistructured patient and clinician interviews provided qualitative feedback on the platform. RESULTS Overall, 276 eligible patients were admitted for colorectal procedures. The risk algorithm stratified 203 (73.6%) as the low-risk group and 73 (26.4%) as the high-risk group. Among the 214 (77.5%) patients with available data, high-risk patients were younger than low-risk patients (age: median 53, IQR 40-65 years, vs median 59, IQR 49-69 years, median difference five years, 95% CI 1-9; P=.02) and were more often female patients (45/73, 62% vs 80/203, 39.4%; odds ratio 2.5, 95% CI 1.4-4.5; P=.002). The risk stratification was reasonably specific (true negative rate=144/200, 72%) but not sensitive (true positive rate=10/31, 32%). Only 39.7% (85/214) patients completed any postoperative quality of recovery questionnaires (only 14, 6.5% patients beyond 60 days after surgery), and 22.9% (49/214) completed a postdischarge medication survey. Interviewed participants welcomed the initiative but noted usability issues and poor platform education. CONCLUSIONS An initial POQI platform prototype was deployed operationally; the risk algorithm had reasonable specificity but poor sensitivity. There was a significant loss to follow-up in postdischarge survey completion. Clinicians and patients appreciated the potential impact of preemptively addressing opioid exposure but expressed shortcomings in the platform's design and implementation. Iterative platform redesign with additional features and reevaluation are required before broader implementation.
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Affiliation(s)
- Matthias Görges
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada
| | - Jonath Sujan
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada
| | - Nicholas C West
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada
| | - Rama Syamala Sreepada
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada
| | - Michael D Wood
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada
| | - Beth A Payne
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
| | - Swati Shetty
- MD Undergraduate Program, The University of British Columbia, Vancouver, BC, Canada
| | - Jean P Gelinas
- Department of Anesthesiology & Pain Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Anesthesiology, Surrey Memorial Hospital, Surrey, BC, Canada
| | - Ainsley M Sutherland
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada
- Department of Anesthesiology, St. Paul's Hospital, Vancouver, BC, Canada
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Chidiac C, Wharton K, Garcia AV, Rhee DS. Cryoablation Reduces Opioid Consumption and Length of Stay After Pulmonary Metastasectomy. J Surg Res 2024; 296:704-710. [PMID: 38364698 DOI: 10.1016/j.jss.2024.01.044] [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: 11/03/2023] [Revised: 01/12/2024] [Accepted: 01/19/2024] [Indexed: 02/18/2024]
Abstract
INTRODUCTION Intraoperative cryoablation of intercostal thoracic nerves is gaining popularity as a technique that decreases postoperative pain in thoracic surgery. Our study evaluates the efficacy and safety of cryoablation in pain management of pediatric cancer patients undergoing thoracotomy. METHODS We reviewed cancer patients undergoing thoracotomies for pulmonary metastasis resection at our children's hospital from 2017 to 2023. Patients who received cryoablation were compared to those who did not. Our primary outcomes were self-reported postoperative pain scores (from 0 to 10) and opioid consumption, measured as oral morphine equivalent per kilogram. RESULTS Thirty eight procedures were performed in 17 patients, of which 11 (64.7%) were males. Cryoablation was used in 14 (32.4%) procedures, while it was not in 24 (67.6%). Median age (17 y in both groups, P = 0.84) and length of surgery (300 cryoablation versus 282 no cryoablation, P = 0.65) were similar between the groups. Patients treated with cryoablation had a shorter hospital stay compared to those who did not (3.0 versus 4.5 d, respectively, P = 0.04) and received a lower total dose of opioids (2.2 oral morphine equivalent per kilogram versus 14.4, P = 0.004). No significant difference was noted in daily pain scores between the two groups (3.8 cryoablation versus 3.9 no cryoablation, P = 0.93). There was no difference in rates of readmissions between the cryoablation and no-cryoablation groups (14.3% versus 8.3%, P = 0.55). CONCLUSIONS Our study suggests that cryoablation of the thoracic nerves during a thoracotomy is associated with reduced opiate consumption and shorter hospital stay. Cryoablation appears to be a promising technique for pain management in this patient population.
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Affiliation(s)
- Charbel Chidiac
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kristin Wharton
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alejandro V Garcia
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel S Rhee
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Ferreira do Couto ML, Fonseca S, Pozza DH. Pharmacogenetic Approaches in Personalized Medicine for Postoperative Pain Management. Biomedicines 2024; 12:729. [PMID: 38672085 PMCID: PMC11048650 DOI: 10.3390/biomedicines12040729] [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: 01/31/2024] [Revised: 03/08/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024] Open
Abstract
Despite technical and pharmacological advancements in recent years, including optimized therapies and personalized medicine, postoperative pain management remains challenging and sometimes undertreated. This review aims to summarize and update how genotype-guided therapeutics within personalized medicine can enhance postoperative pain management. Several studies in the area have demonstrated that genotype-guided therapy has the ability to lower opioid consumption and improve postoperative pain. Gene mutations, primarily OPRM1, CYP2D6, CYP2C9, COMT and ABCB1, have been shown to exert nuanced influences on analgesic response and related pharmacological outcomes. This review underscores the integration of pharmacogenetic-guided personalized medicine into perioperative care, particularly when there is uncertainty regarding opioid prescriptions. This approach leads to superior outcomes in terms of postoperative pain relief and reduced morbidity for numerous patients.
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Affiliation(s)
- Maria Leonor Ferreira do Couto
- Experimental Biology Unit, Department of Biomedicine, Faculty of Medicine of Porto, University of Porto, 4200-319 Porto, Portugal;
| | - Sara Fonseca
- Anesthesiology Department, São João University Hospital Centre, 4200-135 Porto, Portugal;
| | - Daniel Humberto Pozza
- Experimental Biology Unit, Department of Biomedicine, Faculty of Medicine of Porto, University of Porto, 4200-319 Porto, Portugal;
- Institute for Research and Innovation in Health and IBMC (i3S), University of Porto, 4200-135 Porto, Portugal
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6
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Rosendahl A, Thomsen T, Brandstrup B, Møller AM. Chronic post-surgical pain following gastrointestinal surgery: Protocol for a scoping review. Acta Anaesthesiol Scand 2024; 68:430-433. [PMID: 38096810 DOI: 10.1111/aas.14364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 11/28/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND Chronic post-surgical pain (CPSP) significantly impacts people's lives, affecting both socioeconomic aspects as well as their rehabilitation after surgery. Yet, CPSP remains an under-researched field. The prevalence varies depending on type of surgery, which highlights the importance of surgery-specific research. This scoping review aims to investigate CPSP following gastrointestinal surgery in order to map out incidences, risk factors, and impact on quality of life (QoL) as well as identify gaps in research. METHODS The planned review will follow the Preferred Reporting Items for Systematic review and Meta-Analyses (PRISMA) for Scoping Review guidelines. A search strategy will be carried out in major peer-reviewed databases and grey literature will be sought and identified. We will include original studies assessing CPSP after gastrointestinal surgery, with the exception of hernia surgery. We will chart data regarding trial characteristics, patient demographic, surgical diagnosis, risk factors, follow-up times, pain definitions and evaluations as well as impact on QoL. RESULTS We will present the included studies with a narrative summary, supplemented with descriptive statistics of the quantitative data if appropriate. CONCLUSION The planned scoping review will map out the current evidence about CPSP in adults following gastrointestinal surgery. We will identify gaps in research that can support the development of further research into CPSP after gastrointestinal surgery.
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Affiliation(s)
- Amalie Rosendahl
- Department of Anaesthesiology, Herlev and Gentofte Hospital, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Thordis Thomsen
- Department of Anaesthesiology, Herlev and Gentofte Hospital, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Birgitte Brandstrup
- Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
- Department of Surgery, Holbaek Hospital, Holbaek, Denmark
| | - Ann M Møller
- Department of Anaesthesiology, Herlev and Gentofte Hospital, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
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Ranc PA, Rudel A, Bentellis I, Prestat A, Elbaze S, Sala V, Torre F, Pavan LJ, Uri IF, Amoretti N. Patient-Reported Outcomes and Return to Work after CT-Guided Percutaneous Lumbar Discectomy: A Prospective Study. J Vasc Interv Radiol 2024; 35:390-397. [PMID: 38110149 DOI: 10.1016/j.jvir.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/27/2023] [Accepted: 12/08/2023] [Indexed: 12/20/2023] Open
Abstract
PURPOSE To evaluate the effectiveness of percutaneous lumbar discectomy (PLD) under computed tomography (CT) guidance on pain and functional capacities and to estimate the speed of recovery by assessing the time to return to work. MATERIALS AND METHODS Patients treated with PLD were prospectively included between December 2019 and April 2021. Data regarding pain, duration of symptoms, analgesia intakes, time of absence from work, and the Oswestry disability index (ODI) were collected. Patients were followed-up during 6 months. Duration of hospitalization and time to return to work were reported. The Fisher test was used to compare nominal variables, the Kruskal-Wallis test to compare ordinal variables, and the Student t test to compare quantitative continuous variables. RESULTS A total of 87 patients were evaluated (median age, 56 years; interquartile range [IQR], 43-66 years). The median ODI decreased from 44 (IQR, 33-53) to 7 (IQR, 2-17) at 6 months (P < .001). The median visual analog scale score decreased from 8 (IQR, 8-9) to 2 (IQR, 0-3) within 6 months (P < .001). In total, 96.5% of patients were discharged on the day of the procedure, and 3.5% were discharged on the following day. No severe adverse events were reported according to the Society of Interventional Radiology (SIR) classification system. Of the 57 patients previously employed, 50 were able to return to work during the follow-up, with a median time of 8 days (IQR, 0-20 days). CONCLUSIONS Symptomatic lumbar disc herniation can be successfully treated using PLD, resulting in significant improvement in symptoms and functional capacities and a fast return to work.
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Affiliation(s)
- Paul-Alexis Ranc
- Radiology Department Centre Hospitalier universitaire de Nice, Hôpital Pasteur 2, Nice, France.
| | - Alexandre Rudel
- Radiology Department Centre Hospitalier universitaire de Nice, Hôpital Pasteur 2, Nice, France
| | - Imad Bentellis
- Urological Surgery Department, Centre Hospitalier universitaire de Nice, Hôpital Pasteur 2, Nice, France
| | - Alexandre Prestat
- Radiology Department Centre Hospitalier universitaire de Nice, Hôpital Pasteur 2, Nice, France
| | - Simon Elbaze
- Radiology Department, Hôpital Raymond Poincaré, Garches, France
| | - Vincent Sala
- Radiology Department Centre Hospitalier universitaire de Nice, Hôpital Pasteur 2, Nice, France
| | - Federico Torre
- Radiology Department Centre Hospitalier universitaire de Nice, Hôpital Pasteur 2, Nice, France
| | - Luca-Jacopo Pavan
- Radiology Department Centre Hospitalier universitaire de Nice, Hôpital Pasteur 2, Nice, France
| | - Ishaq Fahmi Uri
- Radiology Department, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Nicolas Amoretti
- Radiology Department Centre Hospitalier universitaire de Nice, Hôpital Pasteur 2, Nice, France
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Hara K, Kanda M, Kobayashi Y, Miyamoto T, Inoue T. Factors affecting the length of hospital stay for total knee arthroplasty in Japan: a retrospective study using the diagnosis procedure combination database. Eur J Med Res 2024; 29:122. [PMID: 38355542 PMCID: PMC10865593 DOI: 10.1186/s40001-024-01714-w] [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: 03/19/2023] [Accepted: 02/05/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND We aimed to evaluate the length of hospital stay following total knee arthroplasty to determine the impact of relevant factors using data from the Diagnosis Procedure Combination database. METHODS This was a retrospective observational study. The study cohort included 5,831 patients who had osteoarthritis of the knee and had undergone total knee replacement between February 2018 and October 2022 at 38 hospitals. RESULTS Multivariate analysis showed that the factors influencing the length of stay included: age (p < 0.001), height (p < 0.001), weight (p = 0.049), body mass index (p = 0.008), Barthel index (p < 0.001), method of anesthesia (p < 0.001), bone transplant (p = 0.010), timing of postoperative rehabilitation (p < 0.001), atrial fibrillation (p < 0.001), chronic pain (p < 0.001), and number of institutionally treated cases (p < 0.001) (r = 0.451, p < 0.001). CONCLUSIONS Shorter or longer hospital stays were found to be associated with the patients' background characteristics and facility-specific factors; these can lead to more accurate estimates of the length of hospital stay and appropriate allocation of resources.
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Affiliation(s)
- Kentaro Hara
- Department of Operation Center, National Hospital Organization Nagasaki Medical Center, Nagasaki, 856-8562, Japan
- Department of Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, 852-8523, Japan
| | - Masato Kanda
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, 260-8677, Japan
- Department of Healthcare Management Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-Ku, Chiba, Chiba, 260-8677, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, 260-8677, Japan
| | - Takashi Miyamoto
- Department of Orthopedic Surgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, 856-8562, Japan
| | - Takahiro Inoue
- Department of Healthcare Management Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-Ku, Chiba, Chiba, 260-8677, Japan.
