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Rodriguez-Materon S, Guyton GP. The Philosophy of Surgical Success and Outcomes of Cartiva Versus Fusion. Foot Ankle Clin 2024; 29:521-527. [PMID: 39068026 DOI: 10.1016/j.fcl.2023.12.001] [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] [Indexed: 07/30/2024]
Abstract
Noninferiority studies in surgery are, by their very nature, reductionist. They use multiple variables to generate a yes or no answer about the new device being tested. A binary outcome is appropriate for a regulatory agency such as the Food and Drug Administration, but the clinical situation is more nuanced. It is critical to understand the underlying philosophies and choices that go into trial design when a surgeon is recommending a new device. In the case of Cartiva, any of 3 reasonable alternative means of defining surgical success would have altered the final outcome of the MOTION trial. Additionally, using a more rigorous noninferiority margin rather than adding an additional cushion based upon the argument that motion alone had extra inherent value would have also led to failure of the trial to demonstrate noninferiority.
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Affiliation(s)
- Solangel Rodriguez-Materon
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, 3333 North Calvert Street, Suite 400, Baltimore, MD 21218, USA
| | - Gregory P Guyton
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, 3333 North Calvert Street, Suite 400, Baltimore, MD 21218, USA.
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Cata JP, Zaidi Y, Guerra-Londono JJ, Kharasch ED, Piotrowski M, Kee S, Cortes-Mejia NA, Gloria-Escobar JM, Thall PF, Lin R. Intraoperative methadone administration for total mastectomy: A single center retrospective study. J Clin Anesth 2024; 98:111572. [PMID: 39180867 DOI: 10.1016/j.jclinane.2024.111572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 06/15/2024] [Accepted: 07/29/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Breast cancer is the most frequent type of cancer and the second leading cause of cancer-related mortality in women. Mastectomies remain a key component of the treatment of non-metastatic breast cancer, and strategies to treat acute postoperative pain, a complication affecting nearly all patients undergoing surgery, continues to be an important clinical challenge. This study aimed to determine the impact of intraoperative methadone administration compared to conventional short-acting opioids on pain-related perioperative outcomes in women undergoing a mastectomy. METHODS This single-center retrospective study included adult women undergoing total mastectomy. The primary outcome of this study was postoperative pain intensity on day 1 after surgery. Secondary outcomes included perioperative opioid consumption, perioperative non-opioid analgesics use, duration of surgery and anesthesia, time to extubation, pain intensity in the postanesthesia care unit (PACU), anti-emetic use in PACU, and length of stay in hospital. We used the propensity score-based nearest matching with a 1:3 ratio to balance the patient baseline characteristics. RESULTS 133 patients received methadone, and 2192 patients were treated with short-acting opioids. The analysis demonstrated that methadone was associated with significantly lower intraoperative and postoperative opioid consumption as measured by oral morphine equivalents and lower average pain intensity scores in the postanesthesia care unit. Moreover, methadone was also shown to reduce the use of non-opioid analgesia during surgery. CONCLUSION Our study suggests that the unique pharmacological properties of methadone, including a short onset of action when given intravenously, long-acting pharmacokinetics, and multimodal effects, are associated with better acute pain management after a total mastectomy.
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Affiliation(s)
- Juan P Cata
- Department of Anesthesiology & Perioperative Medicine, MD Anderson Cancer Center, Houston, TX, United States of America; Department of Biostatistics, MD Anderson Cancer Center, Houston, TX, United States of America; Anesthesiology and Surgical Oncology Research Group, Houston, TX, United States of America.
| | - Yusuf Zaidi
- Department of Anesthesiology & Perioperative Medicine, MD Anderson Cancer Center, Houston, TX, United States of America
| | - Juan Jose Guerra-Londono
- Department of Anesthesiology & Perioperative Medicine, MD Anderson Cancer Center, Houston, TX, United States of America; Department of Biostatistics, MD Anderson Cancer Center, Houston, TX, United States of America
| | - Evan D Kharasch
- Department of Anesthesiology, Duke University, Durham, NC, United States of America
| | - Matthew Piotrowski
- Department of Breast Surgical Oncology, MD Anderson Cancer Center, Houston, TX, United States of America
| | - Spencer Kee
- Department of Anesthesiology & Perioperative Medicine, MD Anderson Cancer Center, Houston, TX, United States of America
| | - Nicolas A Cortes-Mejia
- Department of Pain Medicine, MD Anderson Cancer Center, Houston, TX, United States of America
| | - Jose Miguel Gloria-Escobar
- Department of Anesthesiology & Perioperative Medicine, MD Anderson Cancer Center, Houston, TX, United States of America
| | - Peter F Thall
- Anesthesiology and Surgical Oncology Research Group, Houston, TX, United States of America
| | - Ruitao Lin
- Department of Biostatistics, MD Anderson Cancer Center, Houston, TX, United States of America
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Knisely MR, Barnhart HX, Ibemere SO, Kavanagh P, Paice JA, Strouse JJ, Tanabe PJ. Comparison of Measures of Pain Intensity During Sickle Cell Disease Vaso-Occlusive Episodes. THE JOURNAL OF PAIN 2024:104658. [PMID: 39154808 DOI: 10.1016/j.jpain.2024.104658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 07/30/2024] [Accepted: 08/12/2024] [Indexed: 08/20/2024]
Abstract
We aimed to determine the minimal clinically important difference (MCID) in pain severity and agreement between the visual analog scale (VAS) and the verbal numeric rating scale (NRS) in people with sickle cell disease (SCD) experiencing an acute vaso-occlusive episode in the emergency department. In the COMPARE-VOE trial (NCT03933397), participants were administered the VAS (0-100), NRS (0-100), and descriptor scale (a lot better, a little better, same, a little worse, much worse) every 30 minutes while in the emergency department. We analyzed data from 100 participants (mean age 30.2 years; 61% female). We calculated the mean differences and 95% confidence intervals (CIs) between current and preceding scores when the participant reported a little worse or a little better pain for each scale (255 VAS and 150 NRS observations) to assess the MCID for the VAS and NRS. Pearson correlation and the Bland-Altman method were used to assess the agreement among 411 paired VAS and NRS observations. Our results indicated that the MCID for the VAS was 8.77 mm (95% CI: 7.43 mm, 10.83 mm) and the NRS was 8.29 (95% CI: 6.47, 11.60). The VAS and NRS scales had a correlation of .88 (P < .001). The Bland-Altman method indicated a mean difference of -4.6 ± 1.96 and the 95% limits of agreement ranged from 20 to -29. Despite high correlation, there was considerable variability of agreement between the VAS and NRS scales, indicating that these scales are not interchangeable to assess pain during a vaso-occlusive event. PERSPECTIVE: The MCID in pain severity for individuals with a SCD vaso-occlusive episode using the VAS (8.77 mm) is lower than previously reported, and the MCID for NRS was 8.29. The agreement between the VAS and NRS was determined and the scales cannot be used interchangeably to measure SCD pain intensity.
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Affiliation(s)
| | - Huiman X Barnhart
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | | | - Patricia Kavanagh
- Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Judith A Paice
- Department of Medicine, Division of Hematology & Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - John J Strouse
- Department of Medicine, Division of Hematology, Duke University School of Medicine, Durham, North Carolina
| | - Paula J Tanabe
- Duke University School of Nursing, Durham, North Carolina
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Kumaran B, Targett D, Watson T. Benefits of home-based foot neuromuscular electrical stimulation on self-reported function, leg pain and other leg symptoms among community-dwelling older adults: a sham-controlled randomised clinical trial. BMC Geriatr 2024; 24:683. [PMID: 39143586 PMCID: PMC11323382 DOI: 10.1186/s12877-024-05271-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/01/2024] [Indexed: 08/16/2024] Open
Abstract
INTRODUCTION Lower leg pain and symptoms, and poor leg circulation are common in older adults. These can significantly affect their function and quality of life. Neuromuscular electrical stimulation (NMES) applied via the feet as 'foot NMES' activates the leg musculovenous pump. This study investigated the effects of foot NMES administered at home using Revitive® among community-dwelling older adults with lower leg pain and/or other lower leg symptoms such as cramps, or sensations of tired, aching, and heavy feeling legs. METHODS A randomised placebo-controlled study with three groups (2 NMES, 1 Sham) and three assessments (baseline, week 8, week 12 follow-up) was carried out. Self-reported function using Canadian occupational performance measure (COPM), leg pain, overall leg symptoms score (heaviness, tiredness, aching, or cramps), and ankle blood flow were assessed. Analysis of covariance (ANCOVA) and logistic regression were used to compare the groups. Statistical significance was set at p < 0.05 (two-sided 5%). RESULTS Out of 129 participants enrolled, 114 completed the study. The improvement in all outcomes were statistically significant for the NMES interventions compared to Sham at both week 8 (p < 0.01) and week 12 (p < 0.05). The improvement in COPM met the minimal clinically important difference (MCID) for the NMES interventions compared to Sham at both week 8 (p < 0.005) and week 12 (p < 0.05). Improvement in leg pain met MCID at week 8 compared to Sham (p < 0.05). Ankle blood flow increased approximately 3-fold during treatment compared to Sham. Compliance with the interventions was high and no device-related adverse events were reported. CONCLUSIONS The home-based foot NMES is safe, and significantly improved self-reported function, leg pain and overall leg symptoms, and increased ankle blood flow compared to a Sham among older adults. TRIAL REGISTRATION The trial was prospectively registered in ISRCTN on 17/06/2019 with registration number ISRCTN10576209. It can be accessed at https://www.isrctn.com/ISRCTN10576209 .
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Affiliation(s)
- Binoy Kumaran
- School of Health and Social Work, University of Hertfordshire, Hatfield, AL10 9AB, UK.
| | | | - Tim Watson
- School of Health and Social Work, University of Hertfordshire, Hatfield, AL10 9AB, UK
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Trøstheim M, Eikemo M. Hyperalgesia in Patients With a History of Opioid Use Disorder: A Systematic Review and Meta-Analysis. JAMA Psychiatry 2024:2822021. [PMID: 39141367 PMCID: PMC11325249 DOI: 10.1001/jamapsychiatry.2024.2176] [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: 08/15/2024]
Abstract
Importance Short-term and long-term opioid treatment have been associated with increased pain sensitivity (ie, opioid-induced hyperalgesia). Treatment of opioid use disorder (OUD) mainly involves maintenance with methadone and buprenorphine, and observations of heightened cold pain sensitivity among patients are often considered evidence of opioid-induced hyperalgesia. Objective To critically examine the evidence that hyperalgesia in patients with OUD is related to opioid use. Data Sources Web of Science, PubMed, and Embase between March 1, 2023, and April 12, 2024, were searched. Study Selection Studies assessing cold pressor test (CPT) pain responses during treatment seeking, pharmacological treatment, or abstinence in patients with OUD history were included. Data Extraction and Synthesis Multilevel random-effects models with robust variance estimation were used for all analyses. Study quality was rated with the JBI checklist. Funnel plots and Egger regression tests were used to assess reporting bias. Main Outcomes and Measures Main outcomes were pain threshold, tolerance, and intensity in patients and healthy controls, and unstandardized, standardized (Hedges g), and percentage differences (%Δ) in these measures between patients and controls. The association between pain sensitivity and opioid tolerance, withdrawal, and abstinence indices was tested with meta-regression. Results Thirty-nine studies (1385 patients, 741 controls) met the inclusion criteria. Most studies reported CPT data on patients undergoing opioid agonist treatment. These patients had a mean 2- to 3-seconds lower pain threshold (95% CI, -4 to -1; t test P = .01; %Δ, -22%; g = -0.5) and 29-seconds lower pain tolerance (95% CI, -39 to -18; t test P < .001; %Δ, -52%; g = -0.9) than controls. Egger tests suggested that these differences may be overestimated. There were some concerns of bias due to inadequate sample matching and participant dropout. Meta-regressions yielded no clear support for hyperalgesia being opioid related. Conclusion and Relevance Patients receiving opioid agonist treatment for OUD are hypersensitive to cold pain. It remains unclear whether hyperalgesia develops prior to, independent of, or as a result of long-term opioid treatment. Regardless, future studies should investigate the impact of hyperalgesia on patients' well-being and treatment outcomes.
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Affiliation(s)
- Martin Trøstheim
- Kongsberg Hospital, Vestre Viken Hospital Trust, Kongsberg, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Marie Eikemo
- Department of Psychology, University of Oslo, Oslo, Norway
- Department of Physics and Computational Radiology, Oslo University Hospital, Oslo, Norway
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Steiness J, Lunn TH, Hägi-Pedersen D, Jakobsen JC, Mathiesen O. Optimal non-opioid analgesic combinations after total hip arthroplasty - Authors' reply. THE LANCET. RHEUMATOLOGY 2024; 6:e502-e503. [PMID: 38901448 DOI: 10.1016/s2665-9913(24)00154-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 05/31/2024] [Indexed: 06/22/2024]
Affiliation(s)
- Joakim Steiness
- Department of Anaesthesiology, Zealand University Hospital, Køge, DK-4600, Denmark.
| | - Troels Haxholdt Lunn
- Department of Anaesthesiology and Intensive Care, Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen, Denmark
| | - Daniel Hägi-Pedersen
- Department of Anaesthesiology, Næstved-Slagelse_Ringsted Hospitals, Næstved, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Janus Christian Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Ole Mathiesen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Anaesthesiology, Zealand University Hospital, Køge, DK-4600, Denmark
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Navascues-Cornago M, Guthrie S, Morgan PB, Woods J. Determination of the Minimal Clinically Important Difference (MCID) for Ocular Subjective Responses. Transl Vis Sci Technol 2024; 13:28. [PMID: 39150716 PMCID: PMC11343006 DOI: 10.1167/tvst.13.8.28] [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: 02/16/2024] [Accepted: 07/16/2024] [Indexed: 08/17/2024] Open
Abstract
Purpose To determine the minimal clinically important difference (MCID) for contact lens (CL)-related subjective responses and explore whether MCID values differ between subjective responses and study designs. Methods This was a retrospective analysis of data from seven one-week bilateral crossover studies and 14 one-day contralateral CL studies. For comfort, dryness, vision, or ease of insertion, participants rated on a 0-100 visual analogue scale (VAS) and indicated lens preference on a five-point Likert scale featuring strong, slight, and no preferences. For each criterion, four MCID estimates were calculated and averaged: mean VAS score difference for "slight preference," lower limit of 95% confidence interval VAS score difference for "slight preference," difference in mean VAS score difference between "slight" and "no preference" and 0.5 standard deviation of VAS scores. Results The four calculation methods generated a small range of MCID values. For bilateral studies, the averaged MCID was 7.2 (range 5.4-8.8) for comfort, 8.1 (5.2-10.6) for dryness, 7.1 (5.5-9.3) for vision and 7.6 (6.0-10.5) for ease of insertion. For contralateral studies, the averaged MCID was 6.9 (6.1-7.6) for comfort at insertion and 7.5 (6.8-8.2) for end-of-day comfort. Conclusions This work demonstrated very similar MCID values across subjective responses and study designs, in a population of habitual soft CL wearers. In all cases, MCID values were on average seven units on a 0 to 100 VAS. Translational Relevance This work provides MCID values which are important for interpreting ocular subjective responses and planning clinical studies.
