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Chen S, Guo Z, Wei X, Chen Z, Liu N, Yin W, Lan L. Efficacy of preemptive intercostal nerve block on recovery in patients undergoing video-assisted thoracic lobectomy. J Cardiothorac Surg 2023; 18:168. [PMID: 37118846 PMCID: PMC10148478 DOI: 10.1186/s13019-023-02243-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 04/02/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Preemptive intercostal nerve block (pre-ICNB) achieves the same analgesic effects as postoperative ICNB (post-ICNB) remains unclear. This study aimed to evaluate the efficacy of preemptive ICNB on perioperative outcomes for patients undergoing video-assisted thoracic surgery (VATS). METHODS This was a randomized, open-label study (ChiCTR2200055667) from August 1, 2021, to December 30, 2021. Eligible patients scheduled for lobectomy for lung cancer were allocated into the pre-ICNB group and the post-ICNB group. The postoperative pain evaluation, patient rehabilitation, and opioid consumption were observed. RESULTS A total of 81 patients were included. When compared with the post-ICNB group, the pre-ICNB group had a lower proportion of hypertension comorbidity (P = 0.023), significantly lower total consumption of morphine milligram equivalents (MMEs) (P = 0.016), shorter extubation time (P = 0.019). The pre-ICNB group has similar Numeric Rating Scales (NRS) scores of dynamic pain in the post-anesthesia care unit (PACU), postoperative 6 h, 12 h, 24 h, and 48 h (P > 0.05), and had simialr scores of Bruggrmann Comfort Scale (BCS) in postoperative 6 h, 12 h, 24 and 48 h (P > 0.05). The scores of the Mini-mental state examination (MMSE) and Ramsay in the pre-ICNB group were comparable to those in the post-ICNB group, except the scores of MMSE and Ramsay in postoperative 6 h were lower (P = 0.048 and P = 0.019). The pain evaluation in the 1-month follow-up was comparable with that in the post-ICBN group (P > 0.05). CONCLUSIONS Pre- ICNB is equally efficacious in perioperative pain management as post-ICNB, and pre-ICNB significantly reduces intra-operative opioid consumption, providing faster recovery in PACU. TRIAL REGISTRATION Registered in the Chinese Clinical Trial Register (ChiCTR2200055667).
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Affiliation(s)
- Shaojuan Chen
- Department of Anesthesiology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhihua Guo
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xin Wei
- Department of Anesthesiology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhenzhu Chen
- Department of Anesthesiology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Na Liu
- Department of Anesthesiology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weiqiang Yin
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
| | - Lan Lan
- Department of Anesthesiology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
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Elahwal L, Elrahwan S, Elbadry AA. Ilioinguinal and Iliohypogastric Nerve Block for Acute and Chronic Pain Relief After Caesarean Section: A Randomized Controlled Trial. Anesth Pain Med 2022; 12:e121837. [PMID: 35991778 PMCID: PMC9375958 DOI: 10.5812/aapm.121837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/12/2022] [Accepted: 02/13/2022] [Indexed: 11/16/2022] Open
Abstract
Background There is an increasing cesarean section (CS) rate in Egypt. Multiple methods are used to manage pain after CS. Objectives This study aimed to assess the effect of ultrasound-guided bilateral ilioinguinal and iliohypogastric nerve block on pain reduction after CS. Methods We classified 64 cases of elective CS into two equal groups. The block group underwent the nerve block, and the control group did not. Postoperative pain, morphine consumption, time to analgesic request, and complications were compared between the two groups. Results No significant difference was detected between the two groups regarding patient characteristics or operation duration. However, pain scores during rest and movement were significantly lower in the block group than in controls, especially within the first 12 hours following the operation. Morphine consumption was significantly lower in the block group (4.53 ± 1.456) in group B vs. (8.87 ± 2.013) in group C with P-value < 0.001. Time to the first rescue analgesia was significantly longer in the intervention group than in the other group (12.25 vs. 3.81 hours). Pruritis and nausea incidence was significantly higher in controls than in the block group. The incidence of chronic postoperative pain was significantly lower in the block group. Conclusions The ilioinguinal and iliohypogastric nerve block is efficient and safe for managing postoperative pain following CS. It is associated with significant improvement of acute and chronic pain after such operations.
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Affiliation(s)
- Laila Elahwal
- Faculty of Medicine, Tanta University, Tanta, Egypt
- Corresponding Author: Faculty of Medicine, Tanta University, Tanta, Egypt.