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Terradas-Monllor M, Ruiz MA, Ochandorena-Acha M. Postoperative Psychological Predictors for Chronic Postsurgical Pain After a Knee Arthroplasty: A Prospective Observational Study. Phys Ther 2024; 104:pzad141. [PMID: 37831899 DOI: 10.1093/ptj/pzad141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 07/03/2023] [Accepted: 10/10/2023] [Indexed: 10/15/2023]
Abstract
OBJECTIVE Chronic postsurgical pain (CPSP) is a significant adverse effect shown in around 20% of people who had undergone a knee arthroplasty (KA). Psychological risk factors have emerged as significant and potentially modifiable risk factors for its development. However, there is still little evidence when assessing these factors during the acute postoperative period. This study aimed to assess the predictive value of postoperative pain catastrophizing, pain-related fear of movement, anxiety, depression, and pain attitudes in developing CPSP after KA. METHODS A 6-month follow-up prospective observational study design was used. The study sample comprised 115 people who underwent a KA due to painful primary osteoarthritis. Measures of pain catastrophizing, pain-related fear of movement, anxiety, depression, and pain attitudes were obtained 1 week after surgery. CPSP was set at an intensity of ≥30 using a 100-mm visual analog scale at 3 and 6 months after surgery. RESULTS Analysis revealed that baseline pain intensity, pain catastrophizing, pain-related fear of movement, anxiety, depression, and maladaptive pain attitudes were significant predictors of chronic pain at 3 and 6 months after surgery in a univariate analysis. However, at 3 months after surgery, only pain intensity and pain catastrophizing were predictors in the final multivariate model forecasting disturbing pain. Moreover, 6 months after surgery, pain intensity and distrust in medical procedures remained independent predictors. Most of the psychological factors can be grouped into a single dimension defined as pain-related psychological distress. CONCLUSION The results suggest that postoperative pain intensity, pain catastrophizing, and pain attitudes are independent predictors for CPSP after KA. IMPACT Postoperative cognitive and emotional factors should be considered alongside pain intensity during postoperative rehabilitation after KA because they could influence the development of CPSP.
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Affiliation(s)
- Marc Terradas-Monllor
- Faculty of Health Sciences and Welfare, University of Vic-Central University of Catalonia (UVic-UCC), C. Sagrada Família, Vic, Spain
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Center for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), C. Sagrada Família, Vic, Spain
- Anaesthesiology Department, Pain Medicine Section, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Miguel A Ruiz
- Faculty of Psychology, Universidad Autónoma de Madrid, Madrid, Spain
| | - Mirari Ochandorena-Acha
- Faculty of Health Sciences and Welfare, University of Vic-Central University of Catalonia (UVic-UCC), C. Sagrada Família, Vic, Spain
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Center for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), C. Sagrada Família, Vic, Spain
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10
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Fabiano G, Smith TO, Parsons S, Ooms A, Dutton S, Fordham B, Hing C, Lamb S, Pinedo-Villanueva R. Physical activity and health-related quality of life of patients with chronic knee pain after total knee replacement: Analysis of the PEP-TALK trial. Knee 2024; 46:80-88. [PMID: 38070380 DOI: 10.1016/j.knee.2023.11.012] [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: 09/21/2023] [Revised: 11/21/2023] [Accepted: 11/24/2023] [Indexed: 02/20/2024]
Abstract
BACKGROUND Chronic pain is a major challenge for some people after total knee replacement (TKR). The changing impact of this complication during the first post-operative year remains unclear. This analysis aimed to examine how physical activity and health-related quality of life (HRQoL) evolved over the first year after TKR for patients with and without post-operative chronic knee pain. METHODS We conducted a secondary analysis of data from a randomised controlled trial (PEP-TALK), which tested the effectiveness of a behaviour change physiotherapy intervention compared with usual rehabilitation after TKR. Mean UCLA Activity Score and EQ-5D-5L for participants with and without chronic knee pain (14 points or lower in the Oxford Knee Score Pain Subscale (OKS-PS) at six months post-TKR) were compared at six and 12 months post-TKR. RESULTS Data from 83 participants were analysed. For those with chronic knee pain, UCLA Activity Score remained unchanged between baseline to six months (mean: 3.8 to 3.8), decreasing at 12 months (3.0). Those without post-operative chronic knee pain reported improved physical activity from baseline to six months (4.0 vs 4.9), plateauing at 12 months (4.9). Participants with chronic knee pain reported lower baseline HRQoL (0.28 vs 0.48). Both groups improved health utility over one year. Of those without chronic pain at six months, 8.5% returned to chronic pain by 12 months. CONCLUSIONS Monitoring clinical outcomes after six months may be indicated for those at risk of chronic pain post-TKR. Further, sufficiently powered analyses are warranted to increase the generalisability of this exploratory analyses' results.
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Affiliation(s)
- Gianluca Fabiano
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Toby O Smith
- Warwick Medical School, University of Warwick, Coventry, UK.
| | - Scott Parsons
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Alexander Ooms
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Oxford Clinical Trial Research Unit, University of Oxford, Oxford, UK
| | - Susan Dutton
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Oxford Clinical Trial Research Unit, University of Oxford, Oxford, UK
| | - Beth Fordham
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Caroline Hing
- Trauma and Orthopaedic Department, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Sarah Lamb
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Rafael Pinedo-Villanueva
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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11
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Lee YE, Fu CY, Shiue YL, Lu CY, Chen CY, Chen JH, Chen JL, Lam CF. Efficacy and safety of an extended-release sebacoyl dinalbuphine ester for laparoscopic cholecystectomy: A randomized controlled trial. Medicine (Baltimore) 2023; 102:e34423. [PMID: 37543779 PMCID: PMC10403043 DOI: 10.1097/md.0000000000034423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND A long-acting κreceptor agonist parenteral analgesic may theoretically improve acute pain and reduce incidence of chronic postsurgical pain (CPSP) after laparoscopic cholecystectomy with minimal drug-related side effects of the traditional μreceptor opioids. METHODS Eighty adult patients undergoing elective laparoscopic cholecystectomy were randomly assigned to receive single intramuscular injection of an extended-release sebacoyl dinalbuphine ester (SDE, Naldebain 150 mg; n = 40) or placebo (n = 40) after anesthesia induction. Standard multimodal analgesia (MMA) was administered for postoperative pain control. The primary endpoint was pain intensity within 7 days after surgery. The secondary endpoints were incidence CPSP at 3 months and adverse reactions up to 7 days after surgery. RESULTS The highest visual analogue scale (VAS) and area under the curve of VAS 0 to 48 hours after operation were not different between the two groups and a similar proportion of patients requested rescue parenteral analgesics. Average pain intensities were also not different at 72 hours and 7 days after surgery. Incidence of CPSP was 22.5% and 13.1% in patients who received placebo and SDE treatment, respectively (P = .379). Significantly higher incidence of drug-related adverse events, including dizziness, nausea and injection site reactions, were recorded in the SDE group. CONCLUSION A single dose of extended-release analgesic SDE given intraoperatively did not provide sufficient add-on effect for acute and chronic pain management after laparoscopic cholecystectomies in patients who received standard postoperative MMA. Intramuscular injection of 150 mg SDE in patients with average body mass causes adverse events that could have been overlooked. More clinical studies are warranted to determine the target populations who may benefit from SDE injections for improvement of acute and chronic postsurgical pain management.
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Affiliation(s)
- Ying-En Lee
- Department of Anesthesiology, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan
- Institute of Biomedical Sciences, College of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan
- Department of Anesthesiology, Shin-Huey-Shin Hospital, Kaohsiung, Taiwan
| | - Chen-Yu Fu
- Department of Anesthesiology, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan
- Department of Nursing, I-Shou University College of Medicine, Kaohsiung, Taiwan
| | - Yow-Ling Shiue
- Institute of Biomedical Sciences, College of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan
- Institute of Precision Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Chu-Yun Lu
- Department of Nursing, I-Shou University College of Medicine, Kaohsiung, Taiwan
| | - Chung-Yen Chen
- Division of General Surgery, Department of Surgery, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan
- School of Medicine, I-Shou University College of Medicine, Kaohsiung, Taiwan
| | - Jian-Han Chen
- Division of General Surgery, Department of Surgery, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan
- School of Medicine, I-Shou University College of Medicine, Kaohsiung, Taiwan
- Bariatric and Metabolism International Surgery Center, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan
| | - Jen-Lung Chen
- Division of General Surgery, Department of Surgery, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan
| | - Chen-Fuh Lam
- Department of Anesthesiology, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan
- School of Medicine, I-Shou University College of Medicine, Kaohsiung, Taiwan
- Department of Anesthesiology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan
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12
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Tang X, Wu Y, Chen Q, Xu Y, Wang X, Liu S. Deep Neuromuscular Block Attenuates Chronic Postsurgical Pain and Enhances Long-Term Postoperative Recovery After Spinal Surgery: A Randomized Controlled Trial. Pain Ther 2023; 12:1055-1064. [PMID: 37278923 PMCID: PMC10289993 DOI: 10.1007/s40122-023-00528-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/15/2023] [Indexed: 06/07/2023] Open
Abstract
INTRODUCTION The effects of deep neuromuscular block (DNMB) on chronic postsurgical pain (CPSP) have not been conclusively determined. Moreover, a limited number of studies have examined the impact of DNMB on long-term recovery quality after spinal surgery. We investigated the impact of DNMB on CPSP and the quality of long-term recovery in patients who had been subjected to spinal surgery. METHODS This was a randomized, controlled, double-blind, single-center study performed from May 2022 to November 2022. A total of 220 patients who underwent spinal surgery under general anesthesia were randomly assigned to receive either DNMB (post-tetanic count at 1-2) (the D group) or moderate NMB (MNMB) (train-of-four at 1-3) (the M group). The primary endpoint was the incidence of CPSP. The secondary endpoints included the visual analogue scale (VAS) score in the post-anesthesia recovery unit (PACU), at 12, 24, 48 h and 3 months after surgery; postoperative opioid consumption; quality of recovery-15 (QoR-15) scores on the second postoperative day, before discharge, and 3 months after surgery. RESULTS The incidence of CPSP was significantly lower in the D group (30/104, 28.85%) than in the M group (45/105, 42.86%) (p = 0.035). Besides, VAS scores were significantly reduced at the third month in the D group (p = 0.016). In the PACU and 12 h after surgery, VAS scores were also significantly lower in the D group than in the M group (p < 0.001, p = 0.004, respectively). The total amount of postoperative opioid consumption (expressed in total oral morphine equivalents) was significantly less in D group than M group (p = 0.027). At 3 months after surgery, QoR-15 scores were significantly higher in D group than M group (p = 0.003). CONCLUSIONS Compared with MNMB, DNMB significantly reduced CPSP and postoperative opioid consumption in spinal surgery patients. Moreover, DNMB improved the long-term recovery of patients. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR2200058454).
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Affiliation(s)
- Xihui Tang
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, 99 Huaihai West Road, Xuzhou, Jiangsu, 221000, People's Republic of China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Yan Wu
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, 99 Huaihai West Road, Xuzhou, Jiangsu, 221000, People's Republic of China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Qingsong Chen
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, 99 Huaihai West Road, Xuzhou, Jiangsu, 221000, People's Republic of China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Yuqing Xu
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, 99 Huaihai West Road, Xuzhou, Jiangsu, 221000, People's Republic of China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Xinghe Wang
- Department of Anesthesiology, Xuzhou Central Hospital, 199 Jiefang South Road, Xuzhou, Jiangsu, 221009, People's Republic of China.
| | - Su Liu
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, 99 Huaihai West Road, Xuzhou, Jiangsu, 221000, People's Republic of China.
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, People's Republic of China.
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13
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Pergolizzi JV, LeQuang JA, Magnusson P, Varrassi G. Identifying risk factors for chronic postsurgical pain and preventive measures: a comprehensive update. Expert Rev Neurother 2023; 23:1297-1310. [PMID: 37999989 DOI: 10.1080/14737175.2023.2284872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023]
Abstract
INTRODUCTION Chronic postsurgical pain (CPSP) is a prevalent condition that can diminish health-related quality of life, cause functional deficits, and lead to patient distress. Rates of CPSP are higher for certain types of surgeries than others (thoracic, breast, or lower extremity amputations) but can occur after even uncomplicated minimally invasive procedures. CPSP has multiple mechanisms, but always starts as acute postsurgical pain, which involves inflammatory processes and may encompass direct or indirect neural injury. Risk factors for CPSP are largely known but many, such as female sex, younger age, or type of surgery, are not modifiable. The best strategy against CPSP is to quickly and effectively treat acute postoperative pain using a multimodal analgesic regimen that is safe, effective, and spares opioids. AREAS COVERED This is a narrative review of the literature. EXPERT OPINION Every surgical patient is at some risk for CPSP. Control of acute postoperative pain appears to be the most effective approach, but principles of good opioid stewardship should apply. The role of regional anesthetics as analgesics is gaining interest and may be appropriate for certain patients. Finally, patients should be better informed about their relative risk for CPSP.
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Affiliation(s)
| | | | - Peter Magnusson
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Cardiology, Center for Clinical Research, Falun, Sweden
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14
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Adhikari P, Amatya I, Pokharel N, Lamichhane S, Upreti M, Shrestha M, Pant BR, Bhandari S, Dhakal A, Acaroğlu E. Ultrasonography guided erector spinae block in spinal surgery for pain management with enhanced recovery: A comparative study. World Neurosurg X 2023; 19:100209. [PMID: 37206062 PMCID: PMC10189284 DOI: 10.1016/j.wnsx.2023.100209] [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: 11/14/2022] [Revised: 04/21/2023] [Accepted: 04/21/2023] [Indexed: 05/21/2023] Open
Abstract
Background Improved and efficient management of pain can certainly aid enhanced recovery after spinal surgery. Our aim is to evaluate the effect of ESPB in thoracic and lumbar surgeries where we have evaluated VAS for pain, cumulative analgesics consumptions, length of hospital stay and post-operative complications. Methods A cross-sectional comparative study done in HAMS among the erector spinae block group and control group. The analysis of different variable was done according to standard statistical analysis. For quantitative data, univariate and multivariate analysis was performed to determine statistically significant differences using student's t-test for continuous variables. Results 60 patients were analyzed, 30 got spinae block and 30 in control group.The mean pain score for spinae block group were 1.90 ± 0.712 and 3.27 ± 1.230 for control group (p < 0.001). Cumulative mean analgesic consumption values for spinae block vs. control groups were 0.030 ± 0.042 mg vs. 0.091 ± 0.891 mg (p = 0.001) for fentanyl; 1.06E4 ± 2833.300 mg vs. 1.53E4 ± 2848.349 mg (p < 0.001) for paracetamol; 213 ± 64.656 mg vs. 494 ± 58.816 mg (p < 0.001) for ketorol; 5440.00 ± 2060.064 mg vs. 8667.50 ± 2275.006 mg (p < 0.001) for ibuprofen and 121.67 ± 31.303 mg vs. 185.00 ± 51.108 mg (p < 0.001) for tramadol. Conclusions The ESPB technique shows early discharge from hospital and lower cumulative analgesics consumption which indicates enhanced recovery after spine surgery than control group. Improvement of pain using VAS shows immediate post-operative period recovery in those who receives spinae block.
