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Shanthanna H, Wang L, Paul J, Lovrics P, Devereaux PJ, Bhandari M, Thabane L. A prospective cohort study of chronic postsurgical pain after ambulatory surgeries. Curr Med Res Opin 2024; 40:1187-1193. [PMID: 38809229 DOI: 10.1080/03007995.2024.2360128] [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: 11/09/2023] [Accepted: 05/22/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVE The incidence and factors associated with chronic postsurgical pain (CPSP) after ambulatory surgeries have not been well studied. Our primary objective was to determine the incidence of CPSP and secondary objectives included assessment of intensity of CPSP, incidence of moderate-to-severe CPSP, and exploration of factors associated with CPSP. METHODS This is a prospective cohort study of ambulatory surgery patients having procedures with a potential to cause moderate-to-severe postoperative pain. All patients had participated in a randomized controlled trial (RCT) showing no difference in achieving satisfactory analgesia in a recovery unit with either morphine or hydromorphone. CPSP was defined as chronic pain that developed or increased in intensity after the surgical procedure and is localized to the surgical field or within the innervation territory of a nerve in the surgical field, and has persisted for 3 months post-surgery, with the exclusion of other causes of pain. Incidences of CPSP were reported as rate (%) with 95% CI, and intensity using a 0-10 numerical rating scale (95% CI). We used logistic regression to explore factors associated with CPSP adjusting for baseline catastrophizing and depression. RESULTS Among 402 RCT patients, 208 provided data for the 3-month outcome. Incidence of CPSP was 18.8% (39/208), 95% CI = 13.7%-24.7% and 78% (28/39) of them had moderate-to-severe CPSP. Average CPSP intensity was 5.5, 95% CI = 4.7-6.4. Every unit increase in pain over the first 24 h was significantly associated with increased odds of moderate-to-severe CPSP at 3 months; odds ratio = 1.28, 95% CI = 1.04-1.58. CONCLUSIONS Nearly one in five patients develop CPSP after ambulatory surgeries with the majority of them having moderate-to-severe pain. Considering that acute pain after discharge is associated with CPSP and that there are no formal care pathways to address this need, studies need to focus on evaluating feasible strategies to provide continuing care.
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Affiliation(s)
- Harsha Shanthanna
- Department of Anesthesia, St Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - Li Wang
- Department of Anesthesia, St Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - James Paul
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Peter Lovrics
- Department of Surgery, St Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - P J Devereaux
- Departments of Health Research Methods, Evidence, and Impact and Medicine, McMaster University, Hamilton, ON, Canada
| | - Mohit Bhandari
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Departments of Health Research Methods, Evidence, and Impact and Medicine, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
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Djote SM, Muhie DA, Alemayehu GD. Advancing laparoscopy in resource-limited settings. BMC Surg 2024; 24:98. [PMID: 38532330 DOI: 10.1186/s12893-024-02387-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/12/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Although laparoscopic surgery has made remarkable progress and become the standard approach for various surgical procedures worldwide over the past 30 years, its establishment in low-resource settings, particularly in public hospitals, has been challenging. The lack of equipment and trained expertise has hindered its widespread adoption in these settings. Cholecystectomy is one of the most commonly performed procedures using laparoscopy world wide AIM: The aim of the study is to determine whether laparoscopic cholecystectomy is feasible in a resource challenged setting METHODS: The research focused on individuals who underwent laparoscopic or open cholecystectomies at Yekatit 12 Hospital in Addis Ababa, Ethiopia, over a one-year period. Comprehensive data collection was conducted prospectively, encompassing both intraoperative and postoperative parameters. Follow-up was carried out via phone calls. The surgical procedures employed innovative techniques, including the reuse of sterilized single-use equipment and the utilization of local resources. The evaluation involved a comparison of demographic information, intraoperative details (such as critical view determination and operative duration), and postoperative complications, including assessments of pain and wound infections RESULTS: From August 2021 to September 2022, 119 patients were assessed. Among these patients, 65 (54.6%) underwent open cholecystectomies, while the remaining 54 (45.4%) underwent laparoscopic cholecystectomies. The average duration of the laparoscopic cholecystectomies was 90.7 min, which is 17.7 min behind the open. Patients in the laparoscopy group had significantly shorter hospital stays than the open group, and 94% were discharged by post operative day 2. The conversion rate from laparoscopic to open surgery was determined to be 3.3% CONCLUSION: To sum up, the safe execution of laparoscopic cholecystectomies is feasible in public hospitals and settings with limited resources, given adequate training and resource distribution. The study findings showcased superior outcomes, including reduced hospitalization duration and fewer complications, while maintaining comparable levels of operative duration and patient satisfaction in both groups.
