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Wang J, Yang F, Wang X, Pang F. Acupoint Selection in Postoperative Ophthalmic Pain Management: A Data Mining Protocol. J Pain Res 2024; 17:903-909. [PMID: 38476880 PMCID: PMC10929234 DOI: 10.2147/jpr.s449175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/28/2024] [Indexed: 03/14/2024] Open
Abstract
Background Postoperative ophthalmic pain not only induces anxiety and depression among patients, but also prolongs the recovery cycle. However, the management of postoperative pain in ophthalmology is still not standardized. The effectiveness of acupuncture in treating postoperative pain has been validated based on numerous clinical trials and meta-analysis. Our study is to conduct the first data mining analysis to identify the most effective acupoints selection and combinations for treating postoperative ophthalmic pain, inform. Methods We will search bibliographic databases from inception to November 2023. Clinical trials evaluating the effectiveness of acupuncture therapy in the management of postoperative ophthalmic pain will be selected. Reviews, protocols, animal studies, case reports, systematic evaluations and Meta-analyses will be excluded. Primary outcome indicators will be clinical outcomes related to postoperative ophthalmic pain. Descriptive statistics will be performed in Excel 2019. Association rule analysis will be performed in SPSS Modeler 18.0. Exploratory factor analysis and cluster analysis will be performed in SPSS Statistics 25.0. Results This study will investigate the most effective point selection and combination of acupuncture points for the treatment of postoperative ophthalmic pain. Conclusion Our findings will provide evidence for the effectiveness and potential therapeutic prescription of acupuncture for postoperative ophthalmologic pain, helping clinicians and patients work together to make more informed decisions.
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Affiliation(s)
- Jing Wang
- Department of Ophthalmology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People’s Republic of China
| | - Feng Yang
- Department of Ophthalmology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People’s Republic of China
| | - Xing Wang
- M. Kandiah Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Kajang, Selangor, Malaysia
| | - Fang Pang
- Institute of Sports Biology, Shaanxi Normal University, Xi’an, Shaanxi, People’s Republic of China
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Erlenwein J, Tavernini T, Kästner A, Petzke F. [Dealing with "complex" pain patients in eye surgery : Perioperative management of patients with pre-existing chronic pain, opioid consumption and opioid use disorder]. DIE OPHTHALMOLOGIE 2023; 120:1204-1215. [PMID: 37930369 DOI: 10.1007/s00347-023-01949-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 11/07/2023]
Abstract
The quality of postoperative pain management is still considered insufficient in many cases, also in surgical ophthalmology. Complex constellations and comorbidities, such as pre-existing chronic pain, opioid consumption and opioid use disorders represent a special challenge due to psychosocial influencing factors and sometimes psychological and psychiatric comorbidities but also due to pharmacological effects, such as the development of opioid tolerance, the opioid-induced hyperalgesia. This review article aims to impart knowledge on aspects of these comorbidities and the perioperative management to improve the treatment skills of ophthalmologists in the management of pain in these complex patients.
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Affiliation(s)
- Joachim Erlenwein
- Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.
| | - Tabea Tavernini
- Interdisziplinäres Schmerzzentrum, DIAKOVERE Friederikenstift, Hannover, Deutschland
| | - Anne Kästner
- Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
| | - Frank Petzke
- Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
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Erlenwein J, Leister N, Castello R, Wirz S. [Principles of acute pain therapy-An overview taking special features in the patient collective of ophthalmology into consideration]. DIE OPHTHALMOLOGIE 2023; 120:701-710. [PMID: 37340245 DOI: 10.1007/s00347-023-01888-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/02/2023] [Indexed: 06/22/2023]
Abstract
For many years the quality of perioperative pain management in general has been repeatedly reported as inadequate and there is significant evidence to indicate that this is also true after surgical procedures in ophthalmology. The patient population in ophthalmology is quite challenging due to numerous comorbidities and a high average age resulting in numerous contraindications and organ dysfunctions and requiring special knowledge to ensure high quality acute pain management. The following overview covers basic knowledge of acute pain management, with a particular focus on analgesic approaches and the specifics of the patient population and the associated limitations in terms of analgesic and co-analgesic pharmacological options.