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Affiliation(s)
- Prashant Adhikari
- HAMS (Hospital for Advance Medicine and Surgery) Hospital Dhumbarai, Kathmandu, Nepal
- Corresponding author. HAMS (Hospital for Advance Medicine and Surgery) Hospital, Dhumbarai, Kathmandu, Nepal.
| | - Isha Amatya
- Nepal Health Research Coucil, Ramshah Path, Kathmandu, Nepal
| | - Nishma Pokharel
- HAMS (Hospital for Advance Medicine and Surgery) Hospital Dhumbarai, Kathmandu, Nepal
| | - Suraj Lamichhane
- HAMS (Hospital for Advance Medicine and Surgery) Hospital Dhumbarai, Kathmandu, Nepal
| | - Murari Upreti
- HAMS (Hospital for Advance Medicine and Surgery) Hospital Dhumbarai, Kathmandu, Nepal
| | | | - Bhaskar Raj Pant
- HAMS (Hospital for Advance Medicine and Surgery) Hospital Dhumbarai, Kathmandu, Nepal
| | - Sandeep Bhandari
- HAMS (Hospital for Advance Medicine and Surgery) Hospital Dhumbarai, Kathmandu, Nepal
| | | | - Emre Acaroğlu
- Ankara Spine Center, Iran Caddesi 45/2 Kavaklidere, 06700, Ankara, Turkey
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15
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Trajectory of worst pain within the first two weeks following pelvic and sacral tumor surgery and long-term outcome: a pilot observational prospective cohort study. BMC Anesthesiol 2023; 23:73. [PMID: 36894887 PMCID: PMC9996954 DOI: 10.1186/s12871-023-02033-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/02/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Pain management after pelvic and sacral tumor surgery is challenging and requires a multidisciplinary and multimodal approach. Few data on postoperative pain trajectories have been reported after pelvic and sacral tumor surgery. The aim of this pilot study was to determine pain trajectories within the first 2 weeks after surgery and explore the impact on long-term pain outcomes. METHODS Patients scheduled for pelvic and sacral tumor surgery were prospectively recruited. Worst/average pain scores were evaluated postoperatively using questions adapted from the Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R) until pain resolution was reached or up to 6 months after surgery. Pain trajectories over the first 2 weeks were compared using the k-means clustering algorithm. Whether pain trajectories were associated with long-term pain resolution and opioid cessation was assessed using Cox regression analysis. RESULTS A total of 59 patients were included. Two distinct groups of trajectories for worst and average pain scores over the first 2 weeks were generated. The median pain duration in the high vs low pain group was 120.0 (95% CI [25.0, 215.0]) days vs 60.0 (95% CI [38.6, 81.4]) days (log rank p = 0.037). The median time to opioid cessation in the high vs low pain group was 60.0 (95% CI [30.0, 90.0]) days vs 7.0 (95% CI [4.7, 9.3]) days (log rank p < 0.001). After adjusting for patient and surgical factors, the high pain group was independently associated with prolonged opioid cessation (hazard ratio [HR] 2.423, 95% CI [1.254, 4.681], p = 0.008) but not pain resolution (HR 1.557, 95% CI [0.748, 3.243], p = 0.237). CONCLUSIONS Postoperative pain is a significant problem among patients undergoing pelvic and sacral tumor surgery. High pain trajectories during the first 2 weeks after surgery were associated with delayed opioid cessation. Research is needed to explore interventions targeting pain trajectories and long-term pain outcomes. TRIAL REGISTRATION The trial was registered at ClinicalTrials.gov ( NCT03926858 , 25/04/2019).
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16
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Xu R, Jin Y, Tang S, Wang W, Sun YE, Liu Y, Zhang W, Hou B, Huang Y, Ma Z. Association between single nucleotide variants and severe chronic pain in older adult patients after lower extremity arthroplasty. J Orthop Surg Res 2023; 18:184. [PMID: 36895017 PMCID: PMC9999576 DOI: 10.1186/s13018-023-03683-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 03/06/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Hip or knee osteoarthritis (OA) is one of the main causes of disability worldwide and occurs mostly in the older adults. Total hip or knee arthroplasty is the most effective method to treat OA. However, severe postsurgical pain leading to a poor prognosis. So, investigating the population genetics and genes related to severe chronic pain in older adult patients after lower extremity arthroplasty is helpful to improve the quality of treatment. METHODS We collected blood samples from elderly patients who underwent lower extremity arthroplasty from September 2020 to February 2021 at the Drum Tower Hospital Affiliated to Nanjing University Medical School. The enrolled patients provided measures of pain intensity using the numerical rating scale on the 90th day after surgery. Patients were divided into the case group (Group A) and the control group (Group B) including 10 patients respectively by the numerical rating scale. DNA was isolated from the blood samples of the two groups for whole-exome sequencing. RESULTS In total, 661 variants were identified in the 507 gene regions that were significantly different between both groups (P < 0.05), including CASP5, RASGEF1A, CYP4B1, etc. These genes are mainly involved in biological processes, including cell-cell adhesion, ECM-receptor interaction, metabolism, secretion of bioactive substances, ion binding and transport, regulation of DNA methylation, and chromatin assembly. CONCLUSIONS The current study shows some variants within genes are significantly associated with severe postsurgical chronic pain in older adult patients after lower extremity arthroplasty, indicating a genetic predisposition for chronic postsurgical pain. The study was registered according to ICMJE guidelines. The trial registration number is ChiCTR2000031655 and registration date is April 6th, 2020.
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Affiliation(s)
- Rui Xu
- Department of Anesthesiology, Affiliated Drum Tower Hospital, Medical School, Nanjing University, No. 321 of Zhongshan Road, Nanjing, 210008, China
| | - Yinan Jin
- Department of Anesthesiology, Affiliated Drum Tower Hospital, Medical School, Nanjing University, No. 321 of Zhongshan Road, Nanjing, 210008, China
| | - Suhong Tang
- Department of Anesthesiology, Affiliated Drum Tower Hospital, Medical School, Nanjing University, No. 321 of Zhongshan Road, Nanjing, 210008, China
| | - Wenwen Wang
- Department of Anesthesiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, 210008, China
| | - Yu-E Sun
- Department of Anesthesiology, Affiliated Drum Tower Hospital, Medical School, Nanjing University, No. 321 of Zhongshan Road, Nanjing, 210008, China
| | - Yue Liu
- Department of Anesthesiology, Affiliated Drum Tower Hospital, Medical School, Nanjing University, No. 321 of Zhongshan Road, Nanjing, 210008, China
| | - Wei Zhang
- Department of Anesthesiology, Affiliated Drum Tower Hospital, Medical School, Nanjing University, No. 321 of Zhongshan Road, Nanjing, 210008, China
| | - Bailing Hou
- Department of Anesthesiology, Affiliated Drum Tower Hospital, Medical School, Nanjing University, No. 321 of Zhongshan Road, Nanjing, 210008, China
| | - Yulin Huang
- Department of Anesthesiology, Affiliated Drum Tower Hospital, Medical School, Nanjing University, No. 321 of Zhongshan Road, Nanjing, 210008, China.
| | - Zhengliang Ma
- Department of Anesthesiology, Affiliated Drum Tower Hospital, Medical School, Nanjing University, No. 321 of Zhongshan Road, Nanjing, 210008, China.
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17
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van Veenendaal N, Foss NB, Miserez M, Pawlak M, Zwaans WAR, Aasvang EK. A narrative review on the non-surgical treatment of chronic postoperative inguinal pain: a challenge for both surgeon and anaesthesiologist. Hernia 2023; 27:5-14. [PMID: 36315351 PMCID: PMC9931782 DOI: 10.1007/s10029-022-02693-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 09/29/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Chronic pain is one of the most frequent clinical problems after inguinal hernia surgery. Despite more than two decades of research and numerous publications, no evidence exists to allow for chronic postoperative inguinal pain (CPIP) specific treatment algorithms. METHODS This narrative review presents the current knowledge of the non-surgical management of CPIP and makes suggestions for daily practice. RESULTS There is a paucity for high-level evidence of non-surgical options for CPIP. Different treatment options and algorithms have been published for chronic pain patients in the last decades. DISCUSSION AND CONCLUSION It is suggested that non-surgical treatment is introduced in the management of all CPIP patients. The overall approach to interventions should be pragmatic, tiered and multi-interventional, starting with least invasive and only moving to more invasive procedures upon lack of effect. Evaluation should be multidisciplinary and should take place in specialized centres. We strongly suggest to follow general guidelines for treatment of persistent pain and to build a database allowing for establishing CPIP specific evidence for optimal analgesic treatments.
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Affiliation(s)
- N van Veenendaal
- Department of Anesthesiology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - N B Foss
- Department of Anaesthesia and Intensive Care, Hvidovre University Hospital, Copenhagen, Denmark
| | - M Miserez
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - M Pawlak
- North Devon Comprehensive Hernia Centre, North Devon District Hospital, Royal Devon University Healthcare NHS Foundation Trust, Barnstaple, UK
| | - W A R Zwaans
- Department of General Surgery, Máxima Medical Center, Veldhoven, Eindhoven, The Netherlands.,SolviMáx Center of Excellence for Abdominal Wall and Groin Pain, Eindhoven, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - E K Aasvang
- Department of Anesthesiology, Center for Cancer and Organ Diseases, Rigshopitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
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18
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Prevalence and Predictors of Chronic Postsurgical Pain After Video-Assisted Thoracoscopic Surgery: A Systematic Review and Meta-analysis. Pain Ther 2023; 12:117-139. [PMID: 36227420 PMCID: PMC9845490 DOI: 10.1007/s40122-022-00439-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 09/15/2022] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Determining the prevalence of chronic postsurgical pain (CPSP) after video-assisted thoracoscopic surgery (VATS) and identifying CPSP predictors should improve the prognosis of patients undergoing VATS. Although several studies have investigated predictors of CPSP after VATS, there were significant dissimilarities in the findings due to the confounding of predictors. METHODS PubMed, Cochrane, MEDLINE, Web of Science, Chinese Biomedical Literature, and China National Knowledge Infrastructure databases were comprehensively searched using the Medical Subject Headings terms "pain, postoperative," "thoracic surgery, video-assisted," and all related free terms from inception until March 27, 2022. The Stata metaprop package was used to comprehensively analyze the incidence of CPSP following VATS. Furthermore, the pooled odds ratios (OR) or the standardized mean differences (SMD) and their corresponding 95% confidence intervals (95% CI) were calculated, and qualitative analyses were performed for predictors that could not be assessed quantitatively to evaluate the effects of the included risk factors on the occurrence of CPSP. Unadjusted odds ratios were utilized to consider the impact of non-significant estimates if the original study did not report them. RESULTS Of the 4302 studies, 183 were considered eligible, and 17 were finally included in this study. The overall incidence of CPSP after VATS was 35.3% (95% CI 27.1-43.5%). The qualitative synthesis results revealed that female sex, age, and acute postoperative pain were definite predictors of CPSP after VATS. The number of ports, operation time, duration of drainage, and insufficient analgesia were also considered predictors. Consistent, quantitative synthesis results also showed that the aforementioned predictors were closely related to the occurrence of CPSP after VATS. Only by quantitative analysis, postoperative chemotherapy and an educational level less than junior school were also risk factors for CPSP. Other predictors displayed no evidence or unclear evidence of association with CPSP after VATS. CONCLUSION This study preliminarily determined the incidence of CPSP after VATS based on the existing literature. Female sex, age, and acute pain were identified as risk factors for CPSP after VATS, and other potential risk factors were also identified and analyzed. However, as a result of the inclusion of retrospective studies and inevitable limitations in this systematic review and meta-analysis, the results of this study still need to be verified by large-scale prospective clinical studies. TRIAL REGISTRATION CRD42022323179.