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Affiliation(s)
- Surafel Mulatu Djote
- Department of Surgery, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia.
- Asan Medical Center Division of Colorectal Surgery, Seoul, South Korea.
| | - Daniel Ahmed Muhie
- Department of Surgery, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
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Husni M, Jahrami H, Al Shenawi H, Alenenzi SF, Alhawas FN, Asiri MA, Haider F, Alanazi AF, Yaghan RJ. Postoperative Patient Pain Severity and Its Association With Anxiety, Depression, and Sleep Quality. Cureus 2024; 16:e54553. [PMID: 38516489 PMCID: PMC10955440 DOI: 10.7759/cureus.54553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2024] [Indexed: 03/23/2024] Open
Abstract
Introduction The experience of pain is a complex phenomenon. A patient in the acute postsurgical pain setting may feel a constant bombardment of nociceptive input from the surgical site; this in turn influences psychological factors that determine the overall emotional experience of pain, which is significant. The aim of our study was to investigate the severity of pain in postsurgical patients three days after surgery using the 100 mm visual analog scale (VAS). Methods This was a cross-sectional assessment of postoperative pain. Participants were patients between 18 and 64 years of age who had undergone a surgical procedure (laparoscopic or open surgery), three days prior to the data collection and who were admitted or discharged postoperatively at the Al Salmaniya Complex, Manama, Bahrain. Participants were asked demographic questions about whether they had laparoscopic or open surgeries and completed self-reporting scales. Patient Health Questionnaire-9 (PHQ-9) was utilized to screen for both the presence and severity of depression; Generalized Anxiety Disorder 7-item (GAD-7) was administered to screen for anxiety; the Insomnia Severity Index (ISI) was used to evaluate insomnia; and the VAS was used to evaluate pain. Results Sixty-seven patients were recruited, with a mean age of 61.53 years (SD = 7.37). Twenty-nine (43%) were females, 38 (57%) were males, 36 (54%) underwent elective surgery, 31 (46%) underwent emergency surgery, 31 (46%) underwent laparoscopic surgery, and 36 (54%) underwent open surgery. The average score on the Brief Pain Inventory Short Form (BPISF) was 8.12 (SD = 1.16), indicating a moderate level of pain. Twenty-six (43%) patients had moderate-severe insomnia, 21 participants (31%) had no insomnia, 17 participants (25%) had subthreshold insomnia, 28 (42%) had moderate depression, five (7%) had moderate-severe depression, and 34 (51%) had severe depression. Eighteen participants (27%) had mild anxiety, 46 (69%) had moderate anxiety, and 3 (4%) had severe anxiety. Six of the participants (9%) reported moderate pain, while 61 participants (91%) reported severe pain.
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Affiliation(s)
- Mariwan Husni
- Psychiatry, Arabian Gulf University, Manama, BHR
- Psychiatry, Northern Ontario School of Medicine University, Thunder Bay, CAN
| | | | | | | | | | | | - Fayza Haider
- Pediatric Surgery, Salmaniya Medical Complex, Manama, BHR
| | | | - Rami J Yaghan
- Surgery, Arabian Gulf University, Manama, BHR
- Surgery and Urology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, JOR
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Nair AS, Rangaiah M, Dudhedia U, Borkar NB. Analgesic Efficacy and Outcomes of Ultrasound-guided Erector Spinae Plane Block in Patients Undergoing Bariatric and Metabolic Surgeries: A Systematic Review. J Med Ultrasound 2023; 31:178-187. [PMID: 38025009 PMCID: PMC10668896 DOI: 10.4103/jmu.jmu_112_22] [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: 11/08/2022] [Revised: 12/11/2022] [Accepted: 12/21/2022] [Indexed: 12/01/2023] Open
Abstract
Erector spinae plane block (ESPB) has been used as an intervention for providing postoperative analgesia in patients undergoing bariatric and metabolic surgeries. After registering the protocol in PROSPERO, randomized controlled trials and nonrandomized observational studies were searched in various databases till July 2022. The primary outcome was 24-h opioid consumption; the secondary outcomes were intraoperative opioid use, pain scores, time to rescue analgesia, and complications. The risk of bias and Newcastle-Ottawa scale were used to assess the quality of evidence. From the 695 studies identified, 6 studies were selected for analysis. The 24-h opioid consumption was significantly lesser in ESPB group when compared to control (mean difference [MD]: -10.67; 95% confidence interval [CI]: -21.03, -0.31, I² = 99%). The intraoperative opioid consumption was significantly less in the ESPB group (MD: -17.75; 95% CI: -20.36, -15.13, I² = 31%). The time to rescue analgesia was significantly more in the ESPB group (MD: 114.36; CI: 90.42, 138.30, I² = 99%). Although pain scores were significantly less at 6 and 24 h in ESPB group (MD: -2.00, 95% CI: -2.49, -1.51; I² = 0% and MD: -0.48; 95% CI: -0.72, -0.24; I² = 48%), at zero and 12 h, the pain scores were comparable (MD: -1.53, 95% CI: -3.06, -0.00, I² = 97% and MD: -0.80; 95% CI: -1.80, 0.20, I² = 88%). Bilateral ESPB provides opioid-sparing analgesia and better pain scores when compared to control. These results should be interpreted with caution due to high heterogeneity among the included studies.
