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Xie Y, Liang Z, Chen S, Liu J, Lv H, Xing F, Mao Y, Ren Y, Wei X, Wang Z, Xing N, Yang J, Gu X, Yuan J. Effectiveness of perioperative low-dose esketamine infusion for postoperative pain management in pediatric urological surgery: a prospective clinical trial. BMC Anesthesiol 2024; 24:65. [PMID: 38360531 PMCID: PMC10868074 DOI: 10.1186/s12871-024-02450-8] [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: 11/08/2023] [Accepted: 02/08/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Postoperative pain is common in pediatric urological surgery. The study assess the impact of perioperative intravenous infusion of low-dose esketamine on postoperative pain in pediatric urological surgery. METHODS Pediatric patients (n = 80) undergoing urological surgery were randomized into four groups. Patients in the control group were administered an analgesic pump containing only hydromorphone at a dose of 0.1 mg/kg (Hydromorphone Group 1, H1) or 0.15 mg/kg (Hydromorphone Group 2, H2). Patients in the experimental group were injected intravenously with 0.3 mg/kg of esketamine (Esketamine group 1, ES1) or equal volume of saline (Esketamine Group 2, ES2) during anesthesia induction. Esketamine 1.0 mg/kg and hydromorphone 0.1 mg/kg were added to the analgesic pump. Face, Leg, Activity, Crying, and Comfort (FLACC) scale or the Numerical Rating Scale (NRS) and adverse effects were recorded at 2, 6, 24, and 48 h postoperatively. Additionally, total and effective PCA button presses were recorded. RESULTS In comparison to the H1 group, the pain scores were notably reduced at all postoperative time points in both the ES1 and H2 groups. The ES2 group exhibited lower pain scores only at 24 and 48 h postoperatively. When compared to the H2 group, there were no significant differences in pain scores at various postoperative time points in the ES2 group. However, the ES1 group demonstrated significantly lower pain scores at 6, 24 and 48 h postoperatively, and these scores were also significantly lower than those observed in the ES2 group. The total and effective number of PCA button presses in the ES1, ES2 and H2 group were lower than that in the H1 group (P < 0.001). The incidence of adverse effects within 48 h after surgery was 15% in ES1, 22% in ES2, 58% in H1, and 42% in H2, respectively (P = 0.021). CONCLUSIONS The use of low-dose esketamine infusion in analgesia pump can effectively alleviates postoperative pain in pediatric urological patients, leading to a significant reduction in the number of analgesic pump button press. The combined approach of perioperative anesthesia induction and analgesia pump administration is recommended for optimal pain management in these patients. TRIAL REGISTRATION Chinese Clinical Trial Registry- ChiCTR2300073879 (24/07/2023).
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Affiliation(s)
- Yanle Xie
- Department of Anesthesiology, Pain and Perioperative Medicine, the First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Erqi District, Zhengzhou City, Henan Province, China
- Henan Province International Joint Laboratory of Pain, Cognition and Emotion, Zhengzhou, Henan Province, China
| | - Zenghui Liang
- Department of Anesthesiology, Pain and Perioperative Medicine, the First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Erqi District, Zhengzhou City, Henan Province, China
- Henan Province International Joint Laboratory of Pain, Cognition and Emotion, Zhengzhou, Henan Province, China
| | - Shuhan Chen
- Department of Anesthesiology, Pain and Perioperative Medicine, the First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Erqi District, Zhengzhou City, Henan Province, China
- Henan Province International Joint Laboratory of Pain, Cognition and Emotion, Zhengzhou, Henan Province, China
| | - Jing Liu
- Department of Anesthesiology, Pain and Perioperative Medicine, the First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Erqi District, Zhengzhou City, Henan Province, China
| | - Huimin Lv
- Department of Anesthesiology, Pain and Perioperative Medicine, the First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Erqi District, Zhengzhou City, Henan Province, China
- Henan Province International Joint Laboratory of Pain, Cognition and Emotion, Zhengzhou, Henan Province, China
| | - Fei Xing
- Department of Anesthesiology, Pain and Perioperative Medicine, the First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Erqi District, Zhengzhou City, Henan Province, China
- Henan Province International Joint Laboratory of Pain, Cognition and Emotion, Zhengzhou, Henan Province, China
| | - Yuanyuan Mao
- Department of Anesthesiology, Pain and Perioperative Medicine, the First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Erqi District, Zhengzhou City, Henan Province, China
- Henan Province International Joint Laboratory of Pain, Cognition and Emotion, Zhengzhou, Henan Province, China
| | - Yanling Ren
- Department of Anesthesiology, Pain and Perioperative Medicine, the First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Erqi District, Zhengzhou City, Henan Province, China
- Henan Province International Joint Laboratory of Pain, Cognition and Emotion, Zhengzhou, Henan Province, China
| | - Xin Wei
- Department of Anesthesiology, Pain and Perioperative Medicine, the First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Erqi District, Zhengzhou City, Henan Province, China
- Henan Province International Joint Laboratory of Pain, Cognition and Emotion, Zhengzhou, Henan Province, China
| | - Zhongyu Wang
- Department of Anesthesiology, Pain and Perioperative Medicine, the First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Erqi District, Zhengzhou City, Henan Province, China
| | - Na Xing
- Department of Anesthesiology, Pain and Perioperative Medicine, the First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Erqi District, Zhengzhou City, Henan Province, China
- Henan Province International Joint Laboratory of Pain, Cognition and Emotion, Zhengzhou, Henan Province, China
| | - Jianjun Yang
- Department of Anesthesiology, Pain and Perioperative Medicine, the First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Erqi District, Zhengzhou City, Henan Province, China
- Henan Province International Joint Laboratory of Pain, Cognition and Emotion, Zhengzhou, Henan Province, China
| | - Xiyao Gu
- Department of Anesthesiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Key Laboratory of Anesthesiology, Ministry of Education, Shanghai Jiao Tong University, Shanghai, China.
| | - Jingjing Yuan
- Department of Anesthesiology, Pain and Perioperative Medicine, the First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Erqi District, Zhengzhou City, Henan Province, China.