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19
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Alam B, Anwar M, Bareli L, Chowdhury S, Akbari AR. Evaluating the association of preoperative pain beliefs with post-operative pain levels in abdominal surgery patients. J Clin Nurs 2023; 32:647. [PMID: 34169580 DOI: 10.1111/jocn.15924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 05/25/2021] [Accepted: 06/01/2021] [Indexed: 01/18/2023]
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20
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Alharbi RA, Elfeki H, Emmertsen KJ, Mortensen AR, Drewes AM, Christensen P, Laurberg S, Juul T. Chronic pain after colon cancer surgery: Translation and validation of a scoring system. Colorectal Dis 2023; 25:202-210. [PMID: 36100354 DOI: 10.1111/codi.16339] [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: 07/19/2022] [Accepted: 09/06/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The aim of this study was to translate and validate the chronic pain score (CP score) in a cohort of colon cancer patients. Chronic pain following colon cancer surgery is still poorly understood, in particular the lack of a validated tool for measuring chronic pain is a major issue as such an instrument is critical for evaluating the incidence and risk factors. The CP score was created using data from Danish rectal cancer patients. METHODS Danish colorectal cancer survivors diagnosed between 2001 and 2014 completed the CP score and two quality of life (QoL) measures. Clinical data were obtained from a national database. Convergent validity was investigated by testing the association of the CP score with a single ad hoc QoL item and the EORTC QLQ-C30, and discriminative validity was tested as the score's ability to differentiate between gender and age groups. Sensitivity and specificity were evaluated by determining the ability of the score to identify patients with a major impact of pain on QoL. RESULTS Responses from 7127 colon cancer were included. Convergent validity was confirmed, as the score was associated with both QoL measures (p < 0.001). Moreover, the score could differentiate between males/females and older/younger patients (p < 0.001, respectively), reflecting high discriminative validity. Finally, the score was able to identify patients with a major impact on QoL, with a sensitivity of 87% and specificity of 82%. CONCLUSION The CP score is a valid tool for measuring chronic pain after colon cancer surgery and should be used to homogenize outcomes in future studies.
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Affiliation(s)
- Reem A Alharbi
- Department of Clinical Surgery, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia.,King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
| | - Hossam Elfeki
- Department of Surgery, Mansoura University Hospital, Mansoura, Egypt
| | - Katrine J Emmertsen
- Department of Surgery, Regional Hospital Randers, Randers, Denmark.,Danish Cancer Society National Research Centre on Survivorship and Late Adverse Effects After Cancer in Pelvic Organs, Aarhus, Denmark
| | | | - Asbjørn M Drewes
- Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Peter Christensen
- Danish Cancer Society National Research Centre on Survivorship and Late Adverse Effects After Cancer in Pelvic Organs, Aarhus, Denmark.,Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Søren Laurberg
- Danish Cancer Society National Research Centre on Survivorship and Late Adverse Effects After Cancer in Pelvic Organs, Aarhus, Denmark.,Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Therese Juul
- Danish Cancer Society National Research Centre on Survivorship and Late Adverse Effects After Cancer in Pelvic Organs, Aarhus, Denmark.,Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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21
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Kong L, Gao L, Zhang H, Wang X, Zhang J. Does Preoperative Hookwire Localization Influence Postoperative Acute and Chronic Pain After Video-Assisted Thoracoscopic Surgery: A Prospective Cohort Study. J Pain Res 2023; 16:21-32. [PMID: 36636265 PMCID: PMC9830704 DOI: 10.2147/jpr.s387543] [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: 08/25/2022] [Accepted: 12/24/2022] [Indexed: 01/05/2023] Open
Abstract
Purpose This study aimed to investigate whether preoperative computerized tomography-guided hookwire localization-associated pain could affect acute and chronic postsurgical pain (CPSP) in patients undergoing video-assisted thoracoscopic surgery (VATS). Methods We enrolled 161 adult patients who underwent elective VATS; sixty-nine patients experienced hookwire localization (Group A) and 69 did not (Group B). Group A was further subdivided into the multiple localization group (n=35, Group Amultiple) and the single localization group (n=34, Group Asingle) according to the number of hookwires. The numerical rating scale (NRS) was used preoperatively, during recovery at the post-anesthesia care unit (PACU), and the first two days, 3 and 6 months postoperatively. Furthermore, multivariate regression analysis was used to identify the risk factors associated with CPSP. The postoperative adverse events, length of hospital stay, and satisfaction in pain management were also recorded. Results The incidence and severity of acute postoperative pain were similar between Group A and Group B (p > 0.05). The incidence (56.5% vs 30.4%, p = 0.002) and the NRS scores (2.0 [2.0-3.0] vs 1.0 [1.0-2.0], p = 0.011) for CPSP were significantly higher in Group A than in Group B at 3 months postoperatively. On subgroup analysis, compared with Group Asingle, the intensity of CPSP (2.0 [2.0-3.0] vs 2.0 [1.0-2.0], p = 0.005) in Group Amultiple was slightly higher at 3 months postoperatively. Conversely, the CPSP incidence (60.0% vs 29.4%, p = 0.011) was significantly higher at 6 months postoperatively in Group Amultiple. The multivariate regression analysis further validated hookwire localization as a risk factor for CPSP (odds ratio: 6.199, 95% confidence interval 2.049-18.749, p = 0.001). Patient satisfaction relating to pain management at 3 months postoperatively was lower in Group A (p = 0.034). Conclusion The preoperative pain stress of hookwire localization increased the incidence and intensity of CPSP rather than acute pain at 3 months postoperatively, especially in patients with multiple hookwires.
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Affiliation(s)
- Lingchao Kong
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Lingling Gao
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Hong Zhang
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Xin Wang
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Jun Zhang
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China,Correspondence: Jun Zhang, Department of Anesthesiology, Shanghai Cancer Center, Fudan University and Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dong’An Road, Xuhui District, Shanghai, 200032, People’s Republic of China, Tel +86-21-64175590, Fax +86-21-64174774, Email
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22
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Rosèn A, Helgeland E, Pedersen TØ. Continued persistent facial pain despite several surgical interventions in the temporomandibular joint. Dent Clin North Am 2023; 67:61-70. [PMID: 36404081 DOI: 10.1016/j.cden.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article describes a woman in her forties who spontaneously developed facial pain 19 years after double-jaw orthognathic surgery. The focus of her pain was the left side of the face, including the temporomandibular joint (TMJ). Conservative treatment was initiated, including several occlusal splints, in addition to injections with local anesthesia, botulinum toxin, and corticosteroids, with limited effects. Surgical treatments with arthroscopy and discectomy, and ultimately a TMJ prosthesis, improved the patient's joint function but did not reduce pain. The question is whether the degenerated joint was due to progression of the original disease process or to multiple surgical procedures.
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Affiliation(s)
- Annika Rosèn
- Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Bergen, Norway; Department of Oral and Maxillofacial Surgery, Haukeland University Hospital, Bergen, Norway.
| | - Espen Helgeland
- Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Bergen, Norway; Department of Oral and Maxillofacial Surgery, Haukeland University Hospital, Bergen, Norway
| | - Torbjørn Ø Pedersen
- Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Bergen, Norway; Department of Oral and Maxillofacial Surgery, Haukeland University Hospital, Bergen, Norway
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23
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Yu L, Cui X, Song P, Li C, Zhao H, Chang Y. Perioperative pectoral nerve block type II and postoperative recurrence in breast cancer: a randomized controlled trial. BMC Surg 2022; 22:447. [PMID: 36585623 PMCID: PMC9805115 DOI: 10.1186/s12893-022-01895-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 12/23/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND A new technique for analgesia called pectoral nerve block is widely used in surgeries of breast cancer. Pectoral nerve block type II (Pecs II) block has less influence on immunity when compared with general anesthesia method. The purpose of this research is to demonstrate whether Pecs II block has influence on the recurrence of breast cancer after surgical operation. METHODS 526 breast cancer patients were recruited in this research and randomized into general anesthesia group and general anesthesia with Pecs II block group. Recurrence-free survival (RFS), distant recurrence-free survival (DRFS), and overall survival (OS) were evaluated for the two groups. RESULTS Based on the statistical data, only the consumption of remifentanil was dramatically reduced by the performance of Pecs II block when compared with general anesthesia method. The performance of Pecs II block had no significant influence on OS, RFS, and DRFS of breast cancer patients after surgery. ASA physical status III, TNM stage 2 + 3, and mastectomy were proved to have association with lower recurrence-free survival. CONCLUSION In conclusion, the performance of Pecs II block declined the remifentanil consumption during surgery of breast cancer. Meanwhile, the performance of Pecs II block had no significant influence on the OS, RFS, and DRFS of breast cancer patients after surgical resection.
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Affiliation(s)
- Lili Yu
- grid.452270.60000 0004 0614 4777Department of Anesthesiology, Cangzhou Central Hospital, No.16, Xinhua Road, Cangzhou, 061000 Hebei China
| | - Xiuling Cui
- grid.452270.60000 0004 0614 4777Department of Anesthesiology, Cangzhou Central Hospital, No.16, Xinhua Road, Cangzhou, 061000 Hebei China
| | - Panpan Song
- grid.452270.60000 0004 0614 4777Department of Anesthesiology, Cangzhou Central Hospital, No.16, Xinhua Road, Cangzhou, 061000 Hebei China
| | - Chunlei Li
- grid.452270.60000 0004 0614 4777Department of Anesthesiology, Cangzhou Central Hospital, No.16, Xinhua Road, Cangzhou, 061000 Hebei China
| | - Haochen Zhao
- grid.452270.60000 0004 0614 4777Department of Anesthesiology, Cangzhou Central Hospital, No.16, Xinhua Road, Cangzhou, 061000 Hebei China
| | - Yulin Chang
- grid.452270.60000 0004 0614 4777Department of Anesthesiology, Cangzhou Central Hospital, No.16, Xinhua Road, Cangzhou, 061000 Hebei China
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24
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Relationship between Postoperative Pain and Sociocultural Level in Major Orthopedic Surgery. Adv Orthop 2022; 2022:7867719. [PMID: 36267670 PMCID: PMC9578872 DOI: 10.1155/2022/7867719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 08/10/2022] [Accepted: 08/25/2022] [Indexed: 11/17/2022] Open
Abstract
Background Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are associated with moderate to severe postoperative pain (POP). POP is theoretically predictable and may be influenced by sociocultural differences. This study aimed to identify the relationship between POP and the sociocultural level of the patient undergoing THA or TKA. Methods Prospective study, involving informed-consenting adults conducted through consulting patient's clinical processes, preoperative and postoperative questionnaires. Demographic and anthropometric data, type of surgery, ASA classification, sociocultural level of the patient, and POP were assessed. Results 95 patients, all Caucasian and natural from the north of the Portugal, were included. Younger women undergoing TKA reported higher levels of POP. In females, the ASA 3 physical condition was also associated with higher mean pain intensity. Patients with preoperative chronic pain, without depression diagnosis, and unsatisfied with the current profession showed higher levels of reported POP. Retirees, with lower school degree, reported higher levels of minimal pain. Conclusions Job satisfaction, type of surgery, body mass index, presence of chronic pain, and the absence of depression were identified as the main predictors of pain after THA or TKA.
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25
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Baharloo R, Principe J, Rashidi P, Tighe P. Long-Term Postoperative Pain Prediction Using Higher-Order Singular Value Decomposition of Intraoperative Physiological Responses: Prospective Cohort Study. JMIR Perioper Med 2022; 5:e37104. [PMID: 36103231 PMCID: PMC9520382 DOI: 10.2196/37104] [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: 02/07/2022] [Revised: 06/04/2022] [Accepted: 06/29/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Long-term postoperative pain (POP) and patient responses to pain relief medications are not yet fully understood. Although recent studies have developed an index for the nociception level of patients under general anesthesia based on multiple physiological parameters, it remains unclear whether these parameters correlate with long-term POP outcomes. OBJECTIVE This study aims to extract unbiased and interpretable descriptions of how the dynamics of physiological parameters change over time and across patients in response to surgical procedures and intraoperative medications using a multivariate-temporal analysis. We demonstrated that there is an association (correlation) between the main features of intraoperative physiological responses and long-term POP, which has a predictive value, even without claiming causality. METHODS We proposed a complex higher-order singular value decomposition method to accurately decompose patients' physiological responses into multivariate structures evolving over time. We used intraoperative vital signs of 175 patients from a mixed surgical cohort to extract three interconnected, low-dimensional, complex-valued descriptions of patients' physiological responses: multivariate factors, reflecting subphysiological parameters; temporal factors, reflecting common intrasurgery temporal dynamics; and patients' factors, describing interpatient changes in physiological responses. RESULTS Adoption of the complex higher-order singular value decomposition method allowed us to clarify the dynamic correlation structure included in the intraoperative physiological responses. Instantaneous phases of the complex-valued physiological responses of 242 patients within the subspace of principal descriptors enabled us to discriminate between mild and not-mild (moderate-severe) levels of pain at postoperative days 30 and 90. Following rotation of physiological responses before projection to align with the common multivariate-temporal dynamic, the method achieved an area under curve for postoperative day 30 and 90 outcomes of 0.81 and 0.89 for thoracic surgery, 0.87 and 0.83 for orthopedic surgery, 0.87 and 0.88 for urological surgery, 0.86 and 1 for colorectal surgery, 1 and 1 for transplant surgery, and 0.83 and 0.92 for pancreatic surgery, respectively. CONCLUSIONS By categorizing patients into different surgical groups, we identified significant surgery-related principal descriptors. Each of them potentially encodes different surgical stimulation. The dynamics of patients' physiological responses to these surgical events were linked to long-term POP development.
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Affiliation(s)
| | - Jose Principe
- University of Florida, Gainesville, FL, United States
| | | | - Patrick Tighe
- University of Florida, Gainesville, FL, United States
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26
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Liu H, Liu J, Xu W, Chen X. Prophylactic cholecystectomy: A valuable treatment strategy for cholecystolithiasis after gastric cancer surgery. Front Oncol 2022; 12:897853. [PMID: 36176409 PMCID: PMC9513465 DOI: 10.3389/fonc.2022.897853] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/23/2022] [Indexed: 11/24/2022] Open
Abstract
The main treatment for gastric cancer is surgical excision. Gallstones are one of the common postoperative complications of gastric cancer. To avoid the adverse effects of gallstone formation after gastric cancer surgery, we reviewed the causes and risk factors and mechanisms involved in gallstone formation after gastric cancer surgery. The evidence and value regarding prophylactic cholecystectomy (PC) during gastric cancer surgery was also reviewed. Based on previous evidence, we summarized the mechanism and believe that injury or resection of the vagus nerve or changes in intestinal hormone secretion can lead to physiological dysfunction of the gallbladder and Oddi sphincter, and the lithogenic components in the bile are also changed, ultimately leading to CL. Previous studies also have identified many independent risk factors for CL after gastric cancer, such as type of gastrectomy, reconstruction of the digestive tract, degree of lymph node dissection, weight, liver function, sex, age, diabetes and gallbladder volume are closely related to CL development. At present, there are no uniform guidelines for the selection of treatment strategies. As a new treatment strategy, PC has undeniable advantages and is expected to become the standard treatment for CL after gastric cancer in the future. The individualized PC strategy for CL after gastric cancer is the main direction of future research.