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Affiliation(s)
- Maria Navascues-Cornago
- Eurolens Research, Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Sarah Guthrie
- Centre for Ocular Research & Education (CORE), School of Optometry & Vision Science, University of Waterloo, Waterloo, ON, Canada
| | - Philip B. Morgan
- Eurolens Research, Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Jill Woods
- Centre for Ocular Research & Education (CORE), School of Optometry & Vision Science, University of Waterloo, Waterloo, ON, Canada
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Lazaro RM, Smith JM, Bender N, Punreddy A, Barford N, Paul JH. Comparison of Pain With Ultrasound-Guided Intra-Articular Hip Injections With and Without Prior Subcutaneous Local Anesthesia. Clin J Sport Med 2024:00042752-990000000-00219. [PMID: 39046314 DOI: 10.1097/jsm.0000000000001260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 06/22/2024] [Indexed: 07/25/2024]
Abstract
OBJECTIVE To compare pain levels of intra-articular hip steroid injections performed with and without prior subcutaneous local anesthesia (LA) injection. DESIGN Randomized prospective study. SETTING University-based musculoskeletal clinic. PARTICIPANTS Forty-one adult patients undergoing a first-time ultrasound-guided unilateral intra-articular hip steroid injection. INTERVENTIONS Subjects were randomized into 1 of 2 groups: intra-articular hip injection with prior subcutaneous LA with 2 mL of lidocaine 1% (With LA) or hip injection without prior subcutaneous LA (Without LA). Visual analog scale (VAS) pain scores (0-100) were collected before and after each injection. MAIN OUTCOME MEASURES Visual analog scale pain score for the intra-articular hip injection. RESULTS Of the 41 total subjects, 18 were randomized to the Without LA group and 23 to the With LA group. There was no significant difference in baseline (preprocedure) VAS scores between the Without LA (mean ± SD = 39.2 ± 27.2) and With LA (41.2 ± 24.0) groups (P = 0.864). The mean ± SD VAS score for the subcutaneous LA injection in the With LA group was 20.4 ± 16.1. There was no significant difference in VAS scores for the intra-articular hip injection between the Without LA (48.5 ± 27.7) and With LA (39.5 ± 25.7) groups (P = 0.232). CONCLUSIONS Subcutaneous injection of lidocaine before an intra-articular hip injection did not significantly decrease pain from the intra-articular hip injection. Providers may perform intra-articular hip injections with a 22-gauge 3.5-inch spinal needle without the need for an extra subcutaneous LA injection.
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Affiliation(s)
- Rondy Michael Lazaro
- Department of Physical Medicine and Rehabilitation, University of Rochester Medical Center, Rochester, NY
| | - Joshua M Smith
- Lifespan Physician Group, Department of Neurology, Warren Alpert Medical School at Brown University, Providence, RI; and
| | - Nicholas Bender
- Department of Physical Medicine and Rehabilitation, University of Rochester Medical Center, Rochester, NY
| | - Ankit Punreddy
- University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Nathan Barford
- Department of Physical Medicine and Rehabilitation, University of Rochester Medical Center, Rochester, NY
| | - Jennifer H Paul
- Department of Physical Medicine and Rehabilitation, University of Rochester Medical Center, Rochester, NY
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Toumia M, Sassi S, Dhaoui R, Kouraichi C, Bel Haj Ali K, Sekma A, Zorgati A, Jaballah R, Yaakoubi H, Youssef R, Beltaief K, Mezgar Z, Khrouf M, Sghaier A, Jerbi N, Zemni I, Bouida W, Grissa MH, Boubaker H, Boukef R, Msolli MA, Nouira S. Magnesium Sulfate Versus Lidocaine as an Adjunct for Renal Colic in the Emergency Department: A Randomized, Double-Blind Controlled Trial. Ann Emerg Med 2024:S0196-0644(24)00348-2. [PMID: 39033450 DOI: 10.1016/j.annemergmed.2024.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 06/05/2024] [Accepted: 06/07/2024] [Indexed: 07/23/2024]
Abstract
STUDY OBJECTIVE We wished to determine whether the addition of magnesium sulfate (MgSO4) or lidocaine to diclofenac could improve the analgesic efficacy in emergency department (ED) patients with acute renal colic. METHODS In this prospective, double-blinded, randomized controlled trial of patients aged 18 to 65 years with suspected acute renal colic, we randomized them to receive 75 mg intramuscular (IM) diclofenac and then intravenous (IV) MgSO4, lidocaine, or saline solution control. Subjects reported their pain using a numerical rating scale (NRS) before drug administration and then 5, 10, 20, 30, 60, and 90 minutes afterwards. Our primary outcome was the proportion of participants achieving at least a 50% reduction in the NRS score 30 minutes after drug administration. RESULTS We enrolled 280 patients in each group. A 50% or greater reduction in the NRS score at 30 minutes occurred in 227 (81.7%) patients in the MgSO4 group, 204 (72.9%) in the lidocaine group, and 201 (71.8%) in the control group, with significant differences between MgSO4 and lidocaine (8.8%, 95% confidence interval [CI] [1.89 to 15.7], P=.013) and between MgSO4 and control (9.9%, 95% CI [2.95 to 16.84], P=.004). Despite this, differences between all groups at every time point were below the accepted 1.3 threshold for clinical importance. There were no observed differences between groups in the frequency of rescue analgesics and return visits to the ED for renal colic. There were more adverse events, although minor, in the MgSO4 group. CONCLUSION Adding intravenous MgSO4, but not lidocaine, to IM diclofenac offered superior pain relief but at levels below accepted thresholds for clinical importance.
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Affiliation(s)
- Marwa Toumia
- Research Laboratory LR12SP18, Monastir University, Monastir, Tunisia; Emergency Department, Haj Ali Soua Regional Hospital, Monastir, Tunisia
| | - Sarra Sassi
- Research Laboratory LR12SP18, Monastir University, Monastir, Tunisia; Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Randa Dhaoui
- Research Laboratory LR12SP18, Monastir University, Monastir, Tunisia; Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Cyrine Kouraichi
- Research Laboratory LR12SP18, Monastir University, Monastir, Tunisia; Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Khaoula Bel Haj Ali
- Research Laboratory LR12SP18, Monastir University, Monastir, Tunisia; Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Adel Sekma
- Research Laboratory LR12SP18, Monastir University, Monastir, Tunisia; Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Asma Zorgati
- Emergency Department, Sahloul University Hospital, Sousse, Tunisia
| | - Rahma Jaballah
- Emergency Department, Sahloul University Hospital, Sousse, Tunisia
| | - Hajer Yaakoubi
- Emergency Department, Sahloul University Hospital, Sousse, Tunisia
| | - Rym Youssef
- Emergency Department, Sahloul University Hospital, Sousse, Tunisia
| | - Kaouthar Beltaief
- Research Laboratory LR12SP18, Monastir University, Monastir, Tunisia; Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Zied Mezgar
- Emergency Department, Hached University Hospital, Sousse, Tunisia
| | - Mariem Khrouf
- Emergency Department, Hached University Hospital, Sousse, Tunisia
| | - Amira Sghaier
- Emergency Department, Taher Sfar University Hospital, Mahdia, Tunisia
| | - Nahla Jerbi
- Emergency Department, Taher Sfar University Hospital, Mahdia, Tunisia
| | - Imen Zemni
- Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Wahid Bouida
- Research Laboratory LR12SP18, Monastir University, Monastir, Tunisia; Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Mohamed Habib Grissa
- Research Laboratory LR12SP18, Monastir University, Monastir, Tunisia; Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Hamdi Boubaker
- Research Laboratory LR12SP18, Monastir University, Monastir, Tunisia; Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Riadh Boukef
- Research Laboratory LR12SP18, Monastir University, Monastir, Tunisia; Emergency Department, Sahloul University Hospital, Sousse, Tunisia
| | - Mohamed Amine Msolli
- Research Laboratory LR12SP18, Monastir University, Monastir, Tunisia; Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Semir Nouira
- Research Laboratory LR12SP18, Monastir University, Monastir, Tunisia; Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.
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Twidale EK, Neutens S, Hynt L, Dudley N, Streeton C. Methoxyflurane analgesia for outpatient hysteroscopy: A double-blind, randomised, controlled trial. Aust N Z J Obstet Gynaecol 2024. [PMID: 39007504 DOI: 10.1111/ajo.13861] [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: 12/21/2023] [Accepted: 06/23/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Despite clinical and economic benefits, pain during outpatient hysteroscopy (OPH) remains a barrier to use. There is a lack of evidence to support routine use of one analgesic over another versus no analgesic. AIMS To study the efficacy and safety of methoxyflurane analgesia during OPH. MATERIALS AND METHODS A single-centre, randomised, double-blind, placebo-controlled experiment was performed; 90 patients were randomly assigned (1:1). Participants allocated to the treatment group (cases) received 3 mL of methoxyflurane through an inhaler. The control group received a placebo. The primary outcome was a mean difference in pain, via a change in Visual Analog Scale (VAS) score from baseline at diagnostic hysteroscopy. Secondary outcomes were a mean difference in VAS score with any subsequent operative procedures; a mean difference in VAS score at 15 min post-procedure; participant and clinician-reported adverse effects and events; and participant-reported procedure acceptability, adjuvant nitrous oxide (N2O2) use and a composite of 'distress'. RESULTS During diagnostic hysteroscopy, there was a mean difference of 11.5 mm/100 (95% confidence interval (CI) 0.08-22.95), P = 0.05, with the lower score in the cases, compared with controls. During subsequent operative procedures, there was a mean difference of 15 mm/100 (95% CI 2.71-28.22), P = 0.02, with the lower pain score in the cases, compared with controls. There was no significant difference in pain 15 min post-procedure, participant- and clinician- reported adverse effects and events, procedure acceptability and the 'distress' composite. CONCLUSIONS Methoxyflurane significantly reduced pain during OPH compared with placebo, for diagnostic as well as operative procedures. Furthermore, methoxyflurane was well tolerated, with no adverse events.
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Affiliation(s)
- Emily K Twidale
- Department of Women's Health, Te Whatu Ora Waikato, Hamilton, New Zealand
| | - Sofie Neutens
- Department of Women's Health, Te Whatu Ora Waikato, Hamilton, New Zealand
| | - Lyn Hynt
- Department of Computing and Mathematical Sciences, The University of Waikato, Hamilton, New Zealand
| | - Narena Dudley
- Department of Women's Health, Te Whatu Ora Waikato, Hamilton, New Zealand
| | - Catherine Streeton
- Department of Gynaecology, Abortion and Contraception Services, The Royal Women's Hospital, Melbourne, Victoria, Australia
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White TD, Matthew SK, Tubog TD. Postoperative Cesarean Section Pain Management Using Transversus Abdominis Plane Block Versus Intrathecal Morphine: A Systematic Review and Meta-analysis. J Perianesth Nurs 2024:S1089-9472(24)00123-0. [PMID: 39001740 DOI: 10.1016/j.jopan.2024.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/22/2024] [Accepted: 03/29/2024] [Indexed: 07/15/2024]
Abstract
PURPOSE Compare and evaluate the effectiveness of transversus abdominis plane (TAP) block versus intrathecal morphine (ITM) on elective postcesarean section pain, opioid consumption, and related side effects. DESIGN Systematic review and meta-analysis. METHODS A search for evidence was conducted in PubMed, Google Scholar, CINAHL, Cochrane Collaboration Database, UpToDate, Health Source, and gray literature. Only randomized controlled trials (RCTs) were included in the study. The methodological quality of evidence assessment was conducted using the Risk of Bias and Grades of Recommendation, Assessment, Development, and Evaluation system. The meta-analysis used Review Manager (RevMan 5.4, The Cochrane Collaboration). FINDINGS A total of 11 RCTs involving 1,129 patients were analyzed. Compared to ITM, TAP has a similar effect on static (mean difference [MD]; 0.37; 95% confidence interval [CI], -0.04 to 0.79; P = .08) and dynamic pain scores (MD, 0.43; 95% CI, -0.06 to 0.92; P = .09) within the first 48 hours after surgery. Additionally, the TAP block had a lower incidence of postoperative nausea and vomiting (risk ratio, 0.45; 95% CI, 0.31 to 0.66; P < .0001) and increased opioid consumption (MD, 6.78; 95% CI, 3.79 to 9.77; P < .00001). Overall, TAP block and ITM did not differ in the time to first to rescue analgesia, incidence of sedation, and pruritus. CONCLUSIONS Evidence suggests that TAP blocks are equivalent to ITM in pain scores and more effective at lowering the incidence of postoperative nausea and vomiting, yet ITM has been shown to be more effective in reducing postoperative opioid consumption.
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Affiliation(s)
- Tyler D White
- Graduate Programs of Nurse Anesthesia, Texas Wesleyan University, Fort Worth, TX
| | - Shilpa K Matthew
- Graduate Programs of Nurse Anesthesia, Texas Wesleyan University, Fort Worth, TX
| | - Tito D Tubog
- Graduate Programs of Nurse Anesthesia, Texas Wesleyan University, Fort Worth, TX.
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12
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Wessels J, Klinger R, Benson S, Brenner T, Zöllner C, Elsenbruch S, Aulenkamp JL. Preoperative Anxiolysis and Treatment Expectation (PATE Trial): open-label placebo treatment to reduce preoperative anxiety in female patients undergoing gynecological laparoscopic surgery - study protocol for a bicentric, prospective, randomized-controlled trial. Front Psychiatry 2024; 15:1396562. [PMID: 39045553 PMCID: PMC11265268 DOI: 10.3389/fpsyt.2024.1396562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 06/14/2024] [Indexed: 07/25/2024] Open
Abstract
One of the most common concerns of patients undergoing surgery is preoperative anxiety, with a prevalence of up to 48%. The effects of preoperative anxiety continue beyond the preoperative period and are associated with more severe postoperative pain and poorer treatment outcomes. Treatment options for preoperative anxiety are often limited as sedatives cause side effects and their efficacy remains controversial. Placebo research has shown that optimization of positive treatment expectations, as can be achieved through placebo administration and education, has clinically relevant effects on preoperative anxiety, pain and treatment outcomes. As the administration of masked placebos raises ethical questions, clinical studies have increasingly focused on the use of open, non-deceptive placebo administration (open-label placebo, OLP). The use of OLPs to reduce preoperative anxiety and modify clinically relevant postoperative outcomes has not yet been investigated. This bicentric, prospective, randomized-controlled clinical trial (PATE Trial; German Registry for Clinical Studies DRKS00033221), an associated project of the Collaborative Research Center (CRC) 289 "Treatment Expectation", aims to alleviate preoperative anxiety by optimizing positive treatment expectations facilitated by OLP. Furthermore, this study examines a potential enhancement of these effects through aspects of observational learning, operationalized by a positive expectation-enhancing video. In addition, patient's perspective on the self-efficacy and appropriateness of OLPs prior to surgery will be assessed. To achieve these objectives, female patients will be randomized into three groups before undergoing gynecological laparoscopic surgery. One group receives the OLP with a positive rationale conveyed by a study physician. A second group receives the same intervention, OLP administration and rationale provided by a physician, and additionally watches a video on OLP presenting a satisfied patient. A third group receives standard treatment as usual (TAU). Outcome measures will be effects on preoperative anxiety and postoperative experience, particularly visceral and somatic postoperative pain. As the non-deceptive administration of placebos; when indicated; may yield positive outcomes without side effects, and as current treatment of preoperative anxiety is limited, evidence from clinical placebo research has the potential to improve outcomes and patient experience in the surgical setting.
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Affiliation(s)
- Johannes Wessels
- Department of Anesthesiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Regine Klinger
- Department of Anesthesiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Sven Benson
- Institute for Medical Education, Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Thorsten Brenner
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Christian Zöllner
- Department of Anesthesiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Sigrid Elsenbruch
- Department of Neurology, Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University Duisburg-Essen, Essen, Germany
- Department of Medical Psychology and Medical Sociology, Ruhr University Bochum, Bochum, Germany
| | - Jana L. Aulenkamp
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- Department of Neurology, Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University Duisburg-Essen, Essen, Germany
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13
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Rolfzen ML, Shostrom V, Black T, Liu H, Heiser N, Markin NW. Association Between Single-Injection Regional Analgesia and Postoperative Pain in Cardiac Surgery Patients: A Single-Center Retrospective Cohort Study. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00423-3. [PMID: 39030154 DOI: 10.1053/j.jvca.2024.06.033] [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: 12/18/2023] [Revised: 06/07/2024] [Accepted: 06/23/2024] [Indexed: 07/21/2024]
Abstract
OBJECTIVES Effective pain control after cardiac surgery may facilitate recovery. This study aimed to assess the use and association of ultrasound-guided single-injection chest wall blocks with liposomal bupivacaine on postoperative pain scores and short-term opioid requirements after cardiothoracic surgery at a single institution. DESIGN Retrospective cohort study. SETTING Midwestern academic hospital. PARTICIPANTS Adult patients who underwent cardiothoracic surgery between July 1, 2020, and June 30, 2022. INTERVENTIONS Ultrasound-guided single-injection chest wall block with liposomal bupivacaine. MEASUREMENTS AND MAIN RESULTS Of the 1,038 patients included in this study, 301 (29%) received a perioperative nerve block for postoperative sternotomy pain, and 737 (71%) did not. Most of the single-shot blocks were bilateral parasternal intercostal plane blocks (n = 294 [98%]) performed after induction and before surgical incision (n = 280 [93%]). After adjusting for age, gender, American Society of Anesthesiologists status, select comorbidities, and surgical procedure type, mean postoperative pain scores were not significantly different between groups in the immediate postoperative period at all time points assessed (12 ± 2 hours, 24 ± 4 hours, 48 ± 8 hours, and 72 ± 12 hours). Similarly, there was no difference in mean opioid requirements (milligram morphine equivalents) at 72 hours between groups (68.6 [95% confidence interval, 56.3-83.4] vs 62.9 [95% confidence interval, 52.8-74.9], p = 0.195). CONCLUSIONS In this retrospective study, the implementation of single-shot chest wall nerve blocks with liposomal bupivacaine was not associated with decreased postoperative pain scores or opioid consumption at 72 hours in select cardiac surgical patients at one institution.
