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Merighi A. Brain-Derived Neurotrophic Factor, Nociception, and Pain. Biomolecules 2024; 14:539. [PMID: 38785946 PMCID: PMC11118093 DOI: 10.3390/biom14050539] [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: 02/08/2024] [Revised: 04/26/2024] [Accepted: 04/26/2024] [Indexed: 05/25/2024] Open
Abstract
This article examines the involvement of the brain-derived neurotrophic factor (BDNF) in the control of nociception and pain. BDNF, a neurotrophin known for its essential role in neuronal survival and plasticity, has garnered significant attention for its potential implications as a modulator of synaptic transmission. This comprehensive review aims to provide insights into the multifaceted interactions between BDNF and pain pathways, encompassing both physiological and pathological pain conditions. I delve into the molecular mechanisms underlying BDNF's involvement in pain processing and discuss potential therapeutic applications of BDNF and its mimetics in managing pain. Furthermore, I highlight recent advancements and challenges in translating BDNF-related research into clinical practice.
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Affiliation(s)
- Adalberto Merighi
- Department of Veterinary Sciences, University of Turin, 10095 Turin, Italy
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Borges RB, Caumo W, Bavaresco C, Stefani LPC, Santos VSD, Castro SMDJ. The brief measure of preoperative emotional stress screens preoperative maladaptive psychological features and predicts postoperative opioid use: an observational study. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2024; 74:744425. [PMID: 36894010 DOI: 10.1016/j.bjane.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 02/14/2023] [Accepted: 02/18/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND The Brief Measure of Preoperative Emotional Stress (B-MEPS) is a suitable screening tool for Preoperative Emotional Stress (PES). However, personalized decision-making demands practical interpretation of the refined version of B-MEPS. Thus, we propose and validate cut-off points on the B-MEPS to classify PES. Also, we assessed if the cut-off points screened preoperative maladaptive psychological features and predicted postoperative opioid use. METHODS This observational study comprises samples of two other primary studies, with 1009 and 233 individuals, respectively. The latent class analysis derived emotional stress subgroups using B-MEPS items. We compared membership with the B-MEPS score through the Youden index. Concurrent criterion validity of the cut-off points was performed with the severity of preoperative depressive symptoms, pain catastrophizing, central sensitization, and sleep quality. Predictive criterion validity was performed with opioid use after surgery. RESULTS We chose a model with three classes labeled mild, moderate, and severe. The Youden index points -0.1663 and 0.7614 of the B-MEPS score classify individuals, in the severe class, with a sensitivity of 85.7% (80.1%-90.3%) and specificity of 93.5% (91.5-95.1%). The cut-off points of the B-MEPS score have satisfactory concurrent and predictive criterion validity. CONCLUSIONS These findings showed that the preoperative emotional stress index on the B-MEPS offers suitable sensitivity and specificity for discriminating the severity of preoperative psychological stress. They provide a simple tool to identify patients prone to severe PES related to maladaptive psychological features, which might influence the perception of pain and analgesic opioid use in the postoperative period.
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Affiliation(s)
- Rogério Boff Borges
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Programa de Pós-Graduação em Epidemiologia, Porto Alegre, RS, Brazil; Hospital das Clínicas de Porto Alegre, Unidade de Bioestatística, Diretoria de Pesquisa, Porto Alegre, RS, Brazil.