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Affiliation(s)
- Joachim Erlenwein
- Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37085, Göttingen, Deutschland.
| | - Nicolas Leister
- Klinik für Anästhesiologie und Operative Intensivmedizin, Medizinische Fakultät und Universitätsklinikum Köln, Universität zu Köln, Köln, Deutschland
| | - Roberto Castello
- Interdisziplinärer Arbeitskreis Ophthalmoanästhesie, Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin e. V., Nürnberg, Deutschland
| | - Stefan Wirz
- Abteilung für Anästhesie, Interdisziplinäre Intensivmedizin, Schmerzmedizin/Palliativmedizin - Zentrum für Schmerzmedizin, Weaningzentrum, Cura Krankenhaus der GFO Kliniken Bonn, Bad Honnef, Deutschland
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinik Bonn, Bonn, Deutschland
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Erlenwein J, Lauff S, Plohmann J, Dreiling J, Meißner W, Feltgen N. [Identifying patients with risk for severe pain after ophthalmological surgery]. DIE OPHTHALMOLOGIE 2023; 120:692-700. [PMID: 37368014 DOI: 10.1007/s00347-023-01890-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 06/28/2023]
Abstract
Modern ophthalmology includes a wide range of surgical options and, accordingly, also requires appropriate pain management. There are established risk factors for severe postoperative pain that should be identified and considered in the perioperative management. The main risk factors and existing recommendations are presented in this article. Patients at risk should be identified before surgery. It is important that perioperative pain management is implemented in the treatment plan as part of an interdisciplinary cooperation to identify and address the risks as early as possible.
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Affiliation(s)
- Joachim Erlenwein
- Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Sören Lauff
- Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Juliane Plohmann
- Augenklinik der Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
| | - Johannes Dreiling
- Klinik für Anästhesiologie und Intensivmedizin, Sektion Schmerztherapie und Klinik für Innere Medizin II, Abteilung Palliativmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | - Winfried Meißner
- Klinik für Anästhesiologie und Intensivmedizin, Sektion Schmerztherapie und Klinik für Innere Medizin II, Abteilung Palliativmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | - Nicolas Feltgen
- Augenklinik der Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.
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[Resolution of the Federal Joint Committee on the mandatory introduction and implementation of acute pain management concepts-Importance and consequences for ophthalmology]. DIE OPHTHALMOLOGIE 2022:10.1007/s00347-022-01768-3. [PMID: 36515711 DOI: 10.1007/s00347-022-01768-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/04/2022] [Accepted: 11/04/2022] [Indexed: 12/15/2022]
Abstract
Patient-centered and adequate postoperative pain management is an important part of a modern treatment concept and should also be standard in ophthalmology. Due to the "Regulation on the mandatory introduction and implementation of acute pain management concepts for adequate postoperative pain therapy" prescribed by the Federal Joint Committee of the German statutory healthcare system (G-BA), hospitals and outpatient facilities have been required to have regulations on pain management in place since 9 December 2020. It is very likely that the need of pain management in ophthalmic surgery has been systematically underestimated so far and studies on postoperative pain hardly exist. In the opinion of the authors, the decision represents an opportunity to pay more attention to the topic and to develop standards for ophthalmology as well. This article explains the G‑BA decision and the resulting consequences for ophthalmic surgical institutions.
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Toro MD, Nowakowska D, Brzozowska A, Reibaldi M, Avitabile T, Bucolo C, Murabito P, Chisari C, Nowomiejska K, Rejdak R. Pain Following the Use of Anesthesia Formulation Among Individuals Undergoing Cataract Surgery: A Randomized Controlled Trial. Front Pharmacol 2020; 11:440. [PMID: 32372954 PMCID: PMC7176993 DOI: 10.3389/fphar.2020.00440] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 03/20/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To assess the pain intensity of two intracameral anesthetic solutions in patients undergoing cataract surgery and evaluate the factors influencing the patients’ postoperative activities. Methods Sixty-two patients undergoing cataract surgery were randomized to receive the study drug – a manufactured solution of 0.02% tropicamide/0.31% phenylephrine/1% lidocaine (Mydrane) or a traditional anesthetic formulation - solution of 1% lidocaine/0.025% adrenaline as an intraocular anesthetic. The pain intensity was assessed by Visual Analog Scale for Pain (VAS Pain) and Brief Pain Inventory-short form (BPI) on the next day after the surgery. Results The mean pain score measured preoperatively with VAS Pain was 0.34 in Mydrane group and 0.09 in the reference group (p = 0.51). There were no statistically significant differences between the two anesthetic methods with respect to pain intensity during the surgery (p = 0.94) and the influence of pain during the last 24 h on activity (p = 0.79), mood (p = 0.31), social contacts (p = 0.29), sleep (p = 0.5) and the joy of life (p = 0.39). Additionally, there was no statistically significant influence of age, sex, lateralization, co-existing ophthalmological diseases (p = 0.98) and post-operative complications (p = 0.4) on the experienced pain measured during the surgery and in the last 24 h. Conclusions New commercially available intraocular anesthetic solution (Mydrane™) seems to be as effective as off-label traditional anesthetic formulation, in reducing the pain experienced during cataract surgery under topical anesthesia.