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Affiliation(s)
- Megan L Rolfzen
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Valerie Shostrom
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Theodore Black
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Haiying Liu
- Department of Anesthesiology, Associated Anesthesiologists, P.C., West Des Moines, IA, USA
| | - Nicholas Heiser
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Nicholas W Markin
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, USA.
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14
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Koga M, Maeda A, Morioka S. Description of pain associated with persistent postoperative pain after total knee arthroplasty. Sci Rep 2024; 14:15217. [PMID: 38956120 PMCID: PMC11219758 DOI: 10.1038/s41598-024-66122-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: 03/18/2024] [Accepted: 06/26/2024] [Indexed: 07/04/2024] Open
Abstract
After total knee arthroplasty (TKA), approximately 20% of patients experience persistent postoperative pain (PPP). Although preoperative and postoperative pain intensity is a relevant factor, more detailed description of pain is needed to determine specific intervention strategies for clinical conditions. This study aimed to clarify the associations between preoperative and postoperative descriptions of pain and PPP. Fifty-two TKA patients were evaluated for pain intensity and description of pain preoperatively and 2 weeks postoperatively, and the intensities were compared. In addition, the relationship between pain intensity and PPP at 3 and 6 months after surgery was analyzed using a Bayesian approach. Descriptions of arthritis ("Throbbing" and "aching") improved from preoperative to 2 weeks postoperative. Several preoperative ("Shooting", "Aching", "Caused by touch", "Numbness") and postoperative ("Cramping pain") descriptors were associated with pain intensity at 3 months postoperatively, but only "cramping pain" at 2 weeks postoperatively was associated with the presence of PPP at 3 and 6 months postoperatively. In conclusion, it is important to carefully listen to the patient's complaints and determine the appropriate intervention strategy for the clinical condition during perioperative pain management.
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Affiliation(s)
- Masayuki Koga
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, 4-2-2, Umaminaka, Koryo-cho, Kitakatsuragi-gun, Nara, 635-0832, Japan.
- Department of Rehabilitation, Kawanishi City Medical Center, Hyogo, 666-0017, Japan.
| | - Akihisa Maeda
- Department of Rehabilitation, Kyowakai Hospital, Osaka, 564-0001, Japan
| | - Shu Morioka
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, 4-2-2, Umaminaka, Koryo-cho, Kitakatsuragi-gun, Nara, 635-0832, Japan
- Neurorehabilitation Research Center, Kio University, Nara, 635-0832, Japan
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15
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Choi S, Yoon SH, Lee HJ. Beyond measurement: a deep dive into the commonly used pain scales for postoperative pain assessment. Korean J Pain 2024; 37:188-200. [PMID: 38769013 PMCID: PMC11220383 DOI: 10.3344/kjp.24069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/17/2024] [Accepted: 03/18/2024] [Indexed: 05/22/2024] Open
Abstract
This review explores the essential methodologies for effective postoperative pain management, focusing on the need for thorough pain assessment tools, as underscored in various existing guidelines. Herein, the strengths and weaknesses of commonly used pain scales for postoperative pain-the Visual Analog Scale, Numeric Rating Scale, Verbal Rating Scale, and Faces Pain Scale-are evaluated, highlighting the importance of selecting appropriate assessment tools based on factors influencing their effectiveness in surgical contexts. By emphasizing the need to comprehend the minimal clinically important difference (MCID) for these scales in evaluating new analgesic interventions and monitoring pain trajectories over time, this review advocates recognizing the limitations of common pain scales to improve pain assessment strategies, ultimately enhancing postoperative pain management. Finally, five recommendations for pain assessment in research on postoperative pain are provided: first, selecting an appropriate pain scale tailored to the patient group, considering the strengths and weaknesses of each scale; second, simultaneously assessing the intensity of postoperative pain at rest and during movement; third, conducting evaluations at specific time points and monitoring trends over time; fourth, extending the focus beyond the intensity of postoperative pain to include its impact on postoperative functional recovery; and lastly, interpreting the findings while considering the MCID, ensuring that it is clinically significant for the chosen pain scale. These recommendations broaden our understanding of postoperative pain and provide insights that contribute to more effective pain management strategies, thereby enhancing patient care outcomes.
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Affiliation(s)
- Seungeun Choi
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Soo-Hyuk Yoon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ho-Jin Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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16
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Hansford HJ, Jones MD, Cashin AG, Ostelo RW, Chiarotto A, Williams SA, Sharma S, Rose JM, Devonshire JJ, Ferraro MC, Wewege MA, McAuley JH. The smallest worthwhile effect on pain intensity of exercise therapy for people with chronic low back pain: a discrete choice experiment study. J Orthop Sports Phys Ther 2024; 54:477-485. [PMID: 38630543 DOI: 10.2519/jospt.2024.12279] [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] [Indexed: 04/19/2024]
Abstract
OBJECTIVE: To identify the smallest worthwhile effect (SWE) of exercise therapy for people with non-specific chronic low back pain (CLBP). DESIGN: Discrete choice experiment. METHODS: The SWE was estimated as the lowest reduction in pain that participants would consider exercising worthwhile, compared to not exercising i.e., effects due to natural history and other components (e.g., regression to the mean). We recruited English-speaking adults in Australia with non-specific CLBP to our online survey via email obtained from a registry of previous participants and advertisements on social media. We used discrete choice experiment to estimate the SWE of exercise compared to no exercise for pain intensity. We analysed the discrete choice experiment using a mixed logit model, and mitigated hypothetical bias through certainty calibration, with sensitivity analyses performed with different certainty calibration thresholds. RESULTS: Two-hundred and thirteen participants completed the survey. The mean age (±SD) was 50.7±16.5, median (IQR) pain duration 10 years (5-20), and mean pain intensity (±SD) was 5.8±2.3 on a 0-10 numerical rating scale. For people with CLBP the SWE of exercise was a between-group reduction in pain of 20%, compared to no exercise. In the sensitivity analyses, the SWE varied with different levels of certainty calibration; from 0% without certainty calibration to 60% with more extreme certainty calibration. CONCLUSION: This patient-informed threshold of clinical importance could guide the interpretation of findings from randomised trials and meta-analyses of exercise therapy compared to no exercise.
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Affiliation(s)
- Harrison J Hansford
- School of Health Sciences, Faculty of Medicine and Health, UNSW Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Matthew D Jones
- School of Health Sciences, Faculty of Medicine and Health, UNSW Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Aidan G Cashin
- School of Health Sciences, Faculty of Medicine and Health, UNSW Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Raymond Wjg Ostelo
- Department of Health Sciences, Faculty of Science and Amsterdam Movement Science Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
- Department of Epidemiology and Data Science, Amsterdam University Medical Centre, location Vrije Universiteit, Amsterdam Movement Sciences, The Netherlands
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Sam A Williams
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Saurab Sharma
- School of Health Sciences, Faculty of Medicine and Health, UNSW Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - John M Rose
- Neil Smith Research Chair in Sustainable Transport Futures, Institute of Transport and Logistics Studies, The University of Sydney Business School, Sydney, New South Wales, 2006, Australia
| | - Jack J Devonshire
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Michael C Ferraro
- School of Health Sciences, Faculty of Medicine and Health, UNSW Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Michael A Wewege
- School of Health Sciences, Faculty of Medicine and Health, UNSW Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - James H McAuley
- School of Health Sciences, Faculty of Medicine and Health, UNSW Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
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17
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Betancourt C, Sanabria A. Post-thyroidectomy bilateral cervical plexus block relieves pain: a systematic review. Eur Arch Otorhinolaryngol 2024; 281:3765-3778. [PMID: 38709322 DOI: 10.1007/s00405-024-08626-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 03/18/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE To assess the effectiveness of bilateral superficial cervical plexus block (BSCPB) in treating post-thyroidectomy pain. METHODS MEDLINE, Embase, Google Scholar, LILACS, and the Cochrane Central Register of Controlled Trials, were extensively searched. The search period extended from 1968 until December 2022. Randomized controlled trials comparing BSCPB to placebo, no block in patients with thyroidectomy for benign or malignant thyroid disease were included. Outcomes were pain in the first 24 h after surgery. Analgesic rescue, period before the first rescue dosage, and 24-h opioid usage were secondary outcomes. The RoB 2 instrument was used to evaluate the risk of bias. RESULTS 34 of 354 studies were eligible. There were 2,519 patients. BSCPB reduced the intensity of pain postoperatively [SMD: - 1.17 (95% CI: - 1.54 to - 0.81)] and in the first 24 h [- 0.62 (95%: 0.91 to 0.33)]. A considerable delay for the first opioid dose, rescue analgesics, and postoperative opioid usage was also found. CONCLUSION BSCPB's 24-h analgesic efficacy minimizes the requirement for rescue analgesia, postoperative opioid intake, and rescue analgesia start time. The choice of anesthetic and different application methods might affect its effectiveness.
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Affiliation(s)
- Carlos Betancourt
- Head and Neck Service, Hospital Alma Mater, Medellín, Colombia
- CEXCA, Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín, Colombia
| | - Alvaro Sanabria
- Head and Neck Service, Hospital Alma Mater, Medellín, Colombia.
- CEXCA, Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín, Colombia.
- Department of Surgery, School of Medicine, Universidad de Antioquia, Cra. 51d #62-29, Medellín, Colombia.
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18
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Opolka Y, Sundberg C, Juthberg R, Olesen A, Guo L, Persson NK, Ackermann PW. Transcutaneous Electrical Nerve Stimulation Integrated into Pants for the Relief of Postoperative Pain in Hip Surgery Patients: A Randomized Trial. Pain Res Manag 2024; 2024:6866549. [PMID: 39145150 PMCID: PMC11323988 DOI: 10.1155/2024/6866549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/29/2024] [Accepted: 06/08/2024] [Indexed: 08/16/2024]
Abstract
Background The effect of transcutaneous electrical nerve stimulation (TENS) on pain and impression of change was assessed during a 2.5-hour intervention on the first postoperative days following hip surgery in a randomized, single-blinded, placebo-controlled trial involving 30 patients. Methods Mixed-frequency TENS (2 Hz/80 Hz) was administered using specially designed pants integrating modular textile electrodes to facilitate stimulation both at rest and during activity. The treatment outcome was assessed by self-reported pain Numerical Rating Scale (NRS) and Patient Global Impression of Change (PGIC) scores at four time points. The ability to perform a 3-meter walk test and the use of analgesics were also evaluated. Group comparison and repeated-measure analysis were carried out using nonparametric statistics. Results The active TENS group exhibited significantly higher PGIC scores after 30 minutes, which persisted throughout the intervention (all p ≤ 0.001). A reduction in NRS appeared after one hour of active TENS, persisting throughout the intervention (all p ≤ 0.05). The median group differences in pain ratings were greater than the minimum clinically important difference, and the analysis of pain trajectories confirmed clinical significance at the individual level. Moreover, patients in the active TENS group were more likely able to perform a 3-meter walk test by the end of the intervention (p = 0.04). Analysis of the opioid-sparing effect of TENS was inconclusive (p = 0.066). No postoperative surgical complications or TENS-related side effects were observed during the study. Conclusion Mixed-frequency TENS integrated in pants could potentially be an interesting addition to the arsenal of treatments for multimodal analgesia following hip surgery. This trial is registered with NCT05678101.
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Affiliation(s)
- Yohann Opolka
- Polymeric E-Textile Research GroupSwedish School of TextilesUniversity of Borås, Allégatan 1, Borås 501 90, Sweden
| | | | - Robin Juthberg
- Karolinska University Hospital, Solna, Stockholm 171 76, Sweden
- Department of Molecular Medicine and SurgeryKarolinska Institutet, Solna, Stockholm 171 76, Sweden
| | - Amelie Olesen
- Polymeric E-Textile Research GroupSwedish School of TextilesUniversity of Borås, Allégatan 1, Borås 501 90, Sweden
- Smart TextilesScience Park Borås, Allégatan 1, Borås 501 90, Sweden
| | - Li Guo
- Polymeric E-Textile Research GroupSwedish School of TextilesUniversity of Borås, Allégatan 1, Borås 501 90, Sweden
| | - Nils-Krister Persson
- Polymeric E-Textile Research GroupSwedish School of TextilesUniversity of Borås, Allégatan 1, Borås 501 90, Sweden
- Smart TextilesScience Park Borås, Allégatan 1, Borås 501 90, Sweden
| | - Paul W. Ackermann
- Karolinska University Hospital, Solna, Stockholm 171 76, Sweden
- Department of Molecular Medicine and SurgeryKarolinska Institutet, Solna, Stockholm 171 76, Sweden
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19
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Betancourt C, Sanabria A. Post-thyroidectomy pain relief is enhanced by wound infiltration. A systematic review of randomized controlled trials. Surgeon 2024; 22:e133-e140. [PMID: 38360454 DOI: 10.1016/j.surge.2024.02.002] [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: 11/09/2023] [Accepted: 02/01/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Thyroidectomy is a common surgical procedure. Traditional options for pain management, such as analgesics and nonsteroidal anti-inflammatory medications (NSAIDs), are limited by their side effects. Surgical wound infiltration with local anesthetics has the potential to reduce the need for analgesics in a number of surgical procedures. This systematic review and meta-analysis wanted to resolve these concerns and assess the efficacy of WI in the management of postoperative pain after thyroidectomy. MATERIAL AND METHODS The review adhered to Cochrane Collaboration and PRISMA standards. RCTs comparing WI with no infiltration or placebo were included. Patients with benign or malignant thyroid disease who underwent open thyroidectomy were eligible. Postoperative pain was assessed using a visual analogue scale (VAS) as the primary outcome. Time to first rescue dose, the need for analgesic rescue in the first 24 h, and total opioid analgesic consumption were secondary outcomes. Standardized mean difference (SMD) and odds ratio (OR) were used to analyze the data. RESULTS 16 randomized controlled trials involving 1202 patients were included. At 6 and 8 h postoperatively, WI exhibited a statistically significant impact on pain management. In the WI group, the need for analgesic rescue was significantly reduced. At 4 h postoperatively, non-anesthetic medications demonstrated a significant analgesic effect. CONCLUSIONS This systematic review and meta-analysis support the use of WI with local anesthetics for postoperative pain management after thyroidectomy. These findings have significant implications for improving perioperative care, especially in ambulatory settings where effective pain management is essential.
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Affiliation(s)
- Carlos Betancourt
- Head and Neck Service, Hospital Alma Mater. Medellín, Colombia. CEXCA, Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín, Colombia
| | - Alvaro Sanabria
- Head and Neck Service, Hospital Alma Mater. Medellín, Colombia. CEXCA, Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín, Colombia; Department of Surgery, School of Medicine, Universidad de Antioquia, Cra. 51d #62-29, Medellin, Colombia.