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Affiliation(s)
- Haipeng Liu
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, China
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Key Laboratory of Digestive System Tumors of Gansu Province, Lanzhou University Second Hospital, Lanzhou, China
| | - Jie Liu
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Key Laboratory of Digestive System Tumors of Gansu Province, Lanzhou University Second Hospital, Lanzhou, China
| | - Wei Xu
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Key Laboratory of Digestive System Tumors of Gansu Province, Lanzhou University Second Hospital, Lanzhou, China
| | - Xiao Chen
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, China
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Key Laboratory of Digestive System Tumors of Gansu Province, Lanzhou University Second Hospital, Lanzhou, China
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27
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Hung KC, Huang YT, Kuo JR, Hsu CW, Yew M, Chen JY, Lin MC, Chen IW, Sun CK. Elevated Surgical Pleth Index at the End of Surgery Is Associated with Postoperative Moderate-to-Severe Pain: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2022; 12:diagnostics12092167. [PMID: 36140567 PMCID: PMC9498235 DOI: 10.3390/diagnostics12092167] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/02/2022] [Accepted: 09/03/2022] [Indexed: 11/16/2022] Open
Abstract
Despite acceptance of the surgical pleth index (SPI) for monitoring the intraoperative balance between noxious stimulation and anti-nociception under general anesthesia, its efficacy for predicting postoperative moderate-to-severe pain remains unclear. We searched electronic databases (e.g., Google Scholar, MEDLINE, Cochrane Library, and EMBASE) to identify articles focusing on associations of SPI at the end of surgery with immediate moderate-to-severe pain in the postanesthesia care unit from inception to 7 July 2022. A total of six observational studies involving 756 adults published between 2016 and 2020 were eligible for quantitative syntheses. Pooled results revealed higher values of SPI in patients with moderate-to-severe pain than those without (mean difference: 7.82, 95% CI: 3.69 to 11.95, p = 0.002, I2 = 46%). In addition, an elevated SPI at the end of surgery was able to predict moderate-to-severe pain with a sensitivity of 0.71 (95% confidence interval (CI): 0.65–0.77; I2 = 29.01%) and a specificity of 0.58 (95% CI: 0.39–0.74; I2 = 79.31%). The overall accuracy based on the summary receiver operating characteristic (sROC) curve was 0.72. In conclusion, this meta-analysis highlighted the feasibility of the surgical pleth index to predict postoperative moderate-to-severe pain immediately after surgery. Our results from a limited number of studies warrant further investigations for verification.
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Affiliation(s)
- Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City 71004, Taiwan
- Department of Hospital and Health Care Administration, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan City 71710, Taiwan
| | - Yen-Ta Huang
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City 70101, Taiwan
| | - Jinn-Rung Kuo
- Department of Neurosurgery, Chi Mei Medical Center, Tainan City 71004, Taiwan
- Department of Medical Research, Chi Mei Medical Center, Tainan City 71004, Taiwan
| | - Chih-Wei Hsu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City 83301, Taiwan
| | - Ming Yew
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City 71004, Taiwan
| | - Jen-Yin Chen
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City 71004, Taiwan
| | - Ming-Chung Lin
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City 71004, Taiwan
| | - I-Wen Chen
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan City 73657, Taiwan
- Correspondence: (I.-W.C.); (C.-K.S.)
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, Kaohsiung City 82445, Taiwan
- College of Medicine, I-Shou University, Kaohsiung City 84001, Taiwan
- Correspondence: (I.-W.C.); (C.-K.S.)
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28
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van Driel MEC, van Dijk JFM, Baart SJ, Meissner W, Huygen FJPM, Rijsdijk M. Development and validation of a multivariable prediction model for early prediction of chronic postsurgical pain in adults: a prospective cohort study. Br J Anaesth 2022; 129:407-415. [PMID: 35732539 DOI: 10.1016/j.bja.2022.04.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/31/2022] [Accepted: 04/20/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Early identification of patients at risk of developing chronic postsurgical pain (CPSP) is an essential step in reducing pain chronification in postsurgical patients. We aimed to develop and validate a prognostic model for the early prediction of CPSP including pain characteristics indicating altered pain processing within 2 weeks after surgery. METHODS A prospective cohort study was conducted in adult patients undergoing orthopaedic, vascular, trauma, or general surgery between 2018 and 2019. Multivariable logistic regression models for CPSP were developed using data from the University Medical Centre (UMC) Utrecht and validated in data from the Erasmus UMC Rotterdam, The Netherlands. RESULTS In the development (n=344) and the validation (n=150) cohorts, 28.8% and 21.3% of patients reported CPSP. The best performing model (area under the curve=0.82; 95% confidence interval [CI], 0.76-0.87) included preoperative treatment with opioids (odds ratio [OR]=4.04; 95% CI, 2.13-7.70), bone surgery (OR=2.01; 95% CI, 1.10-3.67), numerical rating scale pain score on postoperative day 14 (OR=1.57; 95% CI, 1.34-1.83), and the presence of painful cold within the painful area 2 weeks after surgery (OR=4.85; 95% CI, 1.85-12.68). Predictive performance was confirmed by external validation. CONCLUSIONS As only four easily obtainable predictors are necessary for reliable CPSP prediction, the models are useful for the clinician to be alerted to further assess and treat individual patients at risk. Identification of the presence of painful cold within 2 weeks after surgery as a strong predictor supports altered pain processing as an important contributor to CPSP development.
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Affiliation(s)
- Marjelle E C van Driel
- Pain Clinic, Department of Anaesthesiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Jacqueline F M van Dijk
- Pain Clinic, Department of Anaesthesiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Sara J Baart
- Department of Anaesthesiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Winfried Meissner
- Department of Anaesthesiology and Intensive Care, University Hospital Jena, Jena, Germany
| | - Frank J P M Huygen
- Pain Clinic, Department of Anaesthesiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Mienke Rijsdijk
- Pain Clinic, Department of Anaesthesiology, University Medical Centre Utrecht, Utrecht, The Netherlands.
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29
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Fiore JF, El-Kefraoui C, Chay MA, Nguyen-Powanda P, Do U, Olleik G, Rajabiyazdi F, Kouyoumdjian A, Derksen A, Landry T, Amar-Zifkin A, Bergeron A, Ramanakumar AV, Martel M, Lee L, Baldini G, Feldman LS. Opioid versus opioid-free analgesia after surgical discharge: a systematic review and meta-analysis of randomised trials. Lancet 2022; 399:2280-2293. [PMID: 35717988 DOI: 10.1016/s0140-6736(22)00582-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 03/12/2022] [Accepted: 03/18/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Excessive opioid prescribing after surgery has contributed to the current opioid crisis; however, the value of prescribing opioids at surgical discharge remains uncertain. We aimed to estimate the extent to which opioid prescribing after discharge affects self-reported pain intensity and adverse events in comparison with an opioid-free analgesic regimen. METHODS In this systematic review and meta-analysis, we searched MEDLINE, Embase, the Cochrane Library, Scopus, AMED, Biosis, and CINAHL from Jan 1, 1990, until July 8, 2021. We included multidose randomised controlled trials comparing opioid versus opioid-free analgesia in patients aged 15 years or older, discharged after undergoing a surgical procedure according to the Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity definition (minor, moderate, major, and major complex). We screened articles, extracted data, and assessed risk of bias (Cochrane's risk-of-bias tool for randomised trials) in duplicate. The primary outcomes of interest were self-reported pain intensity on day 1 after discharge (standardised to 0-10 cm visual analogue scale) and vomiting up to 30 days. Pain intensity at further timepoints, pain interference, other adverse events, risk of dissatisfaction, and health-care reutilisation were also assessed. We did random-effects meta-analyses and appraised evidence certainty using the Grading of Recommendations, Assessment, Development, and Evaluations scoring system. The review was registered with PROSPERO (ID CRD42020153050). FINDINGS 47 trials (n=6607 patients) were included. 30 (64%) trials involved elective minor procedures (63% dental procedures) and 17 (36%) trials involved procedures of moderate extent (47% orthopaedic and 29% general surgery procedures). Compared with opioid-free analgesia, opioid prescribing did not reduce pain on the first day after discharge (weighted mean difference 0·01cm, 95% CI -0·26 to 0·27; moderate certainty) or at other postoperative timepoints (moderate-to-very-low certainty). Opioid prescribing was associated with increased risk of vomiting (relative risk 4·50, 95% CI 1·93 to 10·51; high certainty) and other adverse events, including nausea, constipation, dizziness, and drowsiness (high-to-moderate certainty). Opioids did not affect other outcomes. INTERPRETATION Findings from this meta-analysis support that opioid prescribing at surgical discharge does not reduce pain intensity but does increase adverse events. Evidence relied on trials focused on elective surgeries of minor and moderate extent, suggesting that clinicians can consider prescribing opioid-free analgesia in these surgical settings. Data were largely derived from low-quality trials, and none involved patients having major or major-complex procedures. Given these limitations, there is a great need to advance the quality and scope of research in this field. FUNDING The Canadian Institutes of Health Research.
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Affiliation(s)
- Julio F Fiore
- Department of Surgery, McGill University, Montreal, QC, Canada; Division of Experimental Surgery, McGill University, Montreal, QC, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
| | - Charbel El-Kefraoui
- Division of Experimental Surgery, McGill University, Montreal, QC, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | | | - Philip Nguyen-Powanda
- Division of Experimental Surgery, McGill University, Montreal, QC, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Uyen Do
- Division of Experimental Surgery, McGill University, Montreal, QC, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Ghadeer Olleik
- Division of Experimental Surgery, McGill University, Montreal, QC, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Fateme Rajabiyazdi
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada; Department of Systems and Computer Engineering, Carleton University, ON, Canada
| | - Araz Kouyoumdjian
- Department of Surgery, McGill University, Montreal, QC, Canada; Division of Experimental Surgery, McGill University, Montreal, QC, Canada
| | - Alexa Derksen
- Patient Representative, Université de Montréal, Montreal, QC, Canada
| | - Tara Landry
- Medical Libraries, McGill University Health Centre, Montreal, QC, Canada; Bibliothèque de la Santé, Université de Montréal, Montreal, QC, Canada
| | | | - Amy Bergeron
- Medical Libraries, McGill University Health Centre, Montreal, QC, Canada
| | - Agnihotram V Ramanakumar
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Marc Martel
- Faculty of Dentistry, McGill University, Montreal, QC, Canada; Department of Anaesthesia, McGill University, Montreal, QC, Canada
| | - Lawrence Lee
- Department of Surgery, McGill University, Montreal, QC, Canada; Division of Experimental Surgery, McGill University, Montreal, QC, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Gabriele Baldini
- Division of Experimental Surgery, McGill University, Montreal, QC, Canada; Department of Anaesthesia, McGill University, Montreal, QC, Canada
| | - Liane S Feldman
- Department of Surgery, McGill University, Montreal, QC, Canada; Division of Experimental Surgery, McGill University, Montreal, QC, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
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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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Sieberg CB, Karunakaran KD, Kussman B, Borsook D. Preventing pediatric chronic postsurgical pain: Time for increased rigor. Can J Pain 2022; 6:73-84. [PMID: 35528039 PMCID: PMC9067470 DOI: 10.1080/24740527.2021.2019576] [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] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/12/2021] [Accepted: 12/13/2021] [Indexed: 11/15/2022]
Abstract
Chronic postsurgical pain (CPSP) results from a cascade of events in the peripheral and central nervous systems following surgery. Several clinical predictors, including the prior pain state, premorbid psychological state (e.g., anxiety, catastrophizing), intraoperative surgical load (establishment of peripheral and central sensitization), and acute postoperative pain management, may contribute to the patient's risk of developing CPSP. However, research on the neurobiological and biobehavioral mechanisms contributing to pediatric CPSP and effective preemptive/treatment strategies are still lacking. Here we evaluate the perisurgical process by identifying key problems and propose potential solutions for the pre-, intra-, and postoperative pain states to both prevent and manage the transition of acute to chronic pain. We propose an eight-step process involving preemptive and preventative analgesia, behavioral interventions, and the use of biomarkers (brain-based, inflammatory, or genetic) to facilitate timely evaluation and treatment of premorbid psychological factors, ongoing surgical pain, and postoperative pain to provide an overall improved outcome. By achieving this, we can begin to establish personalized precision medicine for children and adolescents presenting to surgery and subsequent treatment selection.