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Affiliation(s)
- Mario D Toro
- Department of General Ophthalmology, Medical University of Lublin, Lublin, Poland.,Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University, Warsaw, Poland
| | - Dominika Nowakowska
- Department of General Ophthalmology, Medical University of Lublin, Lublin, Poland
| | - Agnieszka Brzozowska
- Department of Mathematics and Medical Biostatistics, Medical University of Lublin, Lublin, Poland
| | - Michele Reibaldi
- Department of Ophthalmology, School of Medicine, University of Catania, Catania, Italy
| | - Teresio Avitabile
- Department of Ophthalmology, School of Medicine, University of Catania, Catania, Italy
| | - Claudio Bucolo
- Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, Catania, Italy
| | - Paolo Murabito
- Department of General Surgery and Surgical Specialties, Division of Anesthesiology, Azienda Ospedaliero-Universitaria Policlinico, Catania, Italy
| | - Clara Chisari
- Department "GF. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | | | - Robert Rejdak
- Department of General Ophthalmology, Medical University of Lublin, Lublin, Poland
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Yang MMH, Hartley RL, Leung AA, Ronksley PE, Jetté N, Casha S, Riva-Cambrin J. Preoperative predictors of poor acute postoperative pain control: a systematic review and meta-analysis. BMJ Open 2019; 9:e025091. [PMID: 30940757 PMCID: PMC6500309 DOI: 10.1136/bmjopen-2018-025091] [Citation(s) in RCA: 167] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Inadequate postoperative pain control is common and is associated with poor clinical outcomes. This study aimed to identify preoperative predictors of poor postoperative pain control in adults undergoing inpatient surgery. DESIGN Systematic review and meta-analysis DATA SOURCES: MEDLINE, Embase, CINAHL and PsycINFO were searched through October 2017. ELIGIBILITY CRITERIA Studies in any language were included if they evaluated postoperative pain using a validated instrument in adults (≥18 years) and reported a measure of association between poor postoperative pain control (defined by study authors) and at least one preoperative predictor during the hospital stay. DATA EXTRACTION AND SYNTHESIS Two reviewers screened articles, extracted data and assessed study quality. Measures of association for each preoperative predictor were pooled using random effects models. RESULTS Thirty-three studies representing 53 362 patients were included in this review. Significant preoperative predictors of poor postoperative pain control included younger age (OR 1.18 [95% CI 1.05 to 1.32], number of studies, n=14), female sex (OR 1.29 [95% CI 1.17 to 1.43], n=20), smoking (OR 1.33 [95% CI 1.09 to 1.61], n=9), history of depressive symptoms (OR 1.71 [95% CI 1.32 to 2.22], n=8), history of anxiety symptoms (OR 1.22 [95% CI 1.09 to 1.36], n=10), sleep difficulties (OR 2.32 [95% CI 1.46 to 3.69], n=2), higher body mass index (OR 1.02 [95% CI 1.01 to 1.03], n=2), presence of preoperative pain (OR 1.21 [95% CI 1.10 to 1.32], n=13) and use of preoperative analgesia (OR 1.54 [95% CI 1.18 to 2.03], n=6). Pain catastrophising, American Society of Anesthesiologists status, chronic pain, marital status, socioeconomic status, education, surgical history, preoperative pressure pain tolerance and orthopaedic surgery (vs abdominal surgery) were not associated with increased odds of poor pain control. Study quality was generally high, although appropriate blinding of predictor during outcome ascertainment was often limited. CONCLUSIONS Nine predictors of poor postoperative pain control were identified. These should be recognised as potentially important factors when developing discipline-specific clinical care pathways to improve pain outcomes and to guide future surgical pain research. PROSPERO REGISTRATION NUMBER CRD42017080682.
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Affiliation(s)
- Michael M H Yang
- Department of Clinical Neurosciences, Section of Neurosurgery, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Rebecca L Hartley
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Section of Plastic Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Alexander A Leung
- Division of Endocrinology and Metabolism, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Paul E Ronksley
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Nathalie Jetté
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Steven Casha
- Department of Clinical Neurosciences, Section of Neurosurgery, University of Calgary, Calgary, Alberta, Canada
| | - Jay Riva-Cambrin
- Department of Clinical Neurosciences, Section of Neurosurgery, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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