| | - Wolnei Caumo
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Departamento de Cirurgia, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Médicas, Porto Alegre, RS, Brazil; Hospital das Clínicas de Porto Alegre, Laboratório de Dor e Neuromodulação, Porto Alegre, RS, Brazil
| | - Caroline Bavaresco
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Médicas, Porto Alegre, RS, Brazil
| | - Luciana Paula Cadore Stefani
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Departamento de Cirurgia, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Médicas, Porto Alegre, RS, Brazil
| | | | - Stela Maris de Jezus Castro
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Programa de Pós-Graduação em Epidemiologia, Porto Alegre, RS, Brazil; Hospital das Clínicas de Porto Alegre, Unidade de Bioestatística, Diretoria de Pesquisa, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul, Instituto de Matemática e Estatística, Departamento de Estatística, Porto Alegre, RS, Brazil
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Albayrak E, Gündüz E, Titiz T, Özen Küçükçetin I. The effects of erector spinae plane block (ESPB) on surgery-related stress response in thoracic surgery. Acta Chir Belg 2023:1-7. [PMID: 38112523 DOI: 10.1080/00015458.2023.2297532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 12/16/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Surgical injury induces a stress response to surgery that induces tissue repair with the activation of endocrine, metabolic, and immunological mediators aimed at restoring hemostasis. OBJECTIVE In our study to determine the effect of analgesic method on postoperative respiratory function tests, stress hormone and proinflammatory response in patients undergoing elective thoracotomy surgery. METHODS Seventy-two patients aged between 18 and 75 years with scheduled for elective thoracotomy surgery were included in the study. Thirty-six patients who underwent Erector Spinae Plane block were included in the block group, and 36 patients were included in the control group. IL 6, TNF alpha, cortisol, CRP, insulin and blood glucose levels were measured preoperatively, at the 3rd hour after postoperative extubation and at the 24th postoperative hour. RESULTS We observed that while IL6 and TNF alpha levels decreased in the ESPB group compared to the preoperative period, they increased insignificantly in the control group. CONCLUSION ESPB has a positive effect on stress hormones and proinflammatory cytokines, reduces the use of opioids and analgesics in the intraoperative and postoperative period compared to patients without block, and lower VAS scores are obtained in patients with block.
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Affiliation(s)
- Ercan Albayrak
- Faculty of Medicine Department of Anesthesiology and Reanimation, Akdeniz University, Turkey
| | - Emel Gündüz
- Faculty of Medicine Department of Anesthesiology and Reanimation, Akdeniz University, Turkey
| | - Tülin Titiz
- Faculty of Medicine Department of Anesthesiology and Reanimation, Akdeniz University, Turkey
| | - Ikbal Özen Küçükçetin
- Faculty of Medicine Department of Anesthesiology and Reanimation, Akdeniz University, Turkey
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Adams GR, Gandhi W, Harrison R, van Reekum CM, Wood-Anderson D, Gilron I, Salomons TV. Do "central sensitization" questionnaires reflect measures of nociceptive sensitization or psychological constructs? A systematic review and meta-analyses. Pain 2023; 164:1222-1239. [PMID: 36729810 DOI: 10.1097/j.pain.0000000000002830] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/21/2022] [Indexed: 02/03/2023]
Abstract
ABSTRACT Central sensitization (CS) is defined as an increased nociceptive responsiveness due to sensitization of neurons in the central nervous system, usually the result of prolonged nociceptive input or a disease state associated with noxious inputs (eg, polyarthritis). The concept of CS has recently been adopted in clinical assessments of chronic pain, but its diagnosis in humans may now include a wide range of hypervigilant responses. The purpose of this review is to ascertain whether self-report questionnaires linked with CS are associated with enhanced nociceptive responses or whether they measure sensitivity in a broader sense (ie, emotional responses). According to our published, PROSPERO-registered review protocol (CRD42021208731), a predefined search of studies that involve the Central Sensitization Inventory (CSI) or Pain Sensitivity Questionnaire (PSQ), correlated with either nociceptive sensory tests or emotional hypervigilance was conducted on MEDLINE, PsycINFO, and Web of Science. Correlations between the CSI or PSQ with our primary outcomes were extracted and meta-analysed. A review of 66 studies totalling 13,284 participants found that the CSI (but not the PSQ) strongly correlated with psychological constructs: depression, anxiety, stress, pain catastrophising, sleep, and kinesiophobia. The CSI and PSQ showed weak or no correlations with experimental measures of nociceptive sensitivity: pain thresholds, temporal summation, or conditioned pain modulation. The PSQ did, however, correlate strongly with phasic heat and tonic cold pain tests. The studies reviewed did not provide sufficient evidence that self-report measures reflect a canonical understanding of CS. The CSI more closely reflects psychological hypervigilance than increased responsiveness of nociceptive neurons.