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Tapan M, Ünlü RE, İğde M, Tapan YU, Öztürk MO, Tekindal MA. The effect of local anaesthetic on delayed bleeding in a epigastric flap model of rats. J Wound Care 2021; 30:IIi-IIv. [PMID: 34597170 DOI: 10.12968/jowc.2021.30.sup9a.ii] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Local anaesthetics are often used in plastic surgery practice. Through their mechanism of action, local anaesthetics produce a sympathetic blockage with a subsequent vasodilatation and a resulting local increase of perfusion. The effect of vasodilation of the local anaesthetics causes bleeding locally resulting in haematoma, bruising and/or pain. We present an experimental study of the effects of local anaesthetics on delayed bleeding. METHOD In this animal study, 36 adult male Wistar rats were divided into four groups of nine animals: lidocaine; lidocaine and epinephrine; bupivacaine; and control. An epigastric flap model was harvested. Local anaesthetics that are frequently used in daily practice were administered in equal amounts to the harvested flap. RESULTS After 24 hours, the rats were euthanised to collect and measure all coagula under the epigastric flap. No statistically significant differences in relation to the amount of coagulum were found between the groups. CONCLUSION Our results suggest that proper haemostasis is achieved, there is no difference on the effect of delayed bleeding between the local anaesthetics which are often used.
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Affiliation(s)
- Mehmet Tapan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Akdeniz University, Antalya, Turkey
| | - Ramazan Erkin Ünlü
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ankara City Hospital Bilkent, Ankara, Turkey
| | - Murat İğde
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ankara City Hospital Bilkent, Ankara, Turkey
| | - Yasemin Urcan Tapan
- Deparment of Internal Medicine, Antalya Training and Research Hospital, Antalya, Turkey
| | - Mehmet Onur Öztürk
- Department of Plastic, Reconstructive and Aesthetic Surgery, Izmir Çiğli Regional Education Hospital, Izmir, Turkey
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Venkatraman R, Karthik K, Belinda C, Balaji R. A Randomized Observer-Blinded Controlled Trial to Compare Pre-Emptive with Postoperative Ultrasound-Guided Mandibular Nerve Block for Postoperative Analgesia in Mandibular Fracture Surgeries. Local Reg Anesth 2021; 14:13-20. [PMID: 33603457 PMCID: PMC7882799 DOI: 10.2147/lra.s290462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/20/2021] [Indexed: 12/31/2022] Open
Abstract
Background and Aims Ultrasound-guided (UG) mandibular nerve block is effective for providing postoperative analgesia in mandibular fracture surgeries. The pre-emptive nerve blockade prolongs the duration of postoperative analgesia and reduces the consumption of intraoperative opioids. The aim of this prospective, randomized, single-blinded study was to compare the efficacy of pre-emptive and postoperative UG mandibular nerve block for postoperative analgesia in mandibular fracture surgeries. Methods Sixty patients scheduled for unilateral mandibular fracture surgeries were randomly divided into two groups by computer-generated random numbers and sealed envelope method: Group A received UG mandibular nerve block before surgical incision and group B received after surgery with ropivacaine 0.5% 10mL. The second anesthesiologist, who was blinded to the group involved, monitored the patient. The patients as well as the statistician were also blinded. The patients were started on patient-controlled analgesia (PCA) morphine with bolus 1mg and a lockout interval of 10min. The morphine consumption for 24h was recorded. The pain was assessed by the VAS score. The additional intraoperative fentanyl consumption and time for a request for rescue analgesic were recorded. Results The total morphine consumption was reduced in group A (4.566±0.717mg) than group B (5.93±0.876mg) with a p-value of <0.0001. The time for a request for rescue analgesic was also prolonged in group A (794.08±89.561min) than group B (505.333±3.159min). In group A, only four patients required an additional dose of fentanyl as against 11 patients in group B. The heart rate was also lower in group A 30min after the administration of the block and persisted for two hours intraoperatively. Conclusion Pre-emptive ultrasound-guided mandibular nerve block reduces morphine consumption, prolongs the time for a request for rescue analgesic, reduces intraoperative fentanyl consumption, provides better control of intraoperative heart rate, and better pain scores postoperatively when compared to the postoperative mandibular nerve block. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/0ifMIJ8ooiU
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Affiliation(s)
- Rajagopalan Venkatraman
- Department of Anaesthesia, SRM Medical College Hospital and Research Centre, Potheri, Tamilnadu, 603203, India
| | - Kandhan Karthik
- Department of Anaesthesia, SRM Medical College Hospital and Research Centre, Potheri, Tamilnadu, 603203, India
| | - Cherian Belinda
- Department of Anaesthesia, SRM Medical College Hospital and Research Centre, Potheri, Tamilnadu, 603203, India
| | - Ramamurthy Balaji
- Department of Anaesthesia, SRM Medical College Hospital and Research Centre, Potheri, Tamilnadu, 603203, India