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20
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Pagé MG, Ganty P, Wong D, Rao V, Khan J, Ladha K, Hanlon J, Miles S, Katznelson R, Wijeysundera D, Katz J, Clarke H. A Prospective Cohort Study of Acute Pain and In-Hospital Opioid Consumption After Cardiac Surgery: Associations With Psychological and Medical Factors and Chronic Postsurgical Pain. Anesth Analg 2024; 138:1192-1204. [PMID: 38295119 DOI: 10.1213/ane.0000000000006848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
BACKGROUND Understanding the association of acute pain intensity and opioid consumption after cardiac surgery with chronic postsurgical pain (CPSP) can facilitate implementation of personalized prevention measures to improve outcomes. The objectives were to (1) examine acute pain intensity and daily mg morphine equivalent dose (MME/day) trajectories after cardiac surgery, (2) identify factors associated with pain intensity and opioid consumption trajectories, and (3) assess whether pain intensity and opioid consumption trajectories are risk factors for CPSP. METHODS Prospective observational cohort study design conducted between August 2012 and June 2020 with 1-year follow-up. A total of 1115 adults undergoing cardiac surgery were recruited from the preoperative clinic. Of the 959 participants included in the analyses, 573 completed the 1-year follow-up. Main outcomes were pain intensity scores and MME/day consumption over the first 6 postoperative days (PODs) analyzed using latent growth mixture modeling (GMM). Secondary outcome was 12-month CPSP status. RESULTS Participants were mostly male (76%), with a mean age of 61 ± 13 years. Three distinct linear acute postoperative pain intensity trajectories were identified: "initially moderate pain intensity remaining moderate" (n = 62), "initially mild pain intensity remaining mild" (n = 221), and "initially moderate pain intensity decreasing to mild" (n = 251). Age, sex, emotional distress in response to bodily sensations, and sensitivity to pain traumatization were significantly associated with pain intensity trajectories. Three distinct opioid consumption trajectories were identified on the log MME/day: "initially high level of MME/day gradually decreasing" (n = 89), "initially low level of MME/day remaining low" (n = 108), and "initially moderate level of MME/day decreasing to low" (n = 329). Age and emotional distress in response to bodily sensations were associated with trajectory membership. Individuals in the "initially mild pain intensity remaining mild" trajectory were less likely than those in the "initially moderate pain intensity remaining moderate" trajectory to report CPSP (odds ratio [95% confidence interval, CI], 0.23 [0.06-0.88]). No significant associations were observed between opioid consumption trajectory membership and CPSP status (odds ratio [95% CI], 0.84 [0.28-2.54] and 0.95 [0.22-4.13]). CONCLUSIONS Those with moderate pain intensity right after surgery are more likely to develop CPSP suggesting that those patients should be flagged early on in their postoperative recovery to attempt to alter their trajectory and prevent CPSP. Emotional distress in response to bodily sensations is the only consistent modifiable factor associated with both pain and opioid trajectories.
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Affiliation(s)
- M Gabrielle Pagé
- From the Department of Anesthesiology and Pain Medicine, Faculty of Medicine
- Department of Psychology, Faculty of Arts and Sciences, Université de Montréal, Montreal, Quebec, Canada
- Research Center, Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada
| | - Praveen Ganty
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
| | - Dorothy Wong
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
| | - Vivek Rao
- Department of Cardiovascular Surgery, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - James Khan
- Department of Anesthesia, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Karim Ladha
- Department of Anaesthesia, St. Michael's Hospital, Toronto, Ontario, Canada
| | - John Hanlon
- Department of Anaesthesia, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Sarah Miles
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Rita Katznelson
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
| | | | - Joel Katz
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
- Department of Anesthesiology & Pain Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Hance Clarke
- Department of Anesthesiology & Pain Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
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21
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Mathias N, Huille S, Picci M, Mahoney RP, Pettis RJ, Case B, Helk B, Kang D, Shah R, Ma J, Bhattacharya D, Krishnamachari Y, Doucet D, Maksimovikj N, Babaee S, Garidel P, Esfandiary R, Gandhi R. Towards more tolerable subcutaneous administration: Review of contributing factors for improving combination product design. Adv Drug Deliv Rev 2024; 209:115301. [PMID: 38570141 DOI: 10.1016/j.addr.2024.115301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/21/2024] [Accepted: 03/28/2024] [Indexed: 04/05/2024]
Abstract
Subcutaneous (SC) injections can be associated with local pain and discomfort that is subjective and may affect treatment adherence and overall patient experience. With innovations increasingly focused on finding ways to deliver higher doses and volumes (≥2 mL), there is a need to better understand the multiple intertwined factors that influence pain upon SC injection. As a priority for the SC Drug Development & Delivery Consortium, this manuscript provides a comprehensive review of known attributes from published literature that contribute to pain/discomfort upon SC injection from three perspectives: (1) device and delivery factors that cause physical pain, (2) formulation factors that trigger pain responses, and (3) human factors impacting pain perception. Leveraging the Consortium's collective expertise, we provide an assessment of the comparative and interdependent factors likely to impact SC injection pain. In addition, we offer expert insights and future perspectives to fill identified gaps in knowledge to help advance the development of patient-centric and well tolerated high-dose/high-volume SC drug delivery solutions.
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Affiliation(s)
- Neil Mathias
- Bristol-Myers Squibb, Co., 1 Squibb Dr, New Brunswick, NJ, 08901 USA
| | - Sylvain Huille
- Sanofi, 13 quai Jules Guesde, 94400 Vitry-Sur-Seine, France.
| | - Marie Picci
- Novartis Pharma AG, Fabrikstrasse 4, CH-4056 Basel, Switzerland
| | - Robert P Mahoney
- Comera Life Sciences, 12 Gill St, Suite 4650, Woburn, MA 01801 USA
| | - Ronald J Pettis
- Becton-Dickinson, 21 Davis Drive, Research Triangle Park, NC 27513 USA
| | - Brian Case
- KORU Medical Systems, 100 Corporate Dr, Mahwah, NJ 07430 USA
| | - Bernhard Helk
- Novartis Pharma AG, Werk Klybeck, WKL-681.4.42, CH-4057 Basel, Switzerland
| | - David Kang
- Halozyme Therapeutics, Inc., 12390 El Camino Real, San Diego, CA 92130 USA
| | - Ronak Shah
- Bristol-Myers Squibb, Co., 1 Squibb Dr, New Brunswick, NJ, 08901 USA
| | - Junchi Ma
- Johnson & Johnson Innovative Medicine, 200 Great Valley Pkwy, Malvern, PA 19355 USA
| | | | | | - Dany Doucet
- GSK, 1250 South Collegeville Road, Collegeville, PA 19426 USA
| | | | - Sahab Babaee
- Merck & Co., Inc., 126 E. Lincoln Ave., Rahway, NJ 07065 USA
| | - Patrick Garidel
- Boehringer Ingelheim Pharma GmbH & Co. KG, Birkendorfer Straße 65, 88397 Biberach/Riss, Germany
| | | | - Rajesh Gandhi
- Bristol-Myers Squibb, Co., 1 Squibb Dr, New Brunswick, NJ, 08901 USA
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22
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Desai N, Albrecht E. Minimal clinically important difference: Bridging the gap between statistical significance and clinical meaningfulness. J Clin Anesth 2024; 94:111366. [PMID: 38244304 DOI: 10.1016/j.jclinane.2023.111366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/05/2023] [Accepted: 12/18/2023] [Indexed: 01/22/2024]
Affiliation(s)
- Neel Desai
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; King's College London, London, United Kingdom
| | - Eric Albrecht
- Department of Anaesthesia, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
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23
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Kavakli AS, Sahin T, Koc U, Karaveli A. Reply to Comment on: "Ultrasound-guided external oblique intercostal plane block for postoperative analgesia in laparoscopic sleeve gastrectomy: A prospective, randomized, controlled, patient and observer-blinded study.". Obes Surg 2024; 34:2265-2266. [PMID: 38664284 DOI: 10.1007/s11695-024-07248-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 04/18/2024] [Accepted: 04/23/2024] [Indexed: 05/27/2024]
Affiliation(s)
- Ali Sait Kavakli
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Istinye University, Istanbul, Turkey.
| | - Taylan Sahin
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Istinye University, Istanbul, Turkey
| | - Umit Koc
- Department of General Surgery, Faculty of Medicine, Istinye University, Istanbul, Turkey
| | - Arzu Karaveli
- Department of Anesthesiology and Reanimation, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
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24
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Xiang J, Cao C, Chen J, Kong F, Nian S, Li Z, Li N. Efficacy and safety of ketamine as an adjuvant to regional anesthesia: A systematic review and meta-analysis of randomized controlled trials. J Clin Anesth 2024; 94:111415. [PMID: 38394922 DOI: 10.1016/j.jclinane.2024.111415] [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: 06/10/2023] [Revised: 12/03/2023] [Accepted: 02/09/2024] [Indexed: 02/25/2024]
Abstract
STUDY OBJECTIVE To identify whether adding ketamine to the local anesthetics (LA) in the regional anesthesia could prolong the duration of analgesia. DESIGN A Systematic review and meta-analysis of randomized controlled trials. SETTING The major dates were obtained in the operating room and the postoperative recovery ward. PATIENTS A total of 1011 patients at ASA physical status I and II were included in the analysis. Procedure performed including cesarean section, orthopedic, radical mastectomy, urological or lower abdominal surgery and intracavitary brachytherapy implants insertion. INTERVENTIONS After an extensive search of the electronic database, patients received regional anesthesia combined or not combined general anesthesia and with or without adding ketamine to LA were included in the analysis. The regional anesthesia includes spinal anesthesia, brachial plexus block, pectoral nerve block, transversus abdominis plane block and femoral and sciatic nerve block. MEASUREMENT The primary outcome was the duration of analgesia. Secondary outcomes were the duration and onset time of motor and sensory block as well as the ketamine-related adverse effect. Data are expressed in mean differences in continuous data and odds ratios (OR) for dichotomous data with 95% confidence intervals. The risk of bias of the included studies was evaluated using the revised Cochrane risk of bias tool for randomized trials. The quality of evidence for each outcome was rated according to the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) Working Group system. MAIN RESULT Twenty randomized controlled trials were included in the analysis. When ketamine was used as an adjuvant to LA, the duration of analgesia could be prolonged(172.21 min, 95% CI, 118.20 to 226.22; P<0.00001, I2 = 98%), especially in the peripheral nerve block(366.96 min, 95% CI, 154.19 to 579.74; P = 0.0007, I2 = 98%). Secondary outcomes showed ketamine could prolong the duration of sensory block(29.12 min, 95% CI, 10.22 to 48.01; P = 0.003, I2 = 96%) but no effect on the motor block(6.94 min, 95% CI,-2.65 to 16.53;P = 0.16, I2 = 84%), the onset time of motor and sensory block (motor onset time, -1.17 min, 95% CI, -2.67 to 0.34; P = 0.13, I2 = 100%; sensory onset time, -0.33 min, 95% CI,-0.87 to 0.20; P = 0.23, I2 = 96%) as well as the ketamine-related adverse effect(OR, 1.97, 95% CI,0.93 to 4.17;P = 0.08, I2 = 57%). CONCLUSION This study indicates that ketamine could be an ideal adjuvant to local anesthetics regardless of the types of anesthesia. Overall, the quality of the evidence is low.
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Affiliation(s)
- Jiajia Xiang
- Department of Anesthesiology, 920th Hospital of Joint Logistics Support Force, Kunming, Yunnan, China; Kunming Medical University, Kunming, Yunnan, China
| | - Chunyan Cao
- Department of Obstetrics and Gynecology, 920th Hospital of Joint Logistics Support Force, Kunming, Yunnan, China
| | - Jiayu Chen
- Department of Orthopedics, The First People's Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Fanyi Kong
- Department of Neurology, Affiliated Hospital of Yunnan University, Kunming, Yunnan, China
| | - Sunqi Nian
- Department of Orthopedics, The First People's Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Zhigui Li
- Department of Anesthesiology, 920th Hospital of Joint Logistics Support Force, Kunming, Yunnan, China.
| | - Na Li
- Department of Anesthesiology, 920th Hospital of Joint Logistics Support Force, Kunming, Yunnan, China.
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25
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Hanley AW, Wilson Zingg R, Smith B, Zappa M, White S, Davis A, Worts PR, Culjat C, Martorella G. Mindfulness in the Clinic Waiting Room May Decrease Pain: Results from Three Pilot Randomized Controlled Trials. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024. [PMID: 38757714 DOI: 10.1089/jicm.2024.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Introduction: Mindfulness interventions can improve a broad range of patient outcomes, but traditional mindfulness-based interventions are time and resource intensive. Emerging evidence indicates brief, single-session mindfulness interventions can also improve patient outcomes, and brief mindfulness interventions can be embedded into medical care pathways with minimal disruption. However, the direct impact of a brief mindfulness intervention on patients' pain while waiting in the clinic waiting room remains unexamined. Objective: A series of three, pilot, randomized controlled trials (RCTs) were conducted to examine the impact of a brief, audio-recorded, mindfulness intervention on patients' pain in the clinic waiting room. Method: Study 1 examined an 8-min mindfulness recording delivered before a provider visit; Study 2 examined a 5-min mindfulness recording after a provider visit; and Study 3 examined a 4-min mindfulness recording before a provider visit. Time- and attention-matched control conditions were used in each study. Studies 1 and 2 were conducted in an academic cancer hospital. Study 3 was conducted at a walk-in orthopedic clinic. Pain intensity was measured in each of the three studies. Anxiety and depression symptoms were measured in Studies 2 and 3. Pain unpleasantness was measured in Study 3. Results: A brief (i.e., 4- to 8-min), audio-recorded mindfulness intervention decreased patients' pain intensity in the clinic waiting room, whether delivered before (Study 1 Cohen's d=1.01, Study 3 Cohen's d=0.39) or after (Study 2 Cohen's d=0.89) a provider visit. Mindfulness had a significant effect on anxiety symptoms in both studies in which it was measured. No effect on depression symptoms was observed. Conclusions: Results from these three pilot RCTs indicate brief, audio-recorded, mindfulness interventions may be capable of quickly decreasing clinical symptoms. As such, embedding brief, audio-recorded, mindfulness interventions in clinic waiting rooms may have the potential to improve patient outcomes. The continued investigation of this intervention approach is needed. Clinical Trial Registrations: NCT04477278 and NCT06099964.
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Affiliation(s)
- Adam W Hanley
- Brain Science and Symptom Management Center, College of Nursing, Florida State University, Tallahassee, FL, USA
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | | | - Benjamin Smith
- Wellness and Integrative Health Center, Huntsman Cancer Hospital, Salt Lake City, UT, USA
| | - Melissa Zappa
- Wellness and Integrative Health Center, Huntsman Cancer Hospital, Salt Lake City, UT, USA
| | - Shelley White
- Wellness and Integrative Health Center, Huntsman Cancer Hospital, Salt Lake City, UT, USA
| | - Allison Davis
- Brain Science and Symptom Management Center, College of Nursing, Florida State University, Tallahassee, FL, USA
| | - Phillip R Worts
- Tallahassee Orthopedic Clinic, Tallahassee, FL, USA
- Department of Health, Nutrition, and Food Sciences, Florida State University, Tallahassee, FL, USA
- Institute of Sports Sciences and Medicine, Florida State University, Tallahassee, FL, USA
| | - Carli Culjat
- Florida FIRST, College of Nursing, Florida State University, Tallahassee, FL, USA
| | - Geraldine Martorella
- Brain Science and Symptom Management Center, College of Nursing, Florida State University, Tallahassee, FL, USA
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26
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Derksen BM, Jawahier PA, Wijers O, Knops SP, de Vries MR, van Hooff CCD, Verhofstad MHJ, Schep NWL. Refraining from closed reduction of displaced distal radius fractures in the emergency department-in short: the RECORDED trial. Trials 2024; 25:303. [PMID: 38711069 PMCID: PMC11075287 DOI: 10.1186/s13063-024-08118-5] [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: 12/18/2023] [Accepted: 04/16/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND With roughly 45,000 adult patients each year, distal radius fractures are one of the most common fractures in the emergency department. Approximately 60% of all these fractures are displaced and require surgery. The current guidelines advise to perform closed reduction of these fractures awaiting surgery, as it may lead to post-reduction pain relief and release tension of the surrounding neurovascular structures. Recent studies have shown that successful reduction does not warrant conservative treatment, while patients find it painful or even traumatizing. The aim of this study is to determine whether closed reduction can be safely abandoned in these patients. METHODS In this multicenter randomized clinical trial, we will randomize between closed reduction followed by plaster casting and only plaster casting. Patients aged 18 to 75 years, presenting at the emergency department with a displaced distal radial fracture and requiring surgery according to the attending surgeon, are eligible for inclusion. Primary outcome is pain assessed with daily VAS scores from the visit to the emergency department until surgery. Secondary outcomes are function assessed by PRWHE, length of stay at the emergency department, length of surgery, return to work, patient satisfaction, and complications. A total of 134 patients will be included in this study with follow-up of 1 year. DISCUSSION If our study shows that patients who did not receive closed reduction experience no significant drawbacks, we might be able to reorganize the initial care for distal radial fractures in the emergency department. If surgery is warranted, the patient can be sent home with a plaster cast to await the call for admission, decreasing the time spend in the emergency room drastically. TRIAL REGISTRATION This trial was registered on January 27, 2023.