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Affiliation(s)
- Greig R Adams
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom
| | - Wiebke Gandhi
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom
| | - Richard Harrison
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom
| | - Carien M van Reekum
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom
| | | | - Ian Gilron
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON, Canada
| | - Tim V Salomons
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom
- Department of Psychology, Queen's University, Kingston, ON, Canada
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J Ghadimi D, Looha MA, Akbari ME, Akbari A. Predictors of postoperative pain six months after breast surgery. Sci Rep 2023; 13:8302. [PMID: 37221396 DOI: 10.1038/s41598-023-35426-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 05/17/2023] [Indexed: 05/25/2023] Open
Abstract
Breast cancer, with a high prevalence and survival rate, leads to long-term complications. A major sequel is acute or chronic postoperative pain, and we investigated the possible relationship with clinical and psychological variables. Patients undergoing breast surgery filled out the loneliness (ULS-8) and depression (HADS) questionnaires. Patients rated their pain intensity with the Numerical Rating Scale (0-10, NRS) two days, seven days, and six months after surgery. Of 124 patients, the mean age was 45.86 years old, and the pain scores on the second and seventh postoperative days were 5.33 and 3.57, respectively. Sixth-month pain was significantly correlated with the acute scores with a mean of 3.27; and in the multivariate analysis, it was significantly associated with preoperative pain (p-value = 0.007), self-reported loneliness (p-value = 0.010), and adjuvant radiotherapy (p-value = 0.004). In conclusion, loneliness may be a risk factor for postoperative pain in breast surgery.
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Affiliation(s)
- Delaram J Ghadimi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Azizmohammad Looha
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Atieh Akbari
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Shin HJ, Kim H, Han SH, Do SH, Na HS. Ultrasound assessment of residual gastric volume in older adults undergoing staged-bilateral total knee arthroplasty after consuming carbohydrate-containing fluids: a prospective observational study. Korean J Anesthesiol 2023; 76:128-134. [PMID: 36274254 PMCID: PMC10079000 DOI: 10.4097/kja.22378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/17/2022] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND We compared preoperative residual gastric volume (GV) between the first and second stages of total knee arthroplasty (TKA) in older adults after drinking carbohydrate-containing fluid 2 h prior to surgery. METHODS In this study, 36 patients, aged > 65 years, scheduled for staged bilateral TKA with one-week interval, were enrolled. The patients consumed 400 ml of carbohydrate-containing fluid 2 h prior to surgery. Before the induction of spinal anesthesia, the gastric antral cross-sectional area was measured at the first and second TKA using ultrasound, and the residual GV was calculated. The primary outcome was the residual GV. Qualitative GV (grades 0, 1, and 2) and analgesic consumption after the first TKA were assessed as secondary outcomes. RESULTS The GV (median [Q1, Q3]) was greater in the second-stage TKA (41.1 [22.5, 62.8] ml) than in the first-stage TKA (10.3 [0.0, 27.1] ml) (P < 0.001). In the qualitative assessment, the distribution was not different between the two stages of TKA (P = 0.219) and only one patient showed grade 2 gastric content in the second TKA. When opioid consumption was converted to an equivalent dose of morphine, an average of 53.9 mg of morphine was required after the first TKA. CONCLUSIONS Residual GV after drinking carbohydrate-containing fluid differed according to the stage of TKA, showing a larger residual GV in the second TKA than in the first one. In older adults scheduled to undergo bilateral staged TKA, caution is required in preoperative fasting practice, especially in second-stage surgery.