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Park SK, Yoon S, Kim BR, Choe SH, Bahk JH, Seo JH. Pre-emptive epidural analgesia for acute and chronic post-thoracotomy pain in adults: a systematic review and meta-analysis. Reg Anesth Pain Med 2020; 45:1006-1016. [DOI: 10.1136/rapm-2020-101708] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/14/2020] [Accepted: 09/16/2020] [Indexed: 01/03/2023]
Abstract
Background and objectivesEpidural analgesia is the gold standard for post-thoracotomy pain management and can be started before or after surgical incision. This systematic review and meta-analysis investigated whether pre-emptive epidural analgesia before thoracotomy incision reduces acute and chronic post-thoracotomy pain in adults compared with epidural analgesia after incision.MethodsWe searched databases including MEDLINE, Embase, and CENTRAL for randomized controlled trials comparing epidural analgesia initiated before (pre-emptive group) and after (control group) thoracotomy incision in adults. The primary outcomes were the pain intensity during rest and coughing within 72 hours after surgery and the incidence of pain 1 to 6 months after surgery. Data were combined with random-effects meta-analyses. We rated the quality of evidence as high, moderate, low, and very low using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) method.ResultsWe included 19 trials with 1062 participants involving 529 in the pre-emptive group and 533 in the control group. The pain intensity was significantly lower at rest within 72 hours after surgery (19 studies, n=1062) and during coughing within 48 hours after surgery (11 studies, n=638), and the incidence of pain was significantly lower 1 to 6 months after surgery (6 studies, n=276) in the pre-emptive group than in the control group. The quality of evidence was moderate or low in the primary outcomes.ConclusionsOur review provides low-quality evidence that pre-emptive epidural analgesia reduces the intensity of acute pain and the incidence of chronic pain after thoracotomy in adults.Protocol registration numberCRD42019131620.
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Abstract
Treating acute pain after thoracotomy surgery and preventing the development of chronic post-thoracotomy pain syndrome (PTPS) remain significant challenges in this surgical population. While appropriately treated acute thoracotomy pain often resolves, a significant number of patients develop PTPS, with up to 65% of patients experiencing some pain and 10% suffering life-altering, debilitating pain. Currently, there is very little known about specific molecular targets or novel therapeutic combinations that effectively prevent PTPS. Identifying modifiable clinical risk factors (procedure, physical and mental health, preoperative pain in the surgical area and another regions) seems to the most pragmatic approach for prevention for now. Effective acute pain management adopting a multimodal approach can result in a decreased incidence of PTPS. Interventional techniques such as paraverterbral blocks, intercostal blocks, and erector spinae blocks show some promise as well. Future research should be focused on minimally invasive surgeries and also the effect of ERAS protocols, including early mobilization, nutrition, and early removal of drains, on the development of PTPS.
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Tai YH, Wu HL, Lin SP, Tsou MY, Chang KY. An investigation of the effect of patient-controlled analgesia on long-term quality of life after major surgery: A prospective cohort study. J Chin Med Assoc 2020; 83:194-201. [PMID: 31868859 DOI: 10.1097/jcma.0000000000000241] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Chronic pain is a common postoperative complication in patients undergoing major surgery and may significantly affect their quality of life (QOL). Whether patient-controlled analgesia (PCA) can reduce the risk of chronic postsurgical pain and promote long-term QOL is still unclear. METHODS In this prospective cohort study, we followed up patients undergoing major surgery, recorded changes in their postoperative QOL over time using the World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire and chronic pain events, evaluated the long-term effects of distinct PCA techniques (intravenous, epidural, or none) on their QOL and risk of chronic pain, and explored relevant predictors. The patients' QOL and chronic pain events were collected preoperatively, 3, 6, and 12 months after surgery. Generalized linear mixed models were used to control for individual heterogeneity and adjust for potential confounding factors. RESULTS We included 328 patients undergoing major surgery from September 22, 2015, to December 31, 2016, in this study. Multivariate regression models showed that patients using intravenous PCA had a better QOL in physical health (adjusted coefficient 3.7, 95% CI, 0.5-8.0) compared with those receiving non-PCA treatments. Distinct PCA techniques did not significantly affect QOL in psychological, social relationship, or environmental domains of the WHOQOL-BREF scale or the risk of chronic postsurgical pain. CONCLUSION Patients using intravenous PCA had a better QOL in physical health over time after major surgery, which may have been due to factors other than pain-relieving effects.