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Affiliation(s)
- B M Derksen
- Department of Trauma Surgery, Maasstad Hospital, Rotterdam, the Netherlands.
| | - P A Jawahier
- Department of Trauma Surgery, Maasstad Hospital, Rotterdam, the Netherlands
| | - O Wijers
- Department of Trauma Surgery, Franciscus Gasthuis and Vlietland, Rotterdam, the Netherlands
| | - S P Knops
- Department of Trauma Surgery, Ikazia Hospital, Rotterdam, the Netherlands
| | - M R de Vries
- Department of Trauma Surgery, IJsselland Hospital Rotterdam, Capelle Aan Den IJssel, the Netherlands
| | | | - M H J Verhofstad
- Department of Trauma Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - N W L Schep
- Department of Trauma Surgery, Maasstad Hospital, Rotterdam, the Netherlands
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27
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de Grunt MN, de Jong B, Hollmann MW, Ridderikhof ML, Weenink RP. Parenteral, Non-Intravenous Analgesia in Acute Traumatic Pain-A Narrative Review Based on a Systematic Literature Search. J Clin Med 2024; 13:2560. [PMID: 38731088 PMCID: PMC11084350 DOI: 10.3390/jcm13092560] [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: 03/19/2024] [Revised: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
Traumatic pain is frequently encountered in emergency care and requires immediate analgesia. Unfortunately, most trauma patients report sustained pain upon arrival at and discharge from the Emergency Department. Obtaining intravenous access to administer analgesics can be time-consuming, leading to treatment delay. This review provides an overview of analgesics with both fast onset and parenteral, non-intravenous routes of administration, and also indicates areas where more research is required.
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Affiliation(s)
- Midas N. de Grunt
- Department of Anaesthesiology, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands; (M.N.d.G.); (B.d.J.); (M.W.H.)
| | - Bianca de Jong
- Department of Anaesthesiology, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands; (M.N.d.G.); (B.d.J.); (M.W.H.)
| | - Markus W. Hollmann
- Department of Anaesthesiology, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands; (M.N.d.G.); (B.d.J.); (M.W.H.)
| | - Milan L. Ridderikhof
- Department of Emergency Medicine, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands;
| | - Robert P. Weenink
- Department of Anaesthesiology, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands; (M.N.d.G.); (B.d.J.); (M.W.H.)
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28
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Teunis T, Sayegh GE, Fatehi A, Ring D, Vagner G, Reichel L. Does lidocaine reduce pain intensity during corticosteroid injection? A double-blind randomized controlled equivalence trial. J Hand Surg Eur Vol 2024:17531934241245036. [PMID: 38641946 DOI: 10.1177/17531934241245036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
Of the strategies considered to limit the discomfort of corticosteroid injection, one is to inject without lidocaine to reduce the total volume and avoid acidity. In a Bayesian trial, adults receiving corticosteroid injections were randomized to receive 0.5 mL of triamcinolone with or without 0.5 mL of lidocaine. Serial analysis was performed until a 95% probability of presence or absence of a 1.0-point difference in pain intensity on the 0-10 Numerical Rating Scale was reached. Injections with lidocaine were associated with a median of 2.4-point lower pain intensity during injection with a 95% probability of at least a 1-point reduction. The 95% probability was confirmed in 90% of the repeated analysis (36/40). Lidocaine is associated with lower immediate pain intensity during corticosteroid injection for hand and wrist conditions.Level of evidence: I.
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Affiliation(s)
- Teun Teunis
- Department of Surgery and Perioperative Care Dell Medical School, Austin, TX, USA
| | - George E Sayegh
- Department of Surgery and Perioperative Care Dell Medical School, Austin, TX, USA
| | - Amir Fatehi
- Department of Surgery and Perioperative Care Dell Medical School, Austin, TX, USA
| | - David Ring
- Department of Surgery and Perioperative Care Dell Medical School, Austin, TX, USA
| | - Gregg Vagner
- Department of Surgery and Perioperative Care Dell Medical School, Austin, TX, USA
| | - Lee Reichel
- Department of Surgery and Perioperative Care Dell Medical School, Austin, TX, USA
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29
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Johnston KJA, Cote AC, Hicks E, Johnson J, Huckins LM. Genetically Regulated Gene Expression in the Brain Associated With Chronic Pain: Relationships With Clinical Traits and Potential for Drug Repurposing. Biol Psychiatry 2024; 95:745-761. [PMID: 37678542 PMCID: PMC10924073 DOI: 10.1016/j.biopsych.2023.08.023] [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: 12/28/2022] [Revised: 07/20/2023] [Accepted: 08/28/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Chronic pain is a common, poorly understood condition. Genetic studies including genome-wide association studies have identified many relevant variants, which have yet to be translated into full understanding of chronic pain. Transcriptome-wide association studies using transcriptomic imputation methods such as S-PrediXcan can help bridge this genotype-phenotype gap. METHODS We carried out transcriptomic imputation using S-PrediXcan to identify genetically regulated gene expression associated with multisite chronic pain in 13 brain tissues and whole blood. Then, we imputed genetically regulated gene expression for over 31,000 Mount Sinai BioMe participants and performed a phenome-wide association study to investigate clinical relationships in chronic pain-associated gene expression changes. RESULTS We identified 95 experiment-wide significant gene-tissue associations (p < 7.97 × 10-7), including 36 unique genes and an additional 134 gene-tissue associations reaching within-tissue significance, including 53 additional unique genes. Of the 89 unique genes in total, 59 were novel for multisite chronic pain and 18 are established drug targets. Chronic pain genetically regulated gene expression for 10 unique genes was significantly associated with cardiac dysrhythmia, metabolic syndrome, disc disorders/dorsopathies, joint/ligament sprain, anemias, and neurologic disorder phecodes. Phenome-wide association study analyses adjusting for mean pain score showed that associations were not driven by mean pain score. CONCLUSIONS We carried out the largest transcriptomic imputation study of any chronic pain trait to date. Results highlight potential causal genes in chronic pain development and tissue and direction of effect. Several gene results were also drug targets. Phenome-wide association study results showed significant associations for phecodes including cardiac dysrhythmia and metabolic syndrome, thereby indicating potential shared mechanisms.
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Affiliation(s)
- Keira J A Johnston
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.
| | - Alanna C Cote
- Pamela Sklar Division of Psychiatric Genetics, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Emily Hicks
- Pamela Sklar Division of Psychiatric Genetics, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jessica Johnson
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Laura M Huckins
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.
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30
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Sládečková B, Botek M, Krejčí J, Valenta M, McKune A, Neuls F, Klimešová I. Hydrogen-rich water supplementation promotes muscle recovery after two strenuous training sessions performed on the same day in elite fin swimmers: randomized, double-blind, placebo-controlled, crossover trial. Front Physiol 2024; 15:1321160. [PMID: 38681143 PMCID: PMC11046232 DOI: 10.3389/fphys.2024.1321160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 03/25/2024] [Indexed: 05/01/2024] Open
Abstract
Purpose: Molecular hydrogen has been shown to possess antioxidant, anti-inflammatory, ergogenic, and recovery-enhancing effects. This study aimed to assess the effect of molecular hydrogen administration on muscle performance, damage, and perception of soreness up to 24 h of recovery after two strenuous training sessions performed on the same day in elite fin swimmers. Methods: Eight females (mean ± SD; age 21.5 ± 5.0 years, maximal oxygen consumption 45.0 ± 2.5 mL.kg-1.min-1) and four males (age 18.9 ± 1.3 years, maximal oxygen consumption 52.2 ± 1.7 mL.kg-1.min-1) performed 12 × 50 m sprints in the morning session and a 400 m competitive performance in the afternoon session. Participants consumed hydrogen-rich water (HRW) or placebo 3 days before the sessions (1,260 mL/day) and 2,520 mL on the experimental day. Muscle performance (countermovement jump), muscle damage (creatine kinase), and muscle soreness (100 mm visual analogue scale) were measured during the experimental day and at 12 and 24 h after the afternoon session. Results: HRW compared to placebo reduced blood activity of creatine kinase (156 ± 63 vs. 190 ± 64 U.L-1, p = 0.043), muscle soreness perception (34 ± 12 vs. 42 ± 12 mm, p = 0.045), and improved countermovement jump height (30.7 ± 5.5 cm vs. 29.8 ± 5.8 cm, p = 0.014) at 12 h after the afternoon session. Conclusion: Four days of HRW supplementation is a promising hydration strategy for promoting muscle recovery after two strenuous training sessions performed on the same day in elite fin swimmers. Clinical Trial Registration: clinicaltrials.gov, identifier NCT05799911.
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Affiliation(s)
- Barbora Sládečková
- Department of Social Sciences in Kinanthropology, Faculty of Physical Culture, Palacký University Olomouc, Olomouc, Czechia
| | - Michal Botek
- Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacký University Olomouc, Olomouc, Czechia
| | - Jakub Krejčí
- Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacký University Olomouc, Olomouc, Czechia
| | - Michal Valenta
- Department of Sport, Faculty of Physical Culture, Palacký University Olomouc, Olomouc, Czechia
| | - Andrew McKune
- Faculty of Health, UC-Research Institute for Sport and Exercise, University of Canberra, Canberra, NSW, Australia
- Discipline of Biokinetics, Exercise and Leisure Sciences, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Filip Neuls
- Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacký University Olomouc, Olomouc, Czechia
| | - Iva Klimešová
- Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacký University Olomouc, Olomouc, Czechia
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31
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Arslan-Carlon V, Qadan M, Puttanniah V, Seier K, Gönen M, Yang G, Fischer M, DeMatteo RP, Kingham TP, Jarnagin WR, D’Angelica MI. Randomized Prospective Trial of Epidural Analgesia after Open Hepatectomy. Ann Surg 2024; 279:598-604. [PMID: 38214168 PMCID: PMC10939918 DOI: 10.1097/sla.0000000000006205] [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] [Indexed: 01/13/2024]
Abstract
OBJECTIVE To evaluate whether patient-controlled epidural analgesia (PCEA) improves postoperative pain during ambulation following elective open hepatectomy. BACKGROUND Strategies to alleviate postoperative pain are a critical element of recovery after surgery. However, the optimal postoperative pain management strategy following open hepatectomy remains unclear. METHODS We conducted a prospective, nonblinded, randomized comparison of PCEA (intervention) versus intravenous patient-controlled analgesia (IV PCA; control) for postoperative pain following elective open hepatectomy. The primary end point was pain during ambulation on postoperative day (POD) 2. The study was powered to detect a clinically significant 2-point difference on the pain numeric rating scale (NRS). Secondary end points included pain at rest, morbidity, time to return of bowel function, and length of stay. RESULTS From 2015 to 2020, 231 patients were randomized (116 patients in the PCEA arm and 115 in the IV PCA arm). The incidence of epidural failure was 3% (n=4/116), with no epidural-related complications. Patients in the PCEA arm had a <2-point difference in NRS pain scores during ambulation on POD 2 vs. IV PCA (median 4.0 vs. 5.0, P <0.001). There was no difference in overall complications between the PCEA and IV PCA arms (33% vs. 40%, P =0.276). Secondary outcomes, including pain scores at rest, were similar between the study arms. CONCLUSIONS PCEA was safe following open hepatectomy and was associated with a small difference in pain with activity on POD 2 that did not reach our pre-specified definition of clinical significance.
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Affiliation(s)
- Vittoria Arslan-Carlon
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Motaz Qadan
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Vinay Puttanniah
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kenneth Seier
- Department of Biostatistics & Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mithat Gönen
- Department of Biostatistics & Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gloria Yang
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mary Fischer
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ronald P. DeMatteo
- Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - T. Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
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Steiness J, Hägi-Pedersen D, Lunn TH, Overgaard S, Brorson S, Graungaard BK, Lindberg-Larsen M, Varnum C, Lundstrøm LH, Beck T, Skettrup M, Pedersen NA, Bieder MJ, von Cappeln AG, Pleckaitiene L, Lindholm P, Bukhari SSH, Derby CB, Nielsen MG, Exsteen OW, Vinstrup LØ, Thybo KH, Gasbjerg KS, Nørskov AK, Jakobsen JC, Mathiesen O. Non-opioid analgesic combinations following total hip arthroplasty (RECIPE): a randomised, placebo-controlled, blinded, multicentre trial. THE LANCET. RHEUMATOLOGY 2024; 6:e205-e215. [PMID: 38458208 DOI: 10.1016/s2665-9913(24)00020-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Multimodal postoperative analgesia following total hip arthroplasty is recommended, but the optimal combination of drugs remains uncertain. The aim of the RECIPE trial was to investigate the relative benefit and harm of the different combinations of paracetamol, ibuprofen, and the analgesic adjuvant dexamethasone for treatment of postoperative pain following total hip arthroplasty. METHODS The RECIPE trial was a randomised, blinded, placebo-controlled trial conducted at nine Danish hospitals. Adults scheduled for total hip arthroplasty were randomly assigned (1:1:1:1) using a computer-generated list with stratification by site to receive combinations of oral paracetamol 1000 mg every 6 h, oral ibuprofen 400 mg every 6 h, or a single-dose of intravenous dexamethasone 24 mg in the following groups: paracetamol plus ibuprofen, ibuprofen plus dexamethasone, paracetamol plus dexamethasone, and paracetamol plus ibuprofen plus dexamethasone. The primary outcome was 24 h intravenous morphine consumption, analysed in a modified intention-to-treat population, defined as all randomly assigned participants who underwent total hip arthroplasty. The predefined minimal important difference was 8 mg. Safety outcomes included serious and non-serious adverse events within 90 days and 24 h. The trial was registered with ClinicalTrials.gov, NCT04123873. FINDINGS Between March 5, 2020, and Nov 15, 2022, we randomly assigned 1060 participants, of whom 1043 (589 [56%] women and 454 [44%] men) were included in the modified intention-to-treat population. 261 were assigned to paracetamol plus ibuprofen, 262 to ibuprofen plus dexamethasone, 262 to paracetamol plus dexamethasone, and 258 to paracetamol plus ibuprofen plus dexamethasone. Median 24 h morphine consumption was 24 mg (IQR 12-38) in the paracetamol plus ibuprofen group, 20 mg (12-32) in the paracetamol plus dexamethasone group, 16 mg (10-30) in the ibuprofen plus dexamethasone group, and 15 mg (8-26) in the paracetamol plus ibuprofen plus dexamethasone group. The paracetamol plus ibuprofen plus dexamethasone group had a significantly reduced 24 h morphine consumption compared with paracetamol plus ibuprofen (Hodges-Lehmann median difference -6 mg [99% CI -10 to -3]; p<0·0001) and paracetamol plus dexamethasone (-4 mg [-8 to -1]; p=0·0013), however, none of the comparisons showed differences reaching the minimal important threshold of 8 mg. 91 (35%) of 258 participants in the paracetamol plus ibuprofen plus dexamethasone group had one or more adverse events, compared with 99 (38%) of 262 in the ibuprofen plus dexamethasone group, 103 (39%) of 262 in the paracetamol plus dexamethasone group, and 165 (63%) of 261 in the paracetamol plus ibuprofen group. INTERPRETATION In adults undergoing total hip arthroplasty, a combination of paracetamol, ibuprofen, and dexamethasone had the lowest morphine consumption within 24 h following surgery and the most favourable adverse event profile, with a lower incidence of serious and non-serious adverse events (primarily driven by differences in nausea, vomiting, and dizziness) compared with paracetamol plus ibuprofen. FUNDING The Novo Nordisk Foundation and Næstved-Slagelse-Ringsted Hospitals' Research Fund.