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Affiliation(s)
- Hyun-Jung Shin
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Heeyeon Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung-Hee Han
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Hwan Do
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hyo-Seok Na
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Almedhesh SA, Elgzar WT, Ibrahim HA, Osman HA. The effect of virtual reality on anxiety, stress, and hemodynamic parameters during cesarean section: A randomized controlled clinical trial. Saudi Med J 2022; 43:360-369. [PMID: 35414614 PMCID: PMC9998068 DOI: 10.15537/smj.2022.43.4.20210921] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/21/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To investigate the effect of virtual reality (VR) on anxiety, stress, and hemodynamic parameters during cesarean section (CS). METHODS This is a randomized controlled clinical trial conducted at the operating theatre / Maternal and Children Hospital, Najran, Saudi Arabia from February to October 2021. The study comprised a random sample of 351(176 study and 175 control) low-risk pregnant women undergoing elective CS with regional anesthesia. Data collection was carried out using 5 instruments. Basic and clinical data sheet, maternal hemodynamic parameters assessment sheet, brief measure of preoperative emotional stress, a novel visual facial anxiety scale, and maternal satisfaction scale. Virtual reality group exposed to 3D natural videos associated with calm Quran or music voices via phone using VR glasses immediately after anesthesia until completion of skin suture. The control group left for routine hospital care. RESULTS The VR group showed significantly lower stress and anxiety levels immediately after skin suture and 2h postoperative (p=0.000). Maternal satisfaction 2 hours after CS showed that 58% of the VR group were completely satisfied compared to 11.3% of the control group (FET=135.359 p=0.000). Virtual reality have an impact on hemodynamic parameters at some time points while peripheral oxygen saturation did not differ significantly (p>0.05). CONCLUSION Virtual reality significantly reduced anxiety and stress among women undergoing CS under regional anesthesia. Virtual reality may be added to the routine intraoperative techniques that help induce patient relaxation and increase satisfaction.
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Affiliation(s)
- Sultan A. Almedhesh
- From the Department of Pediatric And Pediatric Cardiologist (Almedhesh), College of
Medicine; from the Department of Maternity and Childhood Nursing (Elgzar, Ibrahim),
Nursing College Najran University; and from the Department of Obstetrics and Gynecology
(Osman), Maternity and Children Hospital, Najran, Kingdom of Saudi Arabia.
| | - Wafaa T. Elgzar
- From the Department of Pediatric And Pediatric Cardiologist (Almedhesh), College of
Medicine; from the Department of Maternity and Childhood Nursing (Elgzar, Ibrahim),
Nursing College Najran University; and from the Department of Obstetrics and Gynecology
(Osman), Maternity and Children Hospital, Najran, Kingdom of Saudi Arabia.
| | - Heba A. Ibrahim
- From the Department of Pediatric And Pediatric Cardiologist (Almedhesh), College of
Medicine; from the Department of Maternity and Childhood Nursing (Elgzar, Ibrahim),
Nursing College Najran University; and from the Department of Obstetrics and Gynecology
(Osman), Maternity and Children Hospital, Najran, Kingdom of Saudi Arabia.
| | - Hiba A. Osman
- From the Department of Pediatric And Pediatric Cardiologist (Almedhesh), College of
Medicine; from the Department of Maternity and Childhood Nursing (Elgzar, Ibrahim),
Nursing College Najran University; and from the Department of Obstetrics and Gynecology
(Osman), Maternity and Children Hospital, Najran, Kingdom of Saudi Arabia.
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A clinical tool to predict severe pain during wound dressing changes. Pain 2021; 163:1716-1727. [DOI: 10.1097/j.pain.0000000000002553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/10/2021] [Indexed: 11/27/2022]
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Geng Z, Bi H, Zhang D, Xiao C, Song H, Feng Y, Cao X, Li X. The impact of multimodal analgesia based enhanced recovery protocol on quality of recovery after laparoscopic gynecological surgery: a randomized controlled trial. BMC Anesthesiol 2021; 21:179. [PMID: 34182929 PMCID: PMC8237447 DOI: 10.1186/s12871-021-01399-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 06/15/2021] [Indexed: 02/08/2023] Open
Abstract