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Affiliation(s)
- Abhijit Sukumaran Nair
- Department of Anaesthesiology, IBRA Hospital, Ministry of Health-Oman, Ibra, Sultanate of Oman
| | - Manamohan Rangaiah
- Department of Anaesthetics and Pain Management, Walsall Manor Hospital, Walsall, United Kingdom
| | - Ujjwalraj Dudhedia
- Department of Anaesthesiology and Pain Management, Dr. L. H. Hiranandani Hospital, Mumbai, Maharashtra, India
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Nguyen TH, Ta NT, Dang AK, Nguyen TT, Dam VAT, Latkin CA, Ho CSH, Ho RCM. A longitudinal assessment of appetite loss and nutritional care among postoperative patients in Vietnam. Front Nutr 2023; 10:1008636. [PMID: 37032772 PMCID: PMC10076707 DOI: 10.3389/fnut.2023.1008636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 03/03/2023] [Indexed: 04/11/2023] Open
Abstract
Background Post-operative appetite loss is an important complication affecting surgical outcomes. It has been estimated that nearly 60% of patients having gastrointestinal or major elective surgeries suffer from malnutrition. Appetite refers to the physical desire for food appetite, and losing appetite after surgery may result in a decrease in body weight, impairment of intestinal absorption and eventually, malnutrition among postoperative patients. This study aims to assess appetite status and other relevant factors among abdominal postoperative patients in Vietnam. Methods A cross-sectional study was conducted on 169 abdominal postoperative patients from June 1st to August 30th, 2016 at Hanoi Medical University Hospital, Hanoi, Vietnam. Appetite score was computed by using the Council on Nutrition Appetite Questionnaire (CNAQ). This study used GEE to account for the potential correlation of outcomes of the longitudinal assessment, assuming an independent correlation structure. Results The primary and secondary outcome measures: highest average appetite score was recorded in the preoperative day and the score declined throughout seven-day duration. Patients who were female, under general anesthetics and being under open surgery tended to get lower appetite scores. The majority of patients had moderate to good appetite in both the preoperative day and seven days post-operation. Conclusion Women should receive more care and help in regaining their appetite after surgery. Treatment for appetite loss through non-pharmaceutical measures should be prioritized. Interventions that increase the appetite of patients after abdominal surgery should be targeted on patients being under general anesthetic as well as open surgery and be undertaken with caution.