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Affiliation(s)
- Christine B. Sieberg
- Biobehavioral Pediatric Pain Lab, Department of Psychiatry & Behavioral Sciences, Boston Children’s Hospital, Boston, Massachusetts, United States
- Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States
| | - Keerthana Deepti Karunakaran
- Biobehavioral Pediatric Pain Lab, Department of Psychiatry & Behavioral Sciences, Boston Children’s Hospital, Boston, Massachusetts, United States
- Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States
| | - Barry Kussman
- Department of Anesthesiology, Critical Care, & Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States
- Department of Anesthesiology, Harvard Medical School, Boston, Massachusetts, United States
| | - David Borsook
- Department of Anesthesiology, Harvard Medical School, Boston, Massachusetts, United States
- Department of Psychiatry and Radiology, Massachusetts General Hospital, Hospital, Harvard Medical School, Boston, Massachusetts, United States
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Gómez M, Izquierdo CE, Mayoral Rojals V, Pergolizzi Jr J, Plancarte Sanchez R, Paladini A, Varrassi G. Considerations for Better Management of Postoperative Pain in Light of Chronic Postoperative Pain: A Narrative Review. Cureus 2022; 14:e23763. [PMID: 35518528 PMCID: PMC9064707 DOI: 10.7759/cureus.23763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/02/2022] [Indexed: 12/02/2022] Open
Abstract
Chronic postoperative pain (CPOP) is prevalent, with particularly high rates in breast surgery, thoracotomy, and amputation. As the world emerges from the coronavirus disease 2019 (COVID-19) lockdowns, it is expected that there will be an increase in surgical procedures, elevating the importance of preventing CPOP in the coming years. Risk factors are emerging to better stratify patients at high risk for CPOP. Perioperative analgesia plays an important role in managing acute postoperative pain and in some cases may limit its transition to CPOP. Acute postoperative pain is adaptive, normal, expected, and has a well-defined trajectory, while CPOP is maladaptive and, as a form of chronic pain, is challenging to treat. Good analgesia, early ambulation, and rehabilitation efforts may be helpful in preventing CPOP following certain surgeries. Enhanced Recovery After Surgery (ERAS) protocols present guidance to help promote recovery and prevent CPOP.
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Sawada R, Watanabe K, Tokumine J, Lefor AK, Ando T, Yorozu T. Ultrasound-guided rectus sheath block for anterior cutaneous nerve entrapment syndrome after laparoscopic surgery: A case report. World J Clin Cases 2022; 10:2357-2362. [PMID: 35321172 PMCID: PMC8895180 DOI: 10.12998/wjcc.v10.i7.2357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 12/18/2021] [Accepted: 01/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Anterior cutaneous nerve entrapment syndrome is defined as abdominal pain due to entrapped intercostal nerves. This is the first report of a patient successfully treated for anterior cutaneous nerve entrapment syndrome after laparoscopic surgery with an ultrasound-guided rectus sheath block. The rectus sheath block physically lysed adhesions and relieved pain from anterior cutaneous nerve entrapment syndrome.
CASE SUMMARY The patient is a 44-year-old man who presented with severe left upper abdominal pain at an operative scar one month after laparoscopic ulcer repair. Diagnosis and treatment were performed using an ultrasound-guided rectus sheath block with 0.1% lidocaine 20 mL. The pain was relieved after the block. The diagnosis was anterior cutaneous nerve entrapment syndrome. Rectus sheath block may be effective for patients with anterior cutaneous nerve entrapment syndrome.
CONCLUSION Ultrasound-guided rectus sheath block is a promising treatment modality for patients with postoperative anterior cutaneous nerve entrapment syndrome due to adhesions.
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Affiliation(s)
- Ryuji Sawada
- Department of Pain Clinic, NTT Medical Center Tokyo, Higashigotanda 141-8625, Tokyo, Japan
| | - Kunitaro Watanabe
- Department of Anesthesiology, Hino Municipal Hospital, Tamadaira 191-0062, Tokyo, Japan
| | - Joho Tokumine
- Department of Anesthesiology, Kyorin University School of Medicine, Mitaka 181-8611, Tokyo, Japan
| | - Alan Kawarai Lefor
- Department of Surgery, Jichi Medical University, Shimotsuke 329-0498, Tochigi, Japan
| | - Tadao Ando
- Department of Anesthesiology, Kyorin University School of Medicine, Mitaka 181-8611, Tokyo, Japan
| | - Tomoko Yorozu
- Department of Anesthesiology, Kyorin University School of Medicine, Mitaka 181-8611, Tokyo, Japan
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Silva HLND, Tanaka GO, Pinheiro TB, Abdouni YA. Prevalência de dor neuropática em pacientes com fratura da extremidade distal do rádio tratada com placa volar bloqueada. Rev Bras Ortop 2022; 57:924-929. [DOI: 10.1055/s-0041-1736526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 06/15/2021] [Indexed: 10/19/2022] Open
Abstract
Resumo
Objetivo Avaliar a prevalência de dor persistente no pós-operatório de fratura da extremidade distal do rádio, assim como detectar precocemente sinais de dor neuropática com o intuito de desenvolver protocolos de prevenção da dor crônica pós-operatória.
Métodos Estudo prospectivo, realizado com 56 pacientes submetidos a redução aberta e fixação interna de fratura da extremidade distal do rádio com placa volar bloqueada no período de março a setembro de 2020. Os pacientes foram submetidos a avaliação de dor neuropática e capacidade funcional através dos questionários Douleur Neuropathique 4 questionnaire (DN4) e Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH, na sigla em inglês). As variáveis qualitativas foram comparadas pelo teste de Mann-Whitney e sua correlação foi analisada pelos testes de correlação de Spearman e de Igualdade de Duas Proporções.
Resultados Foram incluídos no presente estudo 43 pacientes, com idades entre 18 e 66 anos; 39,5% dos participantes apresentaram pontuação ≥ 4 no questionário Douleur neuropathique 4 questionnaire (DN4). Em relação ao Quick-DASH, a média foi de 38,6. Não houve diferença estatística significante entre o sexo do paciente e o valor do DN4 (p = 0,921). Também não foi encontrada correlação estatística entre as variáveis quantitativas DN4 e Quick-DASH (p = 0,061).
Conclusões A prevalência de dor neuropática nos pacientes pós-operatórios analisados foi significativa e a presença de sinais e sintomas de dor neuropática foi fator preditivo positivo para a persistência da dor além de 2 meses em 100% dos casos. Assim, com diagnóstico precoce do componente neuropático de dor, associado ao componente nociceptivo, é possível obter o controle adequado da dor, impedindo sua cronificação e garantindo uma melhor reabilitação.
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Affiliation(s)
- Helbert Luiz Nomura da Silva
- Médico Ex-residente do Grupo de Cirurgia da Mão e Microcirurgia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brasil
| | - Giuliana Olivi Tanaka
- Médico Residente de Ortopedia e Traumatologia do Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brasil
| | - Thiago Barros Pinheiro
- Médico Residente de Ortopedia e Traumatologia do Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brasil
| | - Yussef Ali Abdouni
- Médico Assistente do Grupo de Cirurgia da Mão e Microcirurgia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brasil
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Ambasta S, Kulhari S, Shamshery C, Agarwal A, Singh R, Srivastava M. Postoperative analgesic efficacy of quadratus lumborum block in patients undergoing laparoscopic cholecystectomy: A retrospective study. INDIAN JOURNAL OF PAIN 2022. [DOI: 10.4103/ijpn.ijpn_92_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Holzer KJ, Haroutounian S, Meng A, Wilson EA, Steinberg A, Avidan MS, Kozower BD, Abraham J. Ascertaining Design and Implementation Requirements for a Perioperative Neurocognitive Training Intervention for the Prevention of Persistent Pain After Surgery. PAIN MEDICINE 2021; 23:1355-1365. [PMID: 34931687 PMCID: PMC9607951 DOI: 10.1093/pm/pnab347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 12/03/2021] [Accepted: 12/14/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND Persistent postsurgical pain (PPSP) is a common complication that impacts quality of life, often necessitating long-term opioid treatment. Certain neurocognitive factors, including reduced performance on cognitive flexibility tasks, are associated with increased risk of PPSP. We examine the perceptions of surgical patients and clinicians with regard to perioperative pain management activities and needs; patient acceptance and use of a perioperative neurocognitive training intervention; and implementation feasibility. METHODS We conducted both individual and focus group interviews with patients undergoing thoracic surgery and clinicians in an academic medical center. The Consolidated Framework for Intervention Research guided the development of interview questions related to the adoption and implementation of a neurocognitive intervention to mitigate PPSP. A thematic analysis was used to analyze the responses. RESULTS Forty patients and 15 clinicians participated. Interviews revealed that there is minimal discussion between clinicians and patients about PPSP. Most participants were receptive to a neurocognitive intervention to prevent PPSP, if evidence demonstrating its effectiveness were available. Potential barriers to neurocognitive training program adoption included fatigue, cognitive overload, lack of familiarity with the technology used for delivering the intervention, and immediate postoperative pain and stress. Implementation facilitators would include patient education about the intervention, incentives for its use, and daily reminders. CONCLUSION The study identified several guiding principles for addressing patients' and clinicians' barriers to effectively implementing a neurocognitive training intervention to mitigate PPSP after surgery. To ensure the sustainability of neurocognitive interventions for preventing PPSP, such interventions would need to be adapted to meet patients' and clinicians' needs within the perioperative context.
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Affiliation(s)
| | | | | | | | | | | | | | - Joanna Abraham
- Correspondence to: Joanna Abraham, FAMIA, PhD, Department of Anesthesiology, Institute for Informatics, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8054, St. Louis, M0 63110, USA. Tel: 314-362-5129; E-mail:
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Biz C, de Iudicibus G, Belluzzi E, Dalmau-Pastor M, Bragazzi NL, Funes M, Parise GM, Ruggieri P. Prevalence of chronic pain syndrome in patients who have undergone hallux valgus percutaneous surgery: a comparison of sciatic-femoral and ankle regional ultrasound-guided nerve blocks. BMC Musculoskelet Disord 2021; 22:1043. [PMID: 34911525 PMCID: PMC8675526 DOI: 10.1186/s12891-021-04911-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 11/24/2021] [Indexed: 12/21/2022] Open
Abstract
Background Chronic pain syndrome (CPS) is a common complication after operative procedures, and only a few studies have focused on the evaluation of CPS in foot-forefoot surgery and specifically on HV percutaneous correction. The objective of this study was to compare postoperative pain levels and incidence of CPS in two groups of patients having undergone femoral-sciatic nerve block or ankle block regional anaesthesia before hallux valgus (HV) percutaneous surgery and the association between postoperative pain levels and risk factors between these patient groups. Methods A consecutive patient series was enrolled and evaluated prospectively at 7 days, 1, 3 and 6 months after surgery. The participants were divided into two groups according to the regional anaesthesia received, femoral-sciatic nerve block or ankle block, and their outcomes were compared. The parameters assessed were postoperative pain at rest and during movement by the numerical rating scale (NRS), patient satisfaction using the Visual Analogue Scale (VAS), quality of life and return to daily activities. Statistical analysis was performed. Results One hundred fifty-five patients were assessed, 127 females and 28 males. Pain at rest (p < 0.0001) and during movement (p < 0.0001) significantly decreased during the follow-ups; at 6 months, 13 patients suffered from CPS. Over time, satisfaction remained stable (p > 0.05), quality of life significantly increased and patients returned to daily activities and work (p < 0.0001). No significant impact of type of anaesthesia could be detected. ASA 3 (p = 0.043) was associated to higher pain during movement; BMI (p = 0.005) and lumbago (p = 0.004) to lower satisfaction. No operative-anaesthetic complications were recorded. Postoperative pain at rest and during movement improved over time independently of the regional block used, with low incidence of CPS at last follow-up. Among risk factors, only a higher ASA was associated to higher pain during movement, while higher BMI and lumbago to lower satisfaction. Conclusions Both ultrasound-guided sciatic-femoral and ankle blocks were safe and effective in reducing postoperative pain with low incidence of CPS at last follow-up. Trial registration Clinical Trial NCT02886221. Registered 1 September 2016.
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Affiliation(s)
- Carlo Biz
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, via Giustiniani 3, 35128, Padova, Italy. .,Minimally Invasive Foot and Ankle Society (MIFAS By Grecmip), 2 Rue Georges Negrevergne, 33700, Merignac, France.
| | - Gianfranco de Iudicibus
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, via Giustiniani 3, 35128, Padova, Italy
| | - Elisa Belluzzi
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, via Giustiniani 3, 35128, Padova, Italy. .,Musculoskeletal Pathology and Oncology Laboratory, Orthopaedics and Orthopedics Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, via Giustiniani 3, 3518, Padova, Italy.
| | - Miki Dalmau-Pastor
- Minimally Invasive Foot and Ankle Society (MIFAS By Grecmip), 2 Rue Georges Negrevergne, 33700, Merignac, France.,Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics, Department of Mathematics and Statistics, York University, Toronto, Canada
| | - Manuela Funes
- Institute of Anesthesia and Reanimation, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Gian-Mario Parise
- Institute of Anesthesia and Reanimation, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Pietro Ruggieri
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, via Giustiniani 3, 35128, Padova, Italy
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Doi R, Miyazaki T, Tsuchiya T, Matsumoto K, Tomoshige K, Machino R, Mizoguchi S, Matsumoto T, Yamaguchi K, Takatsuna H, Shiosakai K, Nagayasu T. Mirogabalin treatment of postoperative neuropathic pain after thoracic surgery: study protocol for a multicenter, randomized, open-label, parallel-group, interventional trial. J Thorac Dis 2021; 13:6062-6070. [PMID: 34795952 PMCID: PMC8575802 DOI: 10.21037/jtd-21-741] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/19/2021] [Indexed: 11/06/2022]
Abstract
Background Intercostal nerve damage due to thoracotomy or thoracoscopic manipulation is a major contributor to chronic postsurgical pain after pulmonary resection. Chronic postsurgical pain may last for months or years and can negatively impair physical functioning and daily activities. Global consensus on severe postoperative pain management is lacking, and chronic pain incidence after thoracic surgery remains high. Many patients report neuropathic pain, which can be difficult to treat with currently available therapies. The efficacy and safety of mirogabalin have been demonstrated for other types of neuropathic pain; thus, this study was planned to investigate the efficacy and safety of mirogabalin to treat neuropathic pain after thoracic surgery. Methods In this multicenter, randomized, open-label, parallel-group, interventional study, patients who are diagnosed with neuropathic pain following removal of a chest drain after lung resection will receive conventional therapy (non-steroidal anti-inflammatory drugs and/or acetaminophen) with or without the addition of a clinical dose of mirogabalin for 8 weeks. For patient stratification, a visual analog scale pain intensity score at baseline of <60 vs. ≥60 mm will be used. Treatment efficacy and safety with and without the addition of mirogabalin will be assessed using a questionnaire evaluating postoperative changes in pain severity and activity. The primary study endpoint is the change in pain intensity from baseline to Week 8, measured by the visual analog scale. Additionally, the presence of chronic pain at 12 weeks after enrollment in each treatment group will be recorded. Discussion This protocol has been reviewed and approved by the Clinical Research Review Board of Nagasaki University. Study data will be published in the Japan Registry of Clinical Trials database and peer-reviewed journals. Mirogabalin is already approved for the treatment of other types of neuropathic pain. It is anticipated that this study will provide data to elucidate the impact of mirogabalin treatment, in combination with conventional therapy, to benefit patients with neuropathic pain following thoracic surgery. Trial Registration Japan Registry of Clinical Trials Identifier: jRCTs071200053.