Background Our objective was to evaluate the impact of multimodal analgesia based enhanced recovery protocol on quality of recovery after laparoscopic gynecological surgery. Methods One hundred forty female patients scheduled for laparoscopic gynecological surgery were enrolled in this prospective, randomized controlled trial. Participants were randomized to receive either multimodal analgesia (Study group) or conventional opioid-based analgesia (Control group). The multimodal analgesic protocol consists of pre-operative acetaminophen and gabapentin, intra-operative flurbiprofen and ropivacaine, and post-operative acetaminophen and celecoxib. Both groups received an on-demand mode patient-controlled analgesia pump containing morphine for rescue analgesia. The primary outcome was Quality of Recovery-40 score at postoperative day (POD) 2. Secondary outcomes included numeric pain scores (NRS), opioid consumption, clinical recovery, C-reactive protein, and adverse events. Results One hundred thirty-eight patients completed the study. The global QoR-40 scores at POD 2 were not significantly different between groups, although scores in the pain dimension were higher in Study group (32.1 ± 3.0 vs. 31.0 ± 3.2, P = 0.033). In the Study group, NRS pain scores, morphine consumption, and rescue analgesics in PACU (5.8% vs. 27.5%; P = 0.0006) were lower, time to ambulation [5.0 (3.3–7.0) h vs. 6.5 (5.0–14.8) h; P = 0.003] and time to bowel function recovery [14.5 (9.5–19.5) h vs.17 (13–23.5) h; P = 0.008] were shorter, C-reactive protein values at POD 2 was lower [4(3–6) ng/ml vs. 5 (3–10.5) ng/ml; P = 0.022] and patient satisfaction was higher (9.8 ± 0.5 vs. 8.8 ± 1.2, P = 0.000). Conclusion For minimally invasive laparoscopic gynecological surgery, multimodal analgesia based enhanced recovery protocol offered better pain relief, lower opioid use, earlier ambulation, faster bowel function recovery and higher patient satisfaction, while no improvement in QoR-40 score was found. Trial registration ChiCTR1900026194; Date registered: Sep 26,2019.
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Affiliation(s)
- Zhiyu Geng
- Department of Anesthesiology, Peking University First Hospital, Beijing, China.
| | - Hui Bi
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Dai Zhang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Changji Xiao
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Han Song
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Ye Feng
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Xinni Cao
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Xueying Li
- Department of Biostatics, Peking University First Hospital, Beijing, China
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Hyland SJ, Brockhaus KK, Vincent WR, Spence NZ, Lucki MM, Howkins MJ, Cleary RK. Perioperative Pain Management and Opioid Stewardship: A Practical Guide. Healthcare (Basel) 2021; 9:333. [PMID: 33809571 PMCID: PMC8001960 DOI: 10.3390/healthcare9030333] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/02/2021] [Accepted: 03/10/2021] [Indexed: 12/20/2022] Open
Abstract
Surgical procedures are key drivers of pain development and opioid utilization globally. Various organizations have generated guidance on postoperative pain management, enhanced recovery strategies, multimodal analgesic and anesthetic techniques, and postoperative opioid prescribing. Still, comprehensive integration of these recommendations into standard practice at the institutional level remains elusive, and persistent postoperative pain and opioid use pose significant societal burdens. The multitude of guidance publications, many different healthcare providers involved in executing them, evolution of surgical technique, and complexities of perioperative care transitions all represent challenges to process improvement. This review seeks to summarize and integrate key recommendations into a "roadmap" for institutional adoption of perioperative analgesic and opioid optimization strategies. We present a brief review of applicable statistics and definitions as impetus for prioritizing both analgesia and opioid exposure in surgical quality improvement. We then review recommended modalities at each phase of perioperative care. We showcase the value of interprofessional collaboration in implementing and sustaining perioperative performance measures related to pain management and analgesic exposure, including those from the patient perspective. Surgery centers across the globe should adopt an integrated, collaborative approach to the twin goals of optimal pain management and opioid stewardship across the care continuum.
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Affiliation(s)
- Sara J. Hyland
- Department of Pharmacy, Grant Medical Center (OhioHealth), Columbus, OH 43215, USA
| | - Kara K. Brockhaus
- Department of Pharmacy, St. Joseph Mercy Hospital Ann Arbor, Ypsilanti, MI 48197, USA;
| | | | - Nicole Z. Spence
- Department of Anesthesiology, Boston University School of Medicine, Boston Medical Center, Boston, MA 02118, USA;
| | - Michelle M. Lucki
- Department of Orthopedics, Grant Medical Center (OhioHealth), Columbus, OH 43215, USA;
| | - Michael J. Howkins
- Department of Addiction Medicine, Grant Medical Center (OhioHealth), Columbus, OH 43215, USA;
| | - Robert K. Cleary
- Department of Surgery, St. Joseph Mercy Hospital Ann Arbor, Ypsilanti, MI 48197, USA;
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