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Affiliation(s)
- Tu Huu Nguyen
- Faculty of Nursing and Midwifery, Hanoi Medical University, Hanoi, Vietnam
| | - Nguyet Thi Ta
- Faculty of Nursing and Midwifery, Hanoi Medical University, Hanoi, Vietnam
| | - Anh Kim Dang
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Tham Thi Nguyen
- Institute for Global Health Innovations, Duy Tan University, Danang, Vietnam
- Faculty of Medicine, Duy Tan University, Danang, Vietnam
| | - Vu Anh Trong Dam
- Institute for Global Health Innovations, Duy Tan University, Danang, Vietnam
- Faculty of Medicine, Duy Tan University, Danang, Vietnam
- *Correspondence: Vu Anh Trong Dam,
| | - Carl A. Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Cyrus S. H. Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Roger C. M. Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore
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Intravenous acetaminophen for postoperative pain control after open abdominal and thoracic surgery in pediatric patients: a systematic review and meta-analysis. Pediatr Surg Int 2022; 39:7. [PMID: 36441255 DOI: 10.1007/s00383-022-05282-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/16/2022] [Indexed: 11/29/2022]
Abstract
Pediatric opioid exposure increases short- and long-term adverse events (AE). The addition of intravenous acetaminophen (IVA) to pediatric pain regimes to may reduce opioids but is not well studied postoperatively. Our objective was to quantify the impact of IVA on postoperative pain, opioid use, and AEs in pediatric patients after major abdominal and thoracic surgery. Medline, Embase, CINAHL, Web of Science, and Cochrane Library were searched systematically for randomized controlled trials (RCTs) comparing IVA to other modalities. Five RCTs enrolling 443 patients with an average age of 2.12 years (± 2.81) were included. Trials comparing IVA with opioids to opioids alone were meta-analyzed. Low to very low-quality evidence demonstrated equivalent pain scores between the groups (-0.23, 95% CI -0.88 to 0.40, p 0.47) and a reduction in opioid consumption (-1.95 morphine equivalents/kg/48 h, 95% CI -3.95 to 0.05, p 0.06) and minor AEs (relative risk 0.39, 95% CI 0.11 to 1.43, p 0.15). We conclude that the addition of IVA to opioid-based regimes in pediatric patients may reduce opioid use and minor AEs without increasing postoperative pain. Given the certainty of evidence, further research featuring patient-important outcomes and prolonged follow-up is necessary to confirm these findings.
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Sakurada T, Ueda A, Komukai D, Uchiyama K, Tsujimoto Y, Yuasa H, Ryuzaki M, Ito Y, Tomo M, Nakamoto H. Outcomes after peritoneal dialysis catheter placement by laparoscopic surgery versus open surgery: systematic review and meta-analysis. RENAL REPLACEMENT THERAPY 2019. [DOI: 10.1186/s41100-019-0232-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Bastian K, Buehler PK, Slizyte D, Rüst CA, Toft K, Studer W, Lecheler L, Aguirre J, Siegemund M, Hollinger A. A preoperative single dose of methadone for moderate-to-severely painful surgery reduces postoperative morphine consumption. Minerva Anestesiol 2019; 85:1053-1061. [DOI: 10.23736/s0375-9393.19.13136-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Hartwig M, Allvin R, Bäckström R, Stenberg E. Factors Associated with Increased Experience of Postoperative Pain after Laparoscopic Gastric Bypass Surgery. Obes Surg 2018; 27:1854-1858. [PMID: 28144798 PMCID: PMC5489569 DOI: 10.1007/s11695-017-2570-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Patients with high body mass index (BMI), pre-existing pain and young age and women seem to experience more postoperative pain. Few studies have, however, addressed these risk factors amongst obese patients undergoing bariatric surgery. The aim of the present study was to evaluate risk factors for postoperative pain following laparoscopic gastric bypass surgery. METHODS In this cohort study, we used data from the PAIN OUT register for postoperative pain during the first 24 h after surgery. Primary outcome measure was severity of pain after surgery. Multivariate analyses were conducted to evaluate BMI, young age, gender and pre-existing pain as independent risk factors for postoperative pain. RESULTS We included 192 patients in this study. Younger age (B -0.08, 95%CI -0.11 to -0.05/year; p < 0.001), female gender (B 0.92, 95%CI 0.10-1.75; p = 0.029) and pre-existing pain (B 1.06, 95%CI 0.03-2.09; p = 0.044) were all associated with an increased risk for postoperative pain. In the multivariate analyses, only young age ((adjusted OR 0.95, 95%CI 0.92-0.97/year; p < 0.001) and pre-existing pain (adjusted OR 2.56, 95%CI 1.09-6.00; p = 0.031) remained as independent risk factors for severe postoperative pain. CONCLUSION Younger age and pre-existing pain are associated with severe postoperative pain during the first 24 h after laparoscopic gastric bypass surgery, whereas female gender and high BMI are not.
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Affiliation(s)
- Markus Hartwig
- Department of Anaesthesiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Renée Allvin
- Department of Anaesthesiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Department of Anaesthesiology and Intensive care, Örebro University Hospital, Örebro, Sweden
| | - Ragnar Bäckström
- Department of Anaesthesiology and Intensive care, Örebro University Hospital, Örebro, Sweden
| | - Erik Stenberg
- Department of Surgery, Faculty of Medicine and Health, Örebro University, -70185, Örebro, SE, Sweden.
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