- Henan Province International Joint Laboratory of Pain, Cognition and Emotion, Zhengzhou, Henan Province, China.
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Lorenzo Allegue L, Laredo Velasco L, Recio Vivas AM, Mansilla Domínguez JM, Moñino Ruiz P, Rey LB, Font‐Jiménez I, Vargas Castrillón E. Do we really know if they are in pain? A cross-sectional study in hospitalised adult patients in Spain. Nurs Open 2023; 10:7668-7675. [PMID: 37789558 PMCID: PMC10643832 DOI: 10.1002/nop2.2007] [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: 08/05/2022] [Revised: 01/08/2023] [Accepted: 09/17/2023] [Indexed: 10/05/2023] Open
Abstract
AIMS To describe the prevalence and characteristics of pain in adult hospitalised patients, as well as to analyse the concordance between patient-reported and recorded pain and its impact on analgesic management. DESIGN A cross sectional study. METHODS The study was performed on a sample of 611 patients, from October to December 2017. Data were obtained from patient interviews, review of medical and nursing records and review of electronic prescribing. RESULTS The prevalence of pain at the time of the interview was 36.7%. The median VAS score was 4. 90% of the patients had their pain assessed within the last 24 h; however, concordance between patient-reported pain and recorded pain in the nursing record was slight. CONCLUSION Pain is still often documented inadequately. Despite the wide use of analgesics, half of the patients with moderate to severe pain do not have adequate pain management. A systematic assessment and recording of pain promotes appropriate analgesic prescription. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE The findings of our study provide insight into the main gaps in the correct management of pain in hospitalised patients. A systematic assessment and recording of the pain suffered by the patient facilitates its control and allows a better management of the analgesic prescription by the physician. This information could help hospital managers to develop training programmes on pain assessment and on the importance of doctor-nurse collaboration to improve pain management, increasing the quality of care and reducing hospital costs. REPORTING METHOD The study has adhered to the relevant EQUATOR guidelines, according to The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.
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Affiliation(s)
- Laura Lorenzo Allegue
- Faculty of Biomedical and Health Science, Nursing DepartmentUniversidad Europea de MadridMadridSpain
| | - Leonor Laredo Velasco
- Clinical Pharmacologist in the Department of Clinical PharmacologyHospital Universitario Clínico San CarlosMadridSpain
| | - Ana María Recio Vivas
- Faculty of Biomedical and Health Science, Nursing DepartmentUniversidad Europea de MadridMadridSpain
| | | | - Pedro Moñino Ruiz
- Anaesthesiologist at the Anaesthesia DepartmentHospital Universitario Clínico San CarlosMadridSpain
| | - Luz Bueno Rey
- Head of Clinical Clinical Pharmacology DepartmentHospital Universitario Clínico San CarlosMadridSpain
| | - Isabel Font‐Jiménez
- Faculty of Biomedical and Health Science, Nursing DepartmentUniversidad Europea de MadridMadridSpain
| | - Emilio Vargas Castrillón
- Head of Clinical Clinical Pharmacology DepartmentHospital Universitario Clínico San CarlosMadridSpain
- Institute for Health Research of the Hospital Clínico San Carlos (IdISSC)MadridSpain
- Department of PharmacologyFaculty of Medicine, Universidad Complutense de MadridMadridSpain
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Paladini A, Rawal N, Coca Martinez M, Trifa M, Montero A, Pergolizzi J, Pasqualucci A, Narvaez Tamayo MA, Varrassi G, De Leon Casasola O. Advances in the Management of Acute Postsurgical Pain: A Review. Cureus 2023; 15:e42974. [PMID: 37671225 PMCID: PMC10475855 DOI: 10.7759/cureus.42974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/04/2023] [Indexed: 09/07/2023] Open
Abstract
Despite the millions of surgeries performed every year around the world, postoperative pain remains prevalent and is often addressed with inadequate or suboptimal treatments. Chronic postsurgical pain is surprisingly prevalent, and its rate varies with the type of surgery, as well as with certain patient characteristics. Thus, better clinical training is needed as well as patient education. As pain can be caused by more than one mechanism, multimodal or balanced postsurgical analgesia is appropriate. Pharmacological agents such as opioid and nonopioid pain relievers, as well as adjuvants and nonpharmacologic approaches, can be combined to provide better and opioid-sparing pain relief. Many specialty societies have guidelines for postoperative pain management that emphasize multimodal postoperative analgesia. These guidelines are particularly helpful when dealing with special populations such as pregnant patients or infants and children. Pediatric pain control, in particular, can be challenging as patients may be unable to communicate their pain levels. A variety of validated assessment tools are available for diagnosis. Related to therapy, most guidelines agree on the fact that codeine should be used with extreme caution in pediatric patients as some may be "rapid metabolizers" and its use may be life-threatening. Prehabilitation is a preoperative approach that prepares patients in advance of elective surgery with conditioning exercises and other interventions to optimize their health. Prehabilitation may have aerobic, strength-training, nutritional, and counseling components. Logistical considerations and degree of patient adherence represent barriers to effective prehabilitation programs. Notwithstanding all this, acute postoperative pain represents a clinical challenge that has not yet been well addressed.
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Affiliation(s)
- Antonella Paladini
- Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, ITA
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