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Affiliation(s)
- Ryoichiro Doi
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takuro Miyazaki
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomoshi Tsuchiya
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Keitaro Matsumoto
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Koichi Tomoshige
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ryusuke Machino
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Satoshi Mizoguchi
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takamune Matsumoto
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Keita Yamaguchi
- Oncology Medical Science Department, Daiichi Sankyo Co., Ltd., Tokyo, Japan
| | - Hiroshi Takatsuna
- Primary Medical Science Department, Daiichi Sankyo Co., Ltd., Tokyo, Japan
| | | | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Lopes A, Seligman Menezes M, Antonio Moreira de Barros G. Chronic postoperative pain: ubiquitous and scarcely appraised: narrative review. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2021; 71:649-655. [PMID: 34715995 PMCID: PMC9373680 DOI: 10.1016/j.bjane.2020.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/26/2020] [Accepted: 10/31/2020] [Indexed: 11/21/2022]
Abstract
The International Association for the Study of Pain chose pain prevention as the theme for the 2020 Global Year. Chronic postoperative pain is one the many types of pain that can be potentially prevented. It develops or increases in severity after a surgery, persists for at least three months, even after ruling out all other possible causes of pain. To perform the present narrative review, the authors searched the PubMed database using the following keywords "postoperative pain" OR "postsurgical pain" AND "chronic" OR "persistent". The present review focused on the incidence, pain development and chronification, and predisposing factors. It also discusses prevention, diagnosis, and treatment of chronic postoperative pain. Awareness of occurrence of chronic postoperative pain and recognizing risk factors is crucial for the day-to-day practice of the anesthesiologist. Hence, numerous surgical patients can have their outcome improved by preventing chronic postoperative pain, a condition scarcely identified and without a well-established treatment.
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Affiliation(s)
- Alexandre Lopes
- Universidade Estadual Paulista (UNESP), Departamento de Especialidades Cirúrgicas e Anestesiologia, Botucatu, SP, Brazil.
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Cansever L, Sezen CB, Yaran OV, Duman S, Seyrek Y, Hatipoğlu M, Öneş K, Bedirhan MA. The effect of transcutaneous electric nerve stimulation on chronic postoperative pain and long-term quality of life. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2021; 29:496-502. [PMID: 35096447 PMCID: PMC8762903 DOI: 10.5606/tgkdc.dergisi.2021.19800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/10/2020] [Indexed: 06/14/2023]
Abstract
BACKGROUND This study aims to investigate the effects of transcutaneous electrical nerve stimulation on early-stage postoperative pain and long-term quality of life in patients undergoing thoracotomy. METHODS Between January 2019 and September 2019, a total of 100 patients (76 males, 24 females; mean age: 57.9±11.9 years; range, 51 to 79 years) who underwent thoracotomy due to benign or malignant lesions were included. The patients were divided into two groups: 50 patients who received transcutaneous electrical nerve stimulation (Group 1) and a control group of 50 patients who did not receive transcutaneous electrical nerve stimulation (Group 2). The Short Form-36 life quality scale was used to evaluate patients' quality of life at one month before and after surgery. RESULTS The mean length of hospital stay was 4.9±3.1 days in Group 1 and 6.2±4.6 days in Group 2 (p=0.008). There were no statistically significant differences in early-stage postoperative pain scores between the groups (p>0.05). Compared to Group 2, Group 1 had significantly lower pain scores and higher life quality scores pre- and postoperatively (p<0.05). CONCLUSION Transcutaneous electrical nerve stimulation is an effective method to manage chronic pain in the postoperative period. On the other hand, it does not effectively reduce early-stage postoperative pain or affect complication rates. The prevention of chronic postoperative pain by transcutaneous electrical nerve stimulation improves long-term quality of life of patients.
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Affiliation(s)
- Levent Cansever
- Department of Thoracic Surgery, University of Health Sciences, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Celal Buğra Sezen
- Department of Thoracic Surgery, University of Health Sciences, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Onur Volkan Yaran
- Department of Thoracic Surgery, University of Health Sciences, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Salih Duman
- Department of Thoracic Surgery, Istanbul University Istanbul Medical School, Istanbul, Turkey
| | - Yunus Seyrek
- Department of Thoracic Surgery, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Merve Hatipoğlu
- Department of Thoracic Surgery, Ankara City Hospital, Ankara, Turkey
| | - Kadriye Öneş
- Department of Thoracic Surgery, University of Health Sciences, Istanbul Physical Therapy Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Ali Bedirhan
- Department of Thoracic Surgery, University of Health Sciences, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
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Capsaicin 8% Patch and Chronic Postsurgical Neuropathic Pain. J Pers Med 2021; 11:jpm11100960. [PMID: 34683101 PMCID: PMC8537698 DOI: 10.3390/jpm11100960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 09/23/2021] [Accepted: 09/25/2021] [Indexed: 01/19/2023] Open
Abstract
(1) Background: Surgery is a frequent cause of persistent pain, defined chronic post-surgical pain (CPSP). The capsaicin 8% patch (Qutenza®) is approved for the treatment of postherpetic neuralgia (PHN) and for diabetic peripheral neuropathy (DPN) of the feet. We propose a review of the literature on use of the capsaicin 8% patch to treat neuropathic pain associated with surgery; (2) Methods: We identified the articles by searching electronic databases using a combination of such terms as “capsaicin 8% patch”, “Qutenza®”, and “chronic postsurgical pain”; (3) Results: We identified 14 selected studies reporting on a total of 632 CPSP cases treated with capsaicin 8% patch. Treatment with the capsaicin 8% patch significantly reduced the average pain intensity. Only 5 studies reported adverse events (AEs) after the patch application. The most common AEs were erythema, burning sensation and pain; (4) Conclusions: Our review indicate that capsaicin 8% patch treatment for CPSP is effective, safe and well tolerated, but randomized controlled trials on efficacy, safety and tolerability should be conducted.
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Abstract
Targeted muscle reinnervation (TMR) is the surgical rerouting of severed nerve endings to nearby expendable motor nerve branches. These nerve transfers provide a pathway for axonal growth, limiting the amputated nerve ends' disorganized attempt at regeneration that leads to neuroma formation. In the amputee population, TMR is successful in the treatment and prevention of chronic phantom limb pain and residual limb pain. In the nonamputee population, applications of TMR are ever expanding in the treatment of chronic neuroma pain owing to trauma, compression, or surgery. This article reviews the indications for TMR, preoperative evaluation, and various surgical techniques.
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Li Q, Dai W, Chen X, Su D, Yu W, Gu X. Publication Trends and Hot Spots in Chronic Postsurgical Pain (CPSP) Research: A 10-Year Bibliometric Analysis. J Pain Res 2021; 14:2239-2247. [PMID: 34321922 PMCID: PMC8313379 DOI: 10.2147/jpr.s300744] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 07/03/2021] [Indexed: 12/14/2022] Open
Abstract
Purpose Aging populations and increasing quality of life requirements have attracted growing efforts to study chronic postsurgical pain (CPSP). However, a diverse range of factors are involved in CPSP development, which complicates efforts to predict and treat this disease. To advance research in this field, our study aimed to use bibliometric analysis to quantitatively and qualitatively evaluate CPSP research and predict research hot spots over the last 10 years. Methods Relevant publications between 2011 and 2020 were extracted from the Web of Science Core Collection database. CiteSpace software (v5.7.R2) and the Online Analysis Platform of Literature Metrology were used to analyze research attributes including countries and authors, keywords and co-occurrence, and burst detection to predict trends and hot spots. Results A total of 2493 publications were collected with the number of annual publications showing nearly threefold increase over the past decade. Articles were the primary publication type with the United States as the leading country and the center of national collaboration. Johns Hopkins University provided the leading influence within the CPSP field. Postoperative pain, multimodal analgesia, quality of life, opioid, microglia, cesarean delivery, inguinal hernia, chronification, genetic polymorphism, and lidocaine were the top 10 clusters in co-occurrence cluster analysis. Moreover, burst detection was shown that epidural analgesia, nerve injury, total hip arthroplasty were the new hot spots within the CPSP field. Conclusion Bibliometric mapping not only defined the overall structure of CPSP-related research but its collective information provides crucial assistance to direct ongoing research efforts. The prominent keywords including "risk factor" and "multimodal analgesia" indicate that CPSP prevention and new treatment methods remain hot spots. Nonetheless, the recognition that CPSP is complex and changeable, proposes comprehensive biopsychosocial approaches are needed, and these will be essential to improve CPSP interventions and outcomes.
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Affiliation(s)
- Qi Li
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127, People's Republic of China
| | - Wanbing Dai
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127, People's Republic of China
| | - Xuemei Chen
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127, People's Republic of China
| | - Diansan Su
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127, People's Republic of China
| | - Weifeng Yu
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127, People's Republic of China
| | - Xiyao Gu
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127, People's Republic of China
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Yu Y, Cui L, Qian L, Lei M, Bao Q, Zeng Q, Chen Z, Xu S, Xie J. Efficacy of Perioperative Intercostal Analgesia via a Multimodal Analgesic Regimen for Chronic Post-Thoracotomy Pain During Postoperative Follow-Up: A Big-Data, Intelligence Platform-Based Analysis. J Pain Res 2021; 14:2021-2028. [PMID: 34262336 PMCID: PMC8274524 DOI: 10.2147/jpr.s303610] [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: 04/08/2021] [Accepted: 06/21/2021] [Indexed: 11/24/2022] Open
Abstract
Background Chronic post-thoracotomy pain is still an obstacle for lung-cancer patients even after less invasive surgical procedures. It is unclear whether intercostal analgesia is as useful in the prevention of postoperative chronic pain as it is for acute pain for video-assisted thoracoscopic surgery (VATS). The purpose of this study was to evaluate the efficacy of perioperative intercostal analgesia for chronic pain via a multimodal analgesic regimen for VATS during 6 months of postoperative follow-up. Methods We identified 837 cases of VATS from August 2016 to August 2018. Patients were treated by perioperative intercostal analgesia with 0.75% ropivacaine 50 mg through the intercostal catheter every 8 hours until chest tube extubation (INA group) or conventional analgesia with preoperative 0.75% ropivacaine 50 mg at incision once (CON group). Numerical rating scale (NRS) and neuropathic pain were evaluated in 6 months of post-surgery follow-up. Postoperative adverse effects were recorded. Results In total, there were 419 patients in INA group and 418 patients in CON group. Scores of NRS with motion was lower in INA group at 3 postoperative days (P = 0.032). Occurrence of chronic pain was 28.4% in INA group and 32.8% in CON group at 6 postoperative months, 10.6% of patients experienced increasing pain from 3 to 6 months. Occurrence of considerable neuropathic pain (ID pain score ≥ 2) was 2.1% in INA group and 3.1% in CON group at 6 postoperative months. No differences were found between the two groups. Occurrence of numbness was lower in INA group (6.7% vs 10.5%, P = 0.031), and other pain symptoms did not differ between the groups. The incidence of dizziness, nausea, vomiting and atelectasis was not different between the two groups. Conclusion In a multimodal analgesic regimen of VATS, perioperative intercostal analgesia with 0.75% ropivacaine infusion 50 mg three times in a day does not have an obvious effect on chronic post-thoracotomy pain.