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Affiliation(s)
- Ying-Hsuan Tai
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, ROC
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
| | - Hsiang-Ling Wu
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Shih-Pin Lin
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Mei-Yung Tsou
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Kuang-Yi Chang
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
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Thiyagarajan S, Velraj J, Hussain Ahmed MI, Murugesan R. Subarachnoid block with continuous TAP catheter analgesia produces less chronic pain and better functional outcome after inguinal hernioplasty: a randomized controlled observer-blinded study. Reg Anesth Pain Med 2019; 44:228-233. [PMID: 30700617 DOI: 10.1136/rapm-2018-000029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 07/06/2018] [Accepted: 07/09/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND OBJECTIVES The major concern after inguinal hernioplasty is chronic postsurgical pain and impaired quality of life due to central sensitization. Preoperative, intraoperative, and postoperative pre-emptive analgesia using regional techniques may help prevent the development of central sensitization. This study evaluated the effect of regional anesthesia followed by continuous regional analgesia on postoperative pain and functional outcome following inguinal hernioplasty. METHODS Seventy-two consecutive patients scheduled to undergo open mesh inguinal hernioplasty were randomly allocated to one of three groups: subarachnoid block alone (group SAB), general anesthesia alone (group GA), or subarachnoid block combined with a continuous transverse abdominis plane block (group TAP). Pain and functional outcome was assessed before and 6 months following the surgery using the Core Outcome Measures Index score adapted for patients with hernia (COMI-hernia). During the first 72 hours postoperatively, pain was assessed at rest and during five different activities using the numerical rating scale. RESULTS Six months following the surgery, the COMI-hernia score was lower in group TAP than in group GA or group SAB (0.54±0.41 vs 0.88±0.43 and 1.00±0.54, respectively; p<0.02). Pain at rest (p<0.02) and during activities (p<0.001) was lowest in group TAP during the first 72 hours postoperatively. CONCLUSIONS A subarachnoid block combined with continuous postoperative analgesia via a transverse abdominis plane catheter provided better pain control and functional outcome 6 months following inguinal hernioplasty as well as better postoperative analgesia. CLINICAL TRIAL REGISTRATION CTRI/2016/09/007238.
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Affiliation(s)
- Sivashanmugam Thiyagarajan
- Department of Anesthesiology and Critical Care, Mahatma Gandhi Medical College and Research Institute (MGMC and RI), Sri Balaji Vidyapeeth University, Puducherry, India
| | - Jaya Velraj
- Department of Anesthesiology and Critical Care, Mahatma Gandhi Medical College and Research Institute (MGMC and RI), Sri Balaji Vidyapeeth University, Puducherry, India
| | - M I Hussain Ahmed
- AI Mana General Hospital, AI Rowda, AI Hofoof wal Mubarraz, Al-Mubarraz, Saudi Arabia
| | - Ravishankar Murugesan
- AI Mana General Hospital, AI Rowda, AI Hofoof wal Mubarraz, Al-Mubarraz, Saudi Arabia
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Abstract
The reasons for development of chronic pain are poorly understood. Chronic postoperative pain is linked to severe acute postoperative pain. Head and neck pain is often a complex phenomenon that requires meticulous diagnosis and treatment. Institution of early multimodal analgesic regimens by multidisciplinary teams may attenuate chronic pain formation and propagation in the otolaryngologic patient.
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Affiliation(s)
- Anuj Malhotra
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, KCC 8th Floor, Box 1010, New York, NY 10029, USA
| | - Mourad Shehebar
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, KCC 8th Floor, Box 1010, New York, NY 10029, USA
| | - Yury Khelemsky
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, KCC 8th Floor, Box 1010, New York, NY 10029, USA; Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, KCC 8th Floor, Box 1010, New York, NY 10029, USA.