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Affiliation(s)
- Joakim Steiness
- Department of Anaesthesiology, Zealand University Hospital, Køge, Denmark.
| | - Daniel Hägi-Pedersen
- Department of Anaesthesiology, Næstved-Slagelse-Ringsted Hospitals, Næstved, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Troels Haxholdt Lunn
- Department of Anaesthesiology and Intensive Care, Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Stig Brorson
- Department of Orthopaedic Surgery, Zealand University Hospital, Køge, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ben Kristian Graungaard
- Department of Anaesthesiology, Copenhagen University Hospital, Gentofte Hospital, Copenhagen, Denmark
| | - Martin Lindberg-Larsen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark; Department of Orthopaedic Surgery, Odense University Hospital, Svendborg, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Claus Varnum
- Department of Orthopaedic Surgery, Lillebælt Hospital, Vejle, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Lars Hyldborg Lundstrøm
- Department of Anaesthesiology, Copenhagen University Hospital - North Zealand, Hillerød, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Torben Beck
- Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen, Denmark
| | - Michael Skettrup
- Department of Orthopaedic Surgery, Copenhagen University Hospital, Gentofte Hospital, Copenhagen, Denmark
| | | | - Manuel Josef Bieder
- Department of Orthopaedic Surgery, Næstved-Slagelse-Ringsted Hospitals, Næstved, Denmark
| | | | | | - Peter Lindholm
- Department of Anaesthesiology, Odense University Hospital, Odense, Denmark
| | | | | | - Maria Gantzel Nielsen
- Department of Anaesthesiology and Intensive Care, Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen, Denmark
| | - Oskar Wilborg Exsteen
- Department of Anaesthesiology, Copenhagen University Hospital - North Zealand, Hillerød, Denmark
| | - Louise Ørts Vinstrup
- Department of Anaesthesiology and Intensive Care, Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen, Denmark
| | - Kasper Højgaard Thybo
- Department of Anaesthesiology, Næstved-Slagelse-Ringsted Hospitals, Næstved, Denmark
| | - Kasper Smidt Gasbjerg
- Department of Anaesthesiology, Copenhagen University Hospital, Herlev Hospital, Copenhagen, Denmark
| | - Anders Kehlet Nørskov
- Department of Anaesthesiology, Copenhagen University Hospital - North Zealand, Hillerød, Denmark
| | - Janus Christian Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Ole Mathiesen
- Department of Anaesthesiology, Zealand University Hospital, Køge, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Tagliaferri SD, Belavy DL, Fitzgibbon BM, Bowe SJ, Miller CT, Ehrenbrusthoff K, Owen PJ. How to Interpret Effect Sizes for Biopsychosocial Outcomes and Implications for Current Research. THE JOURNAL OF PAIN 2024; 25:857-861. [PMID: 37871685 DOI: 10.1016/j.jpain.2023.10.014] [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: 05/29/2023] [Revised: 09/27/2023] [Accepted: 10/15/2023] [Indexed: 10/25/2023]
Abstract
Biopsychosocial factors are associated with pain, but they can be difficult to compare. One way of comparing them is to use standardized mean differences. Previously, these effects sizes have been termed as small, medium, or large, if they are bigger than or equal to, respectively, .2, .5, or .8. These cut-offs are arbitrary and recent evidence showed that they need to be reconsidered. We argue it is necessary to determine cut-offs for each biopsychosocial factor. To achieve this, we propose 3 potential approaches: 1) examining, for each factor, how the effect size differs depending upon disease severity; 2) using an existing minimum clinically important difference to anchor the large effect size; and 3) define cut-offs by comparing data from people with and without pain. This is important for pain research, as exploring these methodologies has potential to improve comparability of biopsychosocial factors and lead to more directed treatments. We note assumptions and limitations of these methods that should also be considered. PERSPECTIVE: Standardized mean differences can estimate effect sizes between groups and could theoretically allow for comparison of biopsychosocial factors. However, common thresholds to define effect sizes are arbitrary and likely differ based on outcome. We propose methods that could overcome this and be used to derive biopsychosocial outcome-specific effect sizes.
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Affiliation(s)
- Scott D Tagliaferri
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Faculty of Health, Geelong, Australia; Orygen, Parkville, Australia; Centre for Youth Mental Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Daniel L Belavy
- Hochschule für Gesundheit (University of Applied Sciences), Department of Applied Health Sciences, Division of Physiotherapy, Bochum, Germany
| | - Bernadette M Fitzgibbon
- Monarch Research Institute, Monarch Mental Health Group, Australia; Department of Psychiatry, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Steven J Bowe
- Deakin Biostatistics Unit, Faculty of Health, Deakin University, Geelong, Australia; Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Clint T Miller
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Faculty of Health, Geelong, Australia
| | - Katja Ehrenbrusthoff
- Hochschule für Gesundheit (University of Applied Sciences), Department of Applied Health Sciences, Division of Physiotherapy, Bochum, Germany
| | - Patrick J Owen
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Faculty of Health, Geelong, Australia
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Barbosa-Silva J, Calixtre LB, Von Piekartz D, Driusso P, Armijo-Olivo S. The minimal important difference of patient-reported outcome measures related to female urinary incontinence: a systematic review. BMC Med Res Methodol 2024; 24:60. [PMID: 38459428 PMCID: PMC10921720 DOI: 10.1186/s12874-024-02188-4] [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: 11/06/2023] [Accepted: 02/22/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND The minimal important difference is a valuable metric in ascertaining the clinical relevance of a treatment, offering valuable guidance in patient management. There is a lack of available evidence concerning this metric in the context of outcomes related to female urinary incontinence, which might negatively impact clinical decision-making. OBJECTIVES To summarize the minimal important difference of patient-reported outcome measures associated with urinary incontinence, calculated according to both distribution- and anchor-based methods. METHODS This is a systematic review conducted according to the PRISMA guidelines. The search strategy including the main terms for urinary incontinence and minimal important difference were used in five different databases (Medline, Embase, CINAHL, Web of Science, and Scopus) in 09 June 2021 and were updated in January 09, 2024 with no limits for date, language or publication status. Studies that provided minimal important difference (distribution- or anchor-based methods) for patient-reported outcome measures related to female urinary incontinence outcomes were included. The study selection and data extraction were performed independently by two different researchers. Only studies that reported the minimal important difference according to anchor-based methods were assessed by credibility and certainty of the evidence. When possible, absolute minimal important differences were calculated for each study separately according to the mean change of the group of participants that slightly improved. RESULTS Twelve studies were included. Thirteen questionnaires with their respective minimal important differences reported according to distribution (effect size, standard error of measurement, standardized response mean) and anchor-based methods were found. Most of the measures for anchor methods did not consider the smallest difference identified by the participants to calculate the minimal important difference. All reports related to anchor-based methods presented low credibility and very low certainty of the evidence. We pooled 20 different estimates of minimal important differences using data from primary studies, considering different anchors and questionnaires. CONCLUSIONS There is a high variability around the minimal important difference related to patient-reported outcome measures for urinary incontinence outcomes according to the method of analysis, questionnaires, and anchors used, however, the credibility and certainty of the evidence to support these is still limited.
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Affiliation(s)
- Jordana Barbosa-Silva
- Women's Health Research Laboratory (LAMU), Physical Therapy Department, Federal University of São Carlos, Rodovia Washington Luís, km 235, Monjolinho, São Carlos, SP, 13565-905, Brazil.
- Faculty of Business and Social Sciences, University of Applied Sciences - Hochschule Osnabrück, Osnabrück, Germany.
| | | | - Daniela Von Piekartz
- Faculty of Business and Social Sciences, University of Applied Sciences - Hochschule Osnabrück, Osnabrück, Germany
| | - Patricia Driusso
- Women's Health Research Laboratory (LAMU), Physical Therapy Department, Federal University of São Carlos, Rodovia Washington Luís, km 235, Monjolinho, São Carlos, SP, 13565-905, Brazil
| | - Susan Armijo-Olivo
- Faculty of Business and Social Sciences, University of Applied Sciences - Hochschule Osnabrück, Osnabrück, Germany
- Faculty of Rehabilitation Medicine/Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
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Bjelkarøy MT, Benth JŠ, Simonsen TB, Siddiqui TG, Cheng S, Kristoffersen ES, Lundqvist C. Measuring pain intensity in older adults. Can the visual analogue scale and the numeric rating scale be used interchangeably? Prog Neuropsychopharmacol Biol Psychiatry 2024; 130:110925. [PMID: 38143014 DOI: 10.1016/j.pnpbp.2023.110925] [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: 08/10/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 12/26/2023]
Abstract
OBJECTIVES Visual analogue scale (VAS) and numeric rating scale (NRS) are two commonly used instruments for measuring pain intensity. Both instruments are validated for use in both clinical and research settings, and share a range of similar aspects. Some studies have shown that the two instruments may be used interchangeably, but the results are conflicting. In this study we assessed whether the VAS and the NRS instruments may be used interchangeably when measuring pain intensity in older adults. METHODS Data were collected in a cross-sectional study, as part of the follow-up in a larger longitudinal study conducted at the Akershus University Hospital, Norway 2021 to 2022 and included 39 older adults aged ≥65. Participants were regarded as a normal older adult population as they were not recruited on basis of a specific condition or reports of pain. The participants were asked to rate their pain intensity on an average day using VAS and NRS. Bland-Altman analysis was performed to assess agreement between the two instruments. RESULTS Thirty-seven participants with mean (SD) age of 77 (5.9) were included in the analysis. Mean (SD) pain assessed by VAS and NRS was 2.8 (1.8) and NRS 4.7 (2.2), respectively. A mean difference (SD) of 2.0 (1.9) between the scores of the two instruments was statistically significantly different from zero (p < 0.001) confirming bias. The 95% limits of agreement were estimated to be -1.7 to 5.7. A post-hoc analysis, removing an outlier, resulted in similar conclusions. CONCLUSION There was poor agreement between the VAS and NRS scale for measuring pain intensity in older adults. This suggests that the two instruments should not be used interchangeably when assessing pain intensity in this population. ETHICAL APPROVAL Regional Committees for Medical and Health Research Ethics [2016/2289]. TRIAL REGISTRATION NCT03162081, 22 May 2017.
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Affiliation(s)
- Maria Torheim Bjelkarøy
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, Campus Ahus, Faculty of Medicine, University of Oslo, Lørenskog, Norway.
| | - Jūratė Šaltytė Benth
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, Campus Ahus, Faculty of Medicine, University of Oslo, Lørenskog, Norway.
| | | | - Tahreem Ghazal Siddiqui
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, Campus Ahus, Faculty of Medicine, University of Oslo, Lørenskog, Norway.
| | - Socheat Cheng
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, Campus Ahus, Faculty of Medicine, University of Oslo, Lørenskog, Norway
| | - Espen Saxhaug Kristoffersen
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway; Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - Christofer Lundqvist
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, Campus Ahus, Faculty of Medicine, University of Oslo, Lørenskog, Norway; Department of Neurology, Akershus University Hospital, Lørenskog, Norway.
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N Irwin M, A Cooke D, Berland D, D Marshall V, A Smith M. Efficacy and Safety of Low Dose Naltrexone for Chronic Pain. J Pain Palliat Care Pharmacother 2024; 38:13-19. [PMID: 38301136 DOI: 10.1080/15360288.2024.2302550] [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: 05/24/2023] [Accepted: 12/28/2023] [Indexed: 02/03/2024]
Abstract
Naltrexone is a mu-opioid receptor antagonist increasingly used as an analgesic for chronic pain at low doses. This retrospective, observational cohort study was conducted at an academic medical center to evaluate low-dose naltrexone (LDN) efficacy and describe its use in routine clinical practice. Adults receiving LDN, doses <10 mg for ≥1 month, seen at an outpatient pain clinic from January 1, 2014 to April 1, 2022 were included. The primary outcome was change in the Pain, Enjoyment of Life, and General Activity (PEG) score after LDN. Thirty-one patients were included. Median age was 50 years and 71% were female. Median duration of pain at baseline was 5 years. Mean PEG scores were 7.27 ± 1.39 and 6.62 ± 2.04 at baseline and follow-up, respectively. Mean difference was 0.66 (95% CI [0.10-1.21], p = 0.022). Eighty-seven percent (27) of patients discontinued LDN, 52% (16) for lack of benefit, 23% (7) for loss of benefit, 10% (3) for side effects, and 3% (1) for other reasons. Seven (23%) reported side effects. LDN was associated with a statistically significant reduction in PEG in adult chronic pain patients, however the clinical significance is unclear as over 75% of patients discontinued LDN due to lack of benefit.
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Affiliation(s)
- Madison N Irwin
- Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, Michigan, USA
- University of Michigan Health Department of Pharmacy, Ann Arbor, Michigan, USA
| | - David A Cooke
- University of Michigan Health System, Division of General Medicine, Ann Arbor, Michigan, USA
| | - Daniel Berland
- University of Michigan Health System, Division of General Medicine, Ann Arbor, Michigan, USA
| | - Vincent D Marshall
- Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, Michigan, USA
| | - Michael A Smith
- Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, Michigan, USA
- University of Michigan Health Department of Pharmacy, Ann Arbor, Michigan, USA
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Shigetoh H, Koga M, Tanaka Y, Hirakawa Y, Morioka S. Characterizing clinical progression in patients with musculoskeletal pain by pain severity and central sensitization-related symptoms. Sci Rep 2024; 14:4873. [PMID: 38418550 PMCID: PMC10902372 DOI: 10.1038/s41598-024-55290-4] [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: 04/16/2023] [Accepted: 02/22/2024] [Indexed: 03/01/2024] Open
Abstract
Central sensitization-related symptoms (CSS) are associated with the severity and progression of pain. The relationship between the severity of pain/CSS and clinical progresses remains unclear. This multicenter, collaborative, longitudinal study aimed to characterize the clinical outcomes of patients with musculoskeletal pain by classifying subgroups based on the severity of pain/CSS and examining changes in subgroups over time. We measured the pain intensity, CSS, catastrophic thinking, and body perception disturbance in 435 patients with musculoskeletal pain. Reevaluation of patients after one month included 166 patients for pain intensity outcome and 110 for both pain intensity and CSS outcome analysis. We classified the patients into four groups (mild pain/CSS, severe pain/mild CSS, severe pain/CSS, and mild pain/severe CSS groups) and performed multiple comparison analyses to reveal the differences between the CSS severity groups. Additionally, we performed the adjusted residual chi-square to identify the number of patients with pain improvement, group transition, changing pain, and CSS pattern groups at baseline. The most characteristic result was that the mild and severe CSS groups showed worsening pain. Moreover, many of the group transitions were to the same group, with a few transitioning to a group with mild pain/CSS. Our findings suggest that the severity and improvement of CSS influence pain prognosis.
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Affiliation(s)
- Hayato Shigetoh
- Department of Physical Therapy, Faculty of Health Science, Kyoto Tachibana University, Kyoto, 607-8175, Japan.