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Affiliation(s)
- Yijin Yu
- Department of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Lingyan Cui
- Department of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Lu Qian
- Department of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Min Lei
- Department of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Qi Bao
- Department of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Qingxin Zeng
- Department of Thoracic Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Zhao Chen
- Department of Thoracic Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Shaohua Xu
- Department of Thoracic Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Junran Xie
- Department of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
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Huckhagel T, Westphal M, Klinger R. The Impact of Surgery-Related Muscle Injury on Prevalence and Characteristics of Acute Postcraniotomy Headache - A Prospective Consecutive Case Series. J Neurol Surg A Cent Eur Neurosurg 2021; 83:242-251. [PMID: 34192783 DOI: 10.1055/s-0041-1725958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVE The latest third edition of the International Classification of Headache Disorders delineates diagnostic criteria for acute headache attributed to craniotomy (AHAC), but data on possible predisposing factors are sparse. This prospective observational study aims to evaluate the impact of surgery-related muscle incision on the prevalence, severity, and characteristics of AHAC. PATIENTS AND METHODS Sixty-four consecutive adults (mean age: 54.2 ± 15.2 years; 26 males and 38 females) undergoing cranial neurosurgery for various reasons without preoperative headache were included. After regaining consciousness, all patients reported their average daily headache on a numeric pain rating scale (NRS; range: 0-10), headache characteristics, as well as analgesic consumption from day 1 to 3 after surgery. Three distinct patient cohorts were built with respect to the surgical approach (craniotomy ± muscle incision; burr hole surgery) and group comparisons were performed. Additionally, patients with AHAC ≥ 3 NRS were reevaluated at 7.2 ± 2.3 months following treatment by means of standardized questionnaires to determine the prevalence of persistent headache attributed to craniotomy as well as headache-related disability and quality of life. RESULTS Thirty of 64 (46.9%) patients developed moderate to severe AHAC (NRS ≥ 3) after cranial neurosurgery. There were no significant group differences with regard to age, gender, or general health condition (American Society of Anesthesiologists Physical Status Classification). Craniotomy patients with muscle incision suffered from significantly higher early postoperative mean NRS scores compared with their counterparts without procedure-related muscle injury (3.4 ± 2.3 vs. 2.3 ± 1.9) as well as patients undergoing burr hole surgery (1.2 ± 1.4; p = 0.02). Moreover, the consumption of nonopioid analgesics was almost doubled following muscle-transecting surgery as compared with muscle-preserving procedures (p = 0.03). Young patient age (odds ratio/95% confidence interval for each additional year: 0.93/0.88-0.97) and surgery-related muscle injury (5.23/1.62-19.41) were identified as major risk factors for the development of AHAC ≥ 3 NRS. There was a nonsignificant trend toward higher pain chronification rate as well as headache-related disability after craniotomy with muscle injury. CONCLUSION Surgery-related muscle damage may be an important predisposing factor for AHAC. Therefore, if a transmuscular approach is unavoidable, the neurosurgeon should be aware of the need for adequately adjusted intra- and postoperative analgesia in these cases.
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Affiliation(s)
- Torge Huckhagel
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Regine Klinger
- Department of Anesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Perioperative factors associated with persistent post-surgical pain after hysterectomy, cesarean section, prostatectomy, and donor nephrectomy: a systematic review and meta-analysis. Pain 2021; 163:425-435. [PMID: 34121077 DOI: 10.1097/j.pain.0000000000002361] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/04/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Persistent postsurgical pain (PPSP) is a common, and often disabling postoperative morbidity, but many questions remain about factors associated with PPSP. This systematic review and meta-analysis aimed to identify preoperative, intraoperative and postoperative factors associated with PPSP after gynecological surgeries, namely hysterectomy and cesarean section (C-section), and urological surgeries, namely prostatectomy and donor nephrectomy. Overall, 18 gynecological surgery studies, 4 prostatectomy studies, and 2 donor nephrectomy studies met the review criteria providing data that could be meta-analyzed. Average (±SD) PPSP occurrence after gynecological surgery was 20±11%; factors associated with increased risk of PPSP included smoking, preoperative abdominal or pelvic pain, preoperative pain elsewhere in the body, longer duration of surgery, more intense acute postoperative pain, and surgical wound infection. The use of neuraxial anesthesia was associated with decreased PPSP risk. Average PPSP occurrence was 20±9% after prostatectomy and 15±2% after donor nephrectomy. For urological procedures, the existing data did not allow for identification of significant factors associated with PPSP, except for laparoscopic and hand assisted laparoscopic approaches that were associated with lower incidence of PPSP for donor nephrectomy, and the use of neuraxial anesthesia which was associated with lower incidence of PPSP after prostatectomy. PPSP after gynecological and urological surgeries is common. This systematic review identified important factors associated with C-section and hysterectomy that can help identify women who are at high risk of PPSP. More high-quality studies with consistent methodology are needed to understand the factors associated with PPSP risk, particularly for surgeries such as prostatectomy and nephrectomy.
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Morin C, Patel Y, Javid M, Tevis SE, Fortes T, Flom P, Andaz C, Manasseh DM, Borgen P, Rojas KE. Opioid-Sparing Multimodal Analgesia Protocol for Lumpectomy Patients Results in Superior Postoperative Pain Control. Ann Surg Oncol 2021; 28:5855-5864. [PMID: 34076809 PMCID: PMC8170864 DOI: 10.1245/s10434-021-09963-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/03/2021] [Indexed: 11/27/2022]
Abstract
Background We sought to determine if lumpectomy patients who received perioperative opioid-sparing multimodal analgesia reported less pain when compared with those who received traditional opioid-based care. Study Design A prospective cohort of patients undergoing lumpectomy who received an opioid-sparing multimodal analgesia protocol [no opioids group (NOP)] was compared with a large cohort of patients who received traditional care [opioids group (OG)]. In-hospital and discharge opioids were compared using oral morphine equivalents (OMEs). Postoperative day one and week one pain scores were compared using the Kruskal–Wallis test. Results Overall, 1153 patients underwent lumpectomy: 634 patients received the protocol (NOP), and 519 patients did not (OG). Median pain scores were significantly lower in the NOP cohort when compared with the OG cohort the day after surgery (2 vs. 0, p < 0.001) and the week after surgery (1 vs. 0, p < 0.001). NOP patients were significantly less likely to report severe pain (7–10 on a 10-point scale) the day after surgery compared with OG patients (15.7% vs. 6.9%, p = 0.004). Patients in the NOP cohort were discharged with a median of zero OMEs (range 0–150), while patients in the OG were discharged with a median of 90 OMEs (range 0–360; p < 0.001). Conclusion Implementation of an opioid-sparing multimodal analgesia protocol for lumpectomy patients resulted in superior pain control without a routine opioid prescription. Surgeons can improve their own patients’ outcomes while addressing the larger societal issue of the opioid crisis by adopting similar protocols that decrease the quantity of opioids available for diversion.
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Affiliation(s)
- Claudya Morin
- Department of Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Yamini Patel
- Department of Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Munazza Javid
- Department of Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Sarah E Tevis
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Peter Flom
- Peter Flom Statistical Consulting, New York City, NY, USA
| | | | | | - Patrick Borgen
- Department of Surgery, Maimonides Medical Center, Brooklyn, NY, USA.
| | - Kristin E Rojas
- Dewitt-Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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Karsalia M, Zhang T, Aneizi A, Foster MJ, Schneider MB, Sajak PM, Nadarajah V, Meredith SJ, Henn RF. Predictors of postoperative pain using PROMIS pain interference two-years following knee surgery. J Orthop 2021; 25:271-277. [PMID: 34099956 DOI: 10.1016/j.jor.2021.05.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/09/2021] [Indexed: 12/11/2022] Open
Abstract
Introduction The purpose of this study was to identify preoperative factors associated with worse PROMIS Pain Interference (PI) two years following knee surgery. Methods Participants completed surveys preoperatively and two years postoperatively. Data collected included demographics, medical history, and multiple patient-reported outcomes measures, including PROMIS PI. Results After controlling for confounders, lower income, smoking, worse PROMIS Anxiety, worse Numeric Pain Score body pain, and worse Marx Activity Rating Scale were independent predictors for worse PROMIS PI two years after surgery. Conclusion Worse PROMIS PI two years after elective knee surgery is associated with multiple socio-demographic patient identifiers.
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Affiliation(s)
- Moli Karsalia
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tina Zhang
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ali Aneizi
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Michael J Foster
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Matheus B Schneider
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Patrick Mj Sajak
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Vidushan Nadarajah
- Department of Orthopedic Surgery and Rehabilitation, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Sean J Meredith
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
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Amoretti N, Dalili D, Palominos D, Cornelis F, Theumann N, Cifrian-Perez M, Foti P, Rudel A, Olivier H, Gallo G. Percutaneous discectomy under CT and fluoroscopy guidance: an international multicentric study. Neuroradiology 2021; 63:1135-1143. [PMID: 33783556 DOI: 10.1007/s00234-021-02633-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 01/05/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the technical efficacy, safety, and reproducibility of automated percutaneous lumbar discectomy (APLD) under CT and fluoroscopic guidance, for treating radiculopathy caused by lumbar disc herniation in patients impervious to conservative treatment. METHODS A total of 77 patients with symptomatic lumbar disc herniation were treated with APLD in a prospective multicentric study performed in four centers across three countries. Magnetic resonance imaging and/or computed tomography was used to evaluate the disc herniation before and after the procedure. Only local anesthesia was used during these procedures. Clinical outcomes were measured with the visual analog scale (VAS) for pain at one and 6 months after the procedure. RESULTS Technical success rate was 100% with a mean intervention duration of 30 min (15-45 min). No complications occurred during the procedure. Post-lumbar puncture syndrome occurred in three patients who were successfully treated with blood patches. VAS decreased from a mean of 8 before the intervention to 3 1 month after (p value = 0.001). The requirement for analgesia decreased from 100 to 27%. No statistically significant differences in outcomes were found between the centers. CONCLUSION APLD with dual imaging guidance under local anesthesia is a safe, feasible, and reproducible technique to treat symptomatic lumbar disc herniation.
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Affiliation(s)
- Nicolas Amoretti
- Department of Radiology, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, 30 VoieRomaine, 06000, Nice, France.
| | - Danoob Dalili
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Rd, Oxford, OX3 7LD, UK.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Diego Palominos
- Department of Radiology, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, 30 VoieRomaine, 06000, Nice, France
| | | | - Nicolas Theumann
- Department of Radiology, Centre Hospitalier Universitaire de Lausanne, Lausanne, France
| | - Manuel Cifrian-Perez
- Department of Radiology, Micro Invasive Intervention, Valencia Hospital Universitario y Politecnico la Fe, Valencia, Spain
| | - Pauline Foti
- Department of Radiology, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, 30 VoieRomaine, 06000, Nice, France
| | - Alexandre Rudel
- Department of Radiology, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, 30 VoieRomaine, 06000, Nice, France
| | - Hauger Olivier
- Department of Radiology, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Giacomo Gallo
- Department of Radiology, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, 30 VoieRomaine, 06000, Nice, France
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Chang WS, Hsieh YT, Chen MC, Chang SC, Chen TS, Chang YC, Tsai YC, Lam CF. Characterization of self-anticipated pain score prior to elective surgery - a prospective observational study. BMC Anesthesiol 2021; 21:85. [PMID: 33740887 PMCID: PMC7977573 DOI: 10.1186/s12871-021-01303-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 03/10/2021] [Indexed: 12/05/2022] Open
Abstract
Background Current principles of postoperative pain management are primarily based on the types and extent of surgical intervention. This clinical study measured patient’s self-anticipated pain score before surgery, and compared the anticipated scores with the actual pain levels and analgesic requirements after surgery. Methods This prospective observational study recruited consecutive patients who received elective surgery in the E-Da Hospital, Taiwan from June to August 2018. Patients were asked to subjectively rate their highest anticipated pain level (numeric rating scale, NRS 0–10) for the scheduled surgical interventions during their preoperative anesthesia assessment. After the operation, the actual pain intensity (NRS 0–10) experienced by the patient in the post-anesthesia care unit and the total dose of opioids administered during the perioperative period were recorded. Pain scores ≥4 on NRS were regarded as being unacceptable levels for anticipated or postoperative pain that required more aggressive intervention. Results A total of 996 patients were included in the study. Most of the patients (86%) received general anesthesia and 73.9% of them had a history of previous operation. Female anticipated significantly higher overall pain intensities than the male patients (adjusted odd ratio 1.523, 95% confidence interval 1.126–2.061; P = 0.006). Patients who took regular benzodiazepine at bedtime (P = 0.037) and those scheduled to receive more invasive surgical procedures were most likely to anticipate for higher pain intensity at the preoperative period (P < 0.05). Higher anticipated pain scores (preoperative NRS ≥ 4) were associated with higher actual postoperative pain levels (P = 0.007) in the PACU and higher total equivalent opioid use (P < 0.001) for acute pain management during the perioperative period. Conclusion This observational study found that patients who are female, use regular benzodiazepines at bedtime and scheduled for more invasive surgeries anticipate significantly higher surgery-related pain. Therefore, appropriate preoperative counseling for analgesic control and the management of exaggerated pain expectation in these patients is necessary to improve the quality of anesthesia delivered and patient’s satisfaction. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-021-01303-y.
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Affiliation(s)
- Wei-Shu Chang
- Department of Anesthesiology, E-Da Hospital and E-Da Cancer Hospital, Kaohsiung, Taiwan
| | - Yi-Ting Hsieh
- Department of Anesthesiology, E-Da Hospital and E-Da Cancer Hospital, Kaohsiung, Taiwan
| | - Moa-Chu Chen
- Department of Anesthesiology, E-Da Hospital and E-Da Cancer Hospital, Kaohsiung, Taiwan
| | - Shu-Ching Chang
- Department of Anesthesiology, E-Da Hospital and E-Da Cancer Hospital, Kaohsiung, Taiwan
| | - Tzu-Shan Chen
- Department of Medical Research, E-Da Hospital and E-Da Cancer Hospital, Kaohsiung, Taiwan.,Department of Medical Imaging and Radiological Sciences, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Yun-Chi Chang
- Department of Anesthesiology, E-Da Hospital and E-Da Cancer Hospital, Kaohsiung, Taiwan
| | - Yu-Chuan Tsai
- Department of Anesthesiology, E-Da Hospital and E-Da Cancer Hospital, Kaohsiung, Taiwan
| | - Chen-Fuh Lam
- Department of Anesthesiology, E-Da Hospital and E-Da Cancer Hospital, Kaohsiung, Taiwan. .,School of Medicine, I-Shou University College of Medicine, Kaohsiung, Taiwan.
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