- Neurorehabilitation Research Center, Kio University, Nara, 635-0832, Japan.
| | - Masayuki Koga
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, Nara, 635-0832, Japan
| | - Yoichi Tanaka
- Neurorehabilitation Research Center, Kio University, Nara, 635-0832, Japan
| | - Yoshiyuki Hirakawa
- Neurorehabilitation Research Center, Kio University, Nara, 635-0832, Japan
| | - Shu Morioka
- Neurorehabilitation Research Center, Kio University, Nara, 635-0832, Japan
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, Nara, 635-0832, Japan
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Gámez-Iruela J, Aibar-Almazán A, Afanador-Restrepo DF, Castellote-Caballero Y, Hita-Contreras F, Carcelén-Fraile MDC, González-Martín AM. Mind-Body Training: A Plausible Strategy against Osteomuscular Chronic Pain-A Systematic Review with Meta-Analysis. J Pers Med 2024; 14:200. [PMID: 38392633 PMCID: PMC10890392 DOI: 10.3390/jpm14020200] [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: 01/10/2024] [Revised: 02/05/2024] [Accepted: 02/08/2024] [Indexed: 02/24/2024] Open
Abstract
(1) Background: Chronic pain, which affects more than one in five adults worldwide, has a negative impact on the quality of life, limiting daily activities and generating absences from work. The aim of the present review is to analyze the efficacy of mind-body therapies as therapeutic strategies for patients with chronic pain. (2) Methods: A systematic review with a meta-analysis was carried out, searching PubMed, Scopus, and Web of Science databases using specific keywords. We selected studies that included mind-body therapies as the primary intervention for older adults with chronic pain. The methodological quality of the articles was assessed using the PEDro scale. (3) Results: Of the 861 studies identified, 11 were included in this review, all of which employed different mind-body therapies as an intervention. The selected studies measured chronic pain as the main variable. (4) Conclusions: This review highlights the value of mind-body exercises in reducing chronic pain in older adults, suggesting their integration as a non-pharmacological therapeutic alternative that improves the quality of life, promoting a holistic approach to pain management.
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Affiliation(s)
- Julia Gámez-Iruela
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain
| | - Agustín Aibar-Almazán
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain
| | | | | | - Fidel Hita-Contreras
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain
| | - María Del Carmen Carcelén-Fraile
- Department of Education and Psychology, Faculty of Social Sciences, University of Atlántico Medio, 35017 Las Palmas de Gran Canaria, Spain
| | - Ana María González-Martín
- Department of Education and Psychology, Faculty of Social Sciences, University of Atlántico Medio, 35017 Las Palmas de Gran Canaria, Spain
- Department of Psychology, Centro de Educación Superior de Enseñanza e Investigación Educativa, Plaza de San Martín, 4, 28013 Madrid, Spain
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Ulrich G, Kraus K, Polk S, Zuelzer D, Matuszewski PE. Implementation of a Fascia Iliaca Compartment Block Program in Geriatric Hip Fractures: The Experience at a Level I Academic Trauma Center. J Orthop Trauma 2024; 38:96-101. [PMID: 37941115 DOI: 10.1097/bot.0000000000002722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 10/23/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVES Determine adherence to a newly implemented protocol of fascia iliaca compartment block (FICB) in geriatric hip fractures. METHODS DESIGN Retrospective review. SETTING Level I trauma center. PATIENT SELECTION CRITERIA Patients with a hip fracture treated with cephalomedullary nailing or hemiarthroplasty (CPT codes 27245 or 27236). OUTCOME MEASURES AND COMPARISONS Adherence to a protocol for FICB, time intervals between emergency department arrival, FICB, and surgery stratified by time of admission. RESULTS Three hundred eighty patients were studied (average age 78 years, 70% female). Approximately 53.2% of patients received an FICB, which was less than a predefined acceptable adherence rate of 75% ( P < 0.001). Approximately 5.0% received an FICB within 4 hours and 17.3% within 6 hours from admission. Admission during daylight hours (7 am -7p m ) when compared with evening hours (7 pm -7 am ) was associated with improved timeliness ([8.3% vs. 0% within 4 hours, P < 0.001] [27.5% vs. 2.4% within 6 hours, P < 0.001]). Improved adherence to the protocol was observed over time (odds ratio: 1.0013, 95% confidence interval, 1.0001-1.0025, P = 0.0388). CONCLUSIONS FICB implementation was poor but gradually improved over time. Few patients received an FICB promptly, especially during night hours. Overall, this study demonstrates that implementation of an FICB program at a Level I academic trauma center can be difficult; however, many hurdles can be overcome with institutional support and dedication of resources such as staff, space, and additional training.
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Affiliation(s)
- Gary Ulrich
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky College of Medicine, Lexington, KY
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Froehlich KA, Deleon ZG, Tubog TD. Effects of Gabapentin on Postoperative Pain and Opioid Consumption Following Laparoscopic Cholecystectomy: A Systematic Review and Meta-analysis. J Perianesth Nurs 2024; 39:132-141. [PMID: 37855760 DOI: 10.1016/j.jopan.2023.06.005] [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: 09/29/2022] [Revised: 02/27/2023] [Accepted: 06/02/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE Examine the efficacy of gabapentin on postoperative pain scores and opioid consumption in laparoscopic cholecystectomy. DESIGN Systematic review and meta-analysis. METHODS PubMed, EBSCO, CINAHL, the Cochrane Central Register of Controlled Trials, Google Scholar, and gray literature was used to search the literature. Only randomized controlled trials were included. Outcomes were reported using the risk ratio and mean difference (MD). Risk of bias and the grades of recommendation, assessment, development, and evaluation (GRADE) system was used to the assessed quality of evidence. FINDINGS Nineteen trials involving 2,068 patients were analyzed. Compared to placebo, gabapentin reduced the cumulative pain scores in the first 24 hours after surgery (MD, -1.19; 95% CI, -1.39-0.99; P < .00011), opioid consumption (MD, -3.51; 95% CI, -4.67 to -2.35; P < .00001), and the incidence of postoperative nausea and vomiting (risk ratio, 0.64; 95% CI, 0.52-0.78; P < .00001) with prolonged time to first analgesic rescue (MD, 210.9; 95% CI, 76.90-344.91; P = .002). However, gabapentin has little to no effect on the incidence of sedation, somnolence, and respiratory depression. CONCLUSIONS Gabapentin can be added as part of the multimodal pain management for patients undergoing laparoscopic cholecystectomy. Extrapolation of these findings to clinical settings must take into consideration the limitations identified in this review.
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Affiliation(s)
| | - Zeus G Deleon
- Graduate Programs of Nurse Anesthesia, Texas Wesleyan University, Fort Worth, Texas
| | - Tito D Tubog
- Graduate Programs of Nurse Anesthesia, Texas Wesleyan University, Fort Worth, Texas.
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Wilson AA, Schmid AM, Pestaña P, Tubog TD. Erector Spinae Plane Block on Postoperative Pain and Opioid Consumption After Lumbar Spine Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials. J Perianesth Nurs 2024; 39:122-131. [PMID: 37747377 DOI: 10.1016/j.jopan.2023.06.003] [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: 10/25/2022] [Revised: 02/21/2023] [Accepted: 06/02/2023] [Indexed: 09/26/2023]
Abstract
PURPOSE Evaluate the effectiveness of the erector spinae plane (ESP) block in lumbar spine surgeries. DESIGN Systematic review with meta-analysis. METHODS PubMed, Cochrane Library, CINAHL, Google Scholar, and other gray literature were searched for eligible studies. Risk ratio (RR), mean difference (MD), and standardized mean difference were used to estimate outcomes with suitable effect models. The quality of evidence was assessed using the Risk of Bias algorithm and the grades of recommendation, assessment, development, and evaluation (GRADE) approach. FINDINGS Twenty-two randomized controlled trials involving 1,327 patients were included. The erector spinae plane (ESP) block demonstrated a lower cumulative pain score within the first 48 hours at rest (MD, -1.03; 95% CI, -1.19 to -0.87; P < .00001) and during activity (MD, -1.16; 95% CI, -1.24 to -1.08; P < .00001). In addition, ESP block decreased opioid consumption (MD, -6.25; 95% CI, -8.33 to -4.17; P < .00001) and prolonged the time to first analgesic rescue (MD, 5.66; 95% CI, 3.11-8.20; P < .0001) resulting in fewer patients requesting rescue analgesic (RR, 0.33; 95% CI, 0.13-0.83; P = .02), lower incidence of postoperative nausea and vomiting (RR, 0.29; 95% CI, 0.10-0.79; P = .02) with improved patient satisfaction score (standardized mean difference, 2.17; 95% CI, 1.40-2.94; P < .00001). CONCLUSIONS ESP block can provide effective postoperative pain control for lumbar spine surgery, improve patient satisfaction, and reduce the amount of postoperative opioid use.
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Affiliation(s)
- Alyssa A Wilson
- Graduate Programs of Nurse Anesthesia, Texas Wesleyan University, Fort Worth, TX
| | - Alexis M Schmid
- Graduate Programs of Nurse Anesthesia, Texas Wesleyan University, Fort Worth, TX
| | - Pedro Pestaña
- Graduate Programs of Nurse Anesthesia, Texas Wesleyan University, Fort Worth, TX
| | - Tito D Tubog
- Graduate Programs of Nurse Anesthesia, Texas Wesleyan University, Fort Worth, TX.
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Gerdesmeyer L, Vester J, Schneider C, Wildemann B, Frank C, Schultz M, Seilheimer B, Smit A, Kerkhoffs G. Topical Treatment Is Effective and Safe for Acute Ankle Sprains: The Multi-Center Double-Blind Randomized Placebo-Controlled TRAUMED Trial. J Clin Med 2024; 13:841. [PMID: 38337536 PMCID: PMC10856131 DOI: 10.3390/jcm13030841] [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: 11/27/2023] [Revised: 01/17/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Topical NSAIDs are widely used to treat ankle sprains. Traumed (Tr14) gel is a multicomponent formulation, demonstrating inflammation-resolution properties. METHODS This multicenter, double-blind trial investigated the efficacy and safety of Tr14 gel versus placebo gel and non-inferiority versus 1% diclofenac gel, applied 3×/day for 7 days after acute lateral ankle sprain (EudraCT Number: 2016-004792-50). The primary outcome was AUC for pain on passive movement, assessed by VAS from baseline to Days 4 and 7. RESULTS The trial population included 625 patients aged 18 to 78 years. The AUC scores were 187.88 and 200.75 on Day 4 (p = 0.02) and 294.14 and 353.42 on Day 7 (p < 0.001) for Tr14 and placebo, respectively. For Tr14 compared to diclofenac, the AUC scores were 187.50 and 197.19 on Day 4 (p = 0.3804) and 293.85 and 327.93 on Day 7 (p = 0.0017), respectively. On the FAAM-ADL subscale, Tr14 was superior to placebo and non-inferior to diclofenac at all time points. Time to 50% pain improvement was lowest for Tr14 (6.0 days), compared to placebo (7.1 days) and diclofenac (7.0 days). Adverse events were uncommon and minor. CONCLUSIONS Tr14 gel is effective and safe in acute ankle sprains, compared to placebo gel and diclofenac gel, and has faster pain resolution. TRIAL REGISTRATION The trial was registered in clinicaltrialsregister.eu, EudraCT number 2016-004792-50 on 07.06.2017.
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Affiliation(s)
- Ludger Gerdesmeyer
- Orthopedics and Trauma Surgery, Kiel Municipal Hospital, 24116 Kiel, Germany
| | | | | | - Britt Wildemann
- Experimental Trauma Surgery, Jena University Hospital, Friedrich Schiller University Jena, 07747 Jena, Germany
| | | | | | | | - Alta Smit
- Heel GmbH, 76532 Baden-Baden, Germany
| | - Gino Kerkhoffs
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam University Medical Centers, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
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Pharis HF, DeGenova DT, Passias BJ, Manes TJ, Parizek G, Sybert D. The Safety and Efficacy of Posterior Lumbar Interbody Fusions in the Outpatient Setting. Cureus 2024; 16:e53662. [PMID: 38455778 PMCID: PMC10917700 DOI: 10.7759/cureus.53662] [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: 02/05/2024] [Indexed: 03/09/2024] Open
Abstract
Introduction Outpatient surgical procedures have shown reduced costs, improved patient outcomes, and decreased postoperative complications. Interest in moving orthopedic and neurosurgical spine procedures to the outpatient setting has grown in recent years because of these factors. Studies investigating open posterior lumbar interbody fusions (PLIFs) in the outpatient setting are sparse. Methods The patients who underwent an open PLIF with pedicle screw and rod construct from 2014 to 2018 were retrospectively reviewed. Outpatient procedures were defined by patient discharge being on the same day of the procedure, without admittance to an inpatient ward. Pertinent demographic, clinical, radiographic, and surgical data were collected and analyzed. Results The current study included 36 outpatient PLIF cases with 94.4% of the study cohort undergoing a single-level PLIF. The average Oswestry Disability Index (ODI) score improved by 20.4 points from preoperative measurements (p = 0.0002), and the visual analog scale (VAS) score improved by 27.2 points (p = 0.0001). The postoperative fusion rate was 94.4%. One intraoperative complication occurred (2.78%), and four postoperative complications occurred (11.11%). There were no subsequent admissions throughout the postoperative follow-up period; however, two of the 36 patients (5.56%) did require reoperation, both in an outpatient setting. Conclusions This study demonstrates that open posterior lumbar interbody fusions performed in an outpatient setting can be performed safely and effectively, with a significant reduction in VAS and ODI pain scores.
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Affiliation(s)
| | | | | | | | - Grace Parizek
- Orthopedic Surgery, Ohio University Heritage College of Osteopathic Medicine, Columbus, USA
| | - Daryl Sybert
- Orthopedic Surgery, Mount Carmel Health System, Columbus, USA
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Peralta FM, Condon LP, Torrez D, Neumann KE, Pollet AL, McCarthy RJ. Association of pain catastrophizing with labor pain and analgesia consumption in obstetrical patients. Int J Obstet Anesth 2024; 57:103954. [PMID: 38087766 DOI: 10.1016/j.ijoa.2023.103954] [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: 06/16/2023] [Revised: 10/26/2023] [Accepted: 11/05/2023] [Indexed: 02/04/2024]
Abstract
INTRODUCTION Pain catastrophizing is an exaggerated negative orientation to painful stimuli which in obstetric patients is associated with fear of overwhelming labor pain and negative pain-related outcomes. This study aimed to quantitatively examine the association of pain catastrophizing with maternal labor pain outcomes. METHODS We conducted a prospective observational study of women admitted for a vaginal trial of labor. Subjects completed the 13-item Pain Catastrophizing scale (PCS) questionnaire (scored 0 to 52, higher scores representing greater catastrophizing). Pain was assessed at baseline and at request for neuraxial labor analgesia. Labor and postpartum pain intensity was assessed as the average area under the pain intensity by time curve. Pain at request for analgesia, labor pain, postpartum pain, analgesic consumption, and quality of recovery was compared between high (PCS ≥ 17) and low catastrophizing groups. RESULTS Data from 138/157 (88%) subjects were included in the analysis. Median (IQR) pain scores at request for analgesia were 9 (8,10) and 8 (6,9), a difference of 1 (95% CI 0 to 2.5, P = 0.008) in high-catastrophizing and in low-catastrophizing groups, respectively. Adjusted pain during labor, postpartum pain and opioid analgesic use were not significantly different. High-catastrophizers reported less comfort, ability to mobilize and less control during hospitalization. Post-discharge there were no differences in pain or analgesic use. CONCLUSION We did not observe greater labor or post-delivery pain or increased analgesic use in high-catastrophizing parturients. High catastrophizers reported greater pain when requesting analgesia, which is consistent with the role of catastrophizing in intensifying the experience of pain.
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Affiliation(s)
- F M Peralta
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - L P Condon
- Department of Anesthesiology, Rush University, Chicago, IL, USA
| | - D Torrez
- Department of Anesthesiology, Rush University, Chicago, IL, USA
| | - K E Neumann
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - A L Pollet
- Department of Anesthesiology, Rush University, Chicago, IL, USA
| | - R J McCarthy
- Department of Anesthesiology, Rush University, Chicago, IL, USA
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Ganesan A, Rustagi N, Kaur A, Chaudhry K, Kumar P, Chopane S, Chugh A. Minimal clinically important difference in maxillofacial trauma patients: a prospective cohort study. Br J Oral Maxillofac Surg 2024; 62:177-183. [PMID: 38336576 DOI: 10.1016/j.bjoms.2023.11.016] [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: 08/13/2023] [Revised: 11/17/2023] [Accepted: 11/28/2023] [Indexed: 02/12/2024]
Abstract
The present study estimated the minimal clinically important difference (MCID) for pain on a visual analogue scale - numerical rating scale (VAS-NRS) and mean bite force (MBF) in patients treated for maxillofacial trauma (MFT). This cohort study included 120 MFT patients treated according to AO principles. Preoperative and four-week postoperative pain on the VAS-NRS, and MBF were measured to calculate MCIDs as indicators of functional rehabilitation. The patient's perspective of the treatment was assessed using a four-item anchor question. The MCID was determined by two anchor-based approaches, namely, the change difference (CD) method and receiver operating characteristic (ROC) curve method. According to the CD method, the MCID for pain was 2.4 and the MBF was 147.9 N. Based on the ROC curve, the MCID for pain was 2.5 (sensitivity 91.7%, specificity 47.2%) and MBF was 159.1 N (sensitivity 71.4%, specificity 61.1%). This study demonstrated a high sensitivity (>70%) for MCID, which implies that pain reduction of 2.4-2.5 points on the VAS-NRS and a gain in MBF of 147.9-159.1N are clinically relevant for patients treated for MFT.
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Affiliation(s)
- Aparna Ganesan
- Ex-Junior Resident, Oral & Maxillofacial Surgery, Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, India
| | - Neeti Rustagi
- Additional Professor, Department of Community & Family Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Amanjot Kaur
- Assistant Professor, Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, Vijaypur, Jammu, India
| | - Kirti Chaudhry
- Additional Professor, Oral & Maxillofacial Surgery, Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, India.
| | - Pravin Kumar
- Professor & Head of the Department, Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, India
| | - Shivakumar Chopane
- Ex-Junior Resident, Oral & Maxillofacial Surgery, Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, India
| | - Ankita Chugh
- Professor, Oral & Maxillofacial Surgery, Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, India
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Vella SP, Melman A, Coombs D, Maher CG, Swain MS, Monk E, Machado GC. The effectiveness of allied health and nurse practitioner models-of-care in managing musculoskeletal conditions in the emergency department: a systematic review and meta-analysis. BMC Emerg Med 2024; 24:13. [PMID: 38233743 PMCID: PMC10795385 DOI: 10.1186/s12873-023-00925-4] [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: 10/13/2023] [Accepted: 12/26/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Musculoskeletal conditions are the most common health condition seen in emergency departments. Hence, the most effective approaches to managing these conditions is of interest. This systematic review aimed to evaluate the effectiveness of allied health and nursing models of care for the management of musculoskeletal pain in ED. METHODS MEDLINE, EMBASE, CINAHL and LILACS databases were searched from inception to March 2023 for published randomised trials that compared the effectiveness of allied health and nursing models of care for musculoskeletal conditions in ED to usual ED care. Trials were eligible if they enrolled participants presenting to ED with a musculoskeletal condition including low back pain, neck pain, upper or lower limb pain and any soft tissue injury. Trials that included patients with serious pathology (e.g. malignancy, infection or cauda equina syndrome) were excluded. The primary outcome was patient-flow; other outcomes included pain intensity, disability, hospital admission and re-presentation rates, patient satisfaction, medication prescription and adverse events. Two reviewers performed search screening, data extraction, quality and certainty of evidence assessments. RESULTS We identified 1746 records and included 5 randomised trials (n = 1512 patients). Only one trial (n = 260) reported on patient-flow. The study provides very-low certainty evidence that a greater proportion of patients were seen within 20 min when seen by a physician (98%) than when seen by a nurse (86%) or physiotherapist (77%). There was no difference in pain intensity and disability between patients managed by ED physicians and those managed by physiotherapists. Evidence was limited regarding patient satisfaction, inpatient admission and ED re-presentation rates, medication prescription and adverse events. The certainty of evidence for secondary outcomes ranged from very-low to low, but generally did not suggest a benefit of one model over another. CONCLUSION There is limited research to judge the effectiveness of allied health and nursing models of care for the management of musculoskeletal conditions in ED. Currently, it is unclear as to whether allied health and nurse practitioners are more effective than ED physicians at managing musculoskeletal conditions in ED. Further high-quality trials investigating the impact of models of care on service and health outcomes are needed.
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Affiliation(s)
- Simon P Vella
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
- Sydney Musculoskeletal Health and Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia.
- Royal Prince Alfred Hospital, Level 10N, King George V Building, Missenden Road, Camperdown, NSW, 2050, Australia.
| | - Alla Melman
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Sydney Musculoskeletal Health and Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia
| | - Danielle Coombs
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Sydney Musculoskeletal Health and Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia
| | - Christopher G Maher
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Sydney Musculoskeletal Health and Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia
| | - Michael S Swain
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Elizabeth Monk
- St George Hospital Emergency Department, Sydney, Australia
| | - Gustavo C Machado
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Sydney Musculoskeletal Health and Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia
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Lehto PM, Kortekangas T, Vakkala M, Ohtonen P, Nyman ES, Karvonen K, Liisanantti J, Kaakinen TI. The effect of tourniquet use on postoperative opioid consumption after ankle fracture surgery - a retrospective cohort study. Scand J Pain 2024; 24:sjpain-2023-0051. [PMID: 38126186 DOI: 10.1515/sjpain-2023-0051] [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: 04/22/2023] [Accepted: 10/30/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES A pneumatic tourniquet is often used during ankle fracture surgery to reduce bleeding and enhance the visibility of the surgical field. Tourniquet use causes both mechanical and ischemic pain. The main purpose of this study was to evaluate the effect of tourniquet time on postoperative opioid consumption after ankle fracture surgery. METHODS We retrospectively reviewed the files of 586 adult patients with surgically treated ankle fractures during the years 2014-2016. We evaluated post hoc the effect of tourniquet time on postoperative opioid consumption during the first 24 h after surgery. The patients were divided into quartiles by the tourniquet time (4-43 min; 44-58 min; 59-82 min; and ≥83 min). Multivariable linear regression analysis was used to evaluate the results. RESULTS Tourniquets were used in 486 patients. The use of a tourniquet was associated with an increase in the total postoperative opioid consumption by 5.1 mg (95 % CI 1.6-8.5; p=0.004) during the first 24 postoperative hours. The tourniquet time over 83 min was associated with an increase in the mean postoperative oxycodone consumption by 5.4 mg (95 % CI 1.2 to 9.7; p=0.012) compared to patients with tourniquet time of 4-43 min. CONCLUSIONS The use of a tourniquet and prolonged tourniquet time were associated with higher postoperative opioid consumption during the 24 h postoperative follow-up after surgical ankle fracture fixation. The need for ethical approval and informed consent was waived by the Institutional Review Board of Northern Ostrobothnia Health District because of the retrospective nature of the study.
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Affiliation(s)
- Pasi M Lehto
- Research Group of Surgery, Anaesthesiology and Intensive Care, Medical Research Center of Oulu University, Oulu University Hospital, Oulu, Finland
| | - Tero Kortekangas
- Research Group of Surgery, Anaesthesiology and Intensive Care, Medical Research Center of Oulu University, Oulu University Hospital, Oulu, Finland
| | - Merja Vakkala
- Research Group of Surgery, Anaesthesiology and Intensive Care, Medical Research Center of Oulu University, Oulu University Hospital, Oulu, Finland
| | - Pasi Ohtonen
- Research Service Unit, Oulu University Hospital, Oulu, Finland
| | - Emma-Sofia Nyman
- Research Group of Surgery, Anaesthesiology and Intensive Care, Medical Research Center of Oulu University, Oulu University Hospital, Oulu, Finland
| | - Kaisu Karvonen
- Research Group of Surgery, Anaesthesiology and Intensive Care, Medical Research Center of Oulu University, Oulu University Hospital, Oulu, Finland
| | - Janne Liisanantti
- Research Group of Surgery, Anaesthesiology and Intensive Care, Medical Research Center of Oulu University, Oulu University Hospital, Oulu, Finland
| | - Timo I Kaakinen
- Research Group of Surgery, Anaesthesiology and Intensive Care, Medical Research Center of Oulu University, Oulu University Hospital, Oulu, Finland
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Wetmore DS, Dalal S, Shinn D, Shahi P, Vaishnav A, Chandra A, Melissaridou D, Beckman J, Albert TJ, Iyer S, Qureshi SA. Erector Spinae Plane Block Reduces Immediate Postoperative Pain and Opioid Demand After Minimally Invasive Transforaminal Lumbar Interbody Fusion. Spine (Phila Pa 1976) 2024; 49:7-14. [PMID: 36940258 DOI: 10.1097/brs.0000000000004581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/02/2022] [Indexed: 03/22/2023]
Abstract
STUDY DESIGN Matched cohort comparison. OBJECTIVE To determine perioperative outcomes of erector spinae plane (ESP) block for minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). SUMMARY OF BACKGROUND DATA There is a paucity of data on the impact of lumbar ESP block on perioperative outcomes and its safety in MI-TLIF. MATERIALS AND METHODS Patients who underwent 1-level MI-TLIF and received the ESP block (group E ) were included. An age and sex-matched control group was selected from a historical cohort that received the standard-of-care (group NE). The primary outcome of this study was 24-hour opioid consumption in morphine milligram equivalents. Secondary outcomes were pain severity measured by a numeric rating scale, opioid-related side effects, and hospital length of stay. Outcomes were compared between the two groups. RESULTS Ninety-eight and 55 patients were included in the E and NE groups, respectively. There were no significant differences between the two cohorts in patient demographics. Group E had lower 24-hour postoperative opioid consumption ( P = 0.117, not significant), reduced opioid consumption on a postoperative day (POD) 0 ( P = 0.016), and lower first pain scores postsurgery ( P < 0.001). Group E had lower intraoperative opioid requirements ( P < 0.001), and significantly lower average numeric rating scale pain scores on POD 0 ( P = 0.034). Group E reported fewer opioid-related side effects as compared with group NE, although this was not statistically significant. The average highest postoperative pain score within 3 hours postprocedurally was 6.9 and 7.7 in the E and NE cohorts, respectively ( P = 0.029). The median length of stay was comparable between groups with the majority of patients in both groups being discharged on POD 1. CONCLUSIONS In our retrospective matched cohort, ESP blocks resulted in reduced opioid consumption and decreased pain scores on POD 0 in patients undergoing MI-TLIF. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
| | | | - Daniel Shinn
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medical College, New York, NY
| | | | | | | | | | | | | | - Sravisht Iyer
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Sheeraz A Qureshi
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medical College, New York, NY
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López-de-Uralde-Villanueva I, Fernández-de-Las-Peñas C, Cleland JA, Cook C, de-la-Llave-Rincón AI, Valera-Calero JA, Plaza-Manzano G. Minimal Clinically Important Differences in Hand Pain Intensity (Numerical Pain Rate Scale) and Related-Function (Boston Carpal Tunnel Questionnaire) in Women With Carpal Tunnel Syndrome. Arch Phys Med Rehabil 2024; 105:67-74. [PMID: 37582474 DOI: 10.1016/j.apmr.2023.07.018] [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: 05/10/2023] [Revised: 07/26/2023] [Accepted: 07/29/2023] [Indexed: 08/17/2023]
Abstract
OBJECTIVE To calculate the minimal clinically important differences (MCIDs) for hand pain intensity and the Boston Carpal Tunnel Questionnaire (BCTQ) in a sample of women with carpal tunnel syndrome (CTS). DESIGN Secondary analysis of a randomized controlled trial. SETTING A Hospital Rehabilitation Unit. PARTICIPANTS One hundred twenty women with clinical and electromyographic diagnosis of CTS who were randomly assigned into 2 groups (N=120). INTERVENTIONS One group received 3 sessions of manual physical therapy (n=60) and the other group received surgery (n=60). MAIN OUTCOME MEASURES Mean and the worst pain intensity (numerical pain rate scale, 0-10 points) and functional status and symptoms' severity subscales of the BCTQ questionnaire were assessed before and 1 month after treatment. The Global Rating of Change (GROC) was used as the anchor variable for determining the MCID. RESULTS A change of 1.5 and 2.5 points in mean and the worst pain intensity represents the MCID for Numerical Pain Rating Scale, whereas a change of 0.23 and 0.64 points in functional status and symptoms' severity represents the MCID for each subscale of the BCTQ. All variables showed acceptable discrimination between patients classified as "improved" and those classified as "stable/not improved" (area under the curve≥0.72). Mean pain intensity (Youden index, 0.53; sensitivity: 73.3%; specificity: 80%) and symptoms' severity (Youden index, 0.69; sensitivity: 90%; specificity: 77.8%) showed the best discriminative ability expressed as a percentage of prediction. Participants classified as "improved" had significantly greater improvements in pain intensity, functional status, and symptoms' severity compared with those classified as "stable/not improved". CONCLUSION A change of 1.5 and 2.5 points in mean and the worst pain and a change of 0.23 and 0.64 points in functional status and symptoms' severity represents the MCID for pain intensity and BCTQ in women with CTS 1 month after treatment.
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Affiliation(s)
- Ibai López-de-Uralde-Villanueva
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Complutense University of Madrid, Madrid, Spain; Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Joshua A Cleland
- Doctor of Physical Therapy Program, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA
| | - Chad Cook
- Department of Orthopedics, Duke University, Department of Population
| | - Ana I de-la-Llave-Rincón
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Juan Antonio Valera-Calero
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Complutense University of Madrid, Madrid, Spain; Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Complutense University of Madrid, Madrid, Spain; Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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Lerner DK, Gray M, Liu K, Al-Awady A, Omorogbe A, Ninan S, Goldrich DY, Schaberg M, Del Signore A, Govindaraj S, Iloreta AM. Gabapentin and postoperative pain and opioid consumption: A double-blind randomized controlled trial of perioperative pain management for sinus surgery. Am J Otolaryngol 2024; 45:104108. [PMID: 37948826 DOI: 10.1016/j.amjoto.2023.104108] [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: 08/19/2023] [Accepted: 10/29/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND The link between post-operative narcotic prescription and opioid misuse has spurred a nationwide effort to reduce perioperative opioid use. Previous work has suggested that perioperative gabapentin may reduce post-operative pain and opioid consumption across different procedures, although the optimal regimen remains to be defined. METHODS Chronic rhinosinusitis (CRS) patients undergoing functional endoscopic sinus surgery (FESS) with or without septoplasty were randomized to receive a 7-day pre- and post-operative course of placebo or gabapentin, starting at 300 mg daily and titrated to 300 mg three times daily, in a double-blind fashion. Primary endpoint was pain level using a validated visual analog scale (VAS). Secondary endpoints included post-operative opioid consumption and side effects, as well as modified Lund-Kennedy endoscopy, Lund-Mackay, and SNOT-22 scores. RESULTS Analysis of 35 patients (20 gabapentin, 15 control) showed no significant difference in mean postoperative VAS (p = 0.18) or postoperative opioid consumption between the placebo and gabapentin groups (2.3 and 4.8 oxycodone tablets respectively, p = 0.18). 15 of 35 patients did not require any post-operative oxycodone tablets, and only two patients required more than six tablets. CONCLUSION Preliminary results show no significant change in pain after FESS with or without septoplasty in patients taking 7-day pre- and post-operative gabapentin versus placebo. Results also showed no significant difference in opioid consumption between the treatment and placebo groups. Post-operative pain scores and opioid requirements are both quite low following FESS. Many patients do not need opioids at all, suggesting that routine initial post-operative opioid prescriptions can be limited accordingly.
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Affiliation(s)
- David K Lerner
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mingyang Gray
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Katherine Liu
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Abdurrahman Al-Awady
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Aisosa Omorogbe
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sen Ninan
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David Y Goldrich
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Madeleine Schaberg
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anthony Del Signore
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Satish Govindaraj
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alfred Marc Iloreta
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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