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Reyad RM, Shaker EH, Ghobrial HZ, Abbas DN, Reyad EM, Abd Alrahman AAM, AL‐Demery A, Issak ERH. The impact of ultrasound‐guided continuous serratus anterior plane block versus intravenous patient‐controlled analgesia on the incidence and severity of post‐thoracotomy pain syndrome: A randomized, controlled study. Eur J Pain 2019; 24:159-170. [DOI: 10.1002/ejp.1473] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 08/26/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Raafat M. Reyad
- Department of Anesthesia and Pain Medicine National Cancer Institute Cairo University Cairo Egypt
| | - Ehab H. Shaker
- Department of Anesthesia and Pain Medicine National Cancer Institute Cairo University Cairo Egypt
| | - Hossam Z. Ghobrial
- Department of Anesthesia and Pain Medicine National Cancer Institute Cairo University Cairo Egypt
| | - Dina N. Abbas
- Department of Anesthesia and Pain Medicine National Cancer Institute Cairo University Cairo Egypt
| | - Ehab M. Reyad
- Department of Clinical Pathology National Hepatology and Tropical Medicine Research Institute Cairo Egypt
| | | | - Amr AL‐Demery
- Department of Surgical Oncology National Cancer Institute Cairo University Cairo Egypt
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Lee J, Kim S. The effects of ultrasound-guided serratus plane block, in combination with general anesthesia, on intraoperative opioid consumption, emergence time, and hemodynamic stability during video-assisted thoracoscopic lobectomy: A randomized prospective study. Medicine (Baltimore) 2019; 98:e15385. [PMID: 31045789 PMCID: PMC6504301 DOI: 10.1097/md.0000000000015385] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Thoracotomy is one of the most painful surgeries; therefore, video-assisted thoracoscopic surgery (VATS) was developed to reduce the surgical stress of thoracotomy. Although VATS results in reduced postoperative pain compared with thoracotomy, it is still painful. Serratus plane block (SPB) is a novel technique that provides lateral chest wall analgesia by blocking the lateral branch of the intercostal nerve. METHODS We conducted a prospective study in 50 patients, aged 20 to 75 years, undergoing three-port VATS lobectomy. Group G (n = 25) received conventional general anesthesia and Group S (n = 25) received SPB before induction of general anesthesia. In Group S, 20 ml of 0.375% ropivacaine was injected between the serratus anterior and latissimus dorsi muscles. During surgery, anesthesia was maintained by adjusting the propofol dose to maintain a bispectral index of 40 to 60 and the remifentanil dose to maintain blood pressure and heart rate within 70 to 130% of baseline. RESULTS Intraoperative remifentanil consumption was significantly lower in Group S compared to that in Group G (519.9 μg vs 1047.7 μg, P < .001). Moreover, emergence time was significantly shorter in Group S compared to Group G (10.8 minutes vs 14.9 minutes, P = .01). However, there were no significant differences in systolic blood pressure and heart rate (HR) between the groups at each time point. The doses of rescue drugs for the control of blood pressure and HR were not significantly different between the 2 groups. CONCLUSIONS Ultrasound-guided SPB could be a safe and effective regional anesthesia technique for VATS.
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Affiliation(s)
- Jungwon Lee
- Department of Anesthesiology and Pain Medicine, Yeungnam University College of Medicine
| | - Saeyoung Kim
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
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Kim DH, Kim N, Lee JH, Jo M, Choi YS. Efficacy of preemptive analgesia on acute postoperative pain in children undergoing major orthopedic surgery of the lower extremities. J Pain Res 2018; 11:2061-2070. [PMID: 30288096 PMCID: PMC6162994 DOI: 10.2147/jpr.s175169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Children undergoing major orthopedic surgery of the lower extremities can experience severe postoperative pain; yet, the ideal postoperative pain management strategy is unknown. Thus, in this patient population, we investigated the effect of intraoperative epidural infusion of local anesthetic on acute postoperative pain and analgesic consumption. Patients and methods Patients (N=50, 3-12 years) randomly received either ropivacaine 0.15% (preemptive group) or normal saline (control group) as an initial bolus of 0.2 mL/kg, followed by continuous infusion of 0.15 mL/kg/h throughout surgery. Following surgery, patient-controlled epidural analgesia with ropivacaine 0.1% was provided. The main study outcomes were the revised Face, Legs, Activity, Cry, and Consolability pain scores, epidural ropivacaine consumption, and additional analgesic requirements during the first 48 hours postoperatively. Results Forty-seven patients completed the study, 23 in the preemptive group and 24 in the control group, respectively. The revised Face, Legs, Activity, Cry, and Consolability pain scores were significantly lower in the preemptive group only at 30 minutes after postanesthesia care unit arrival and 6 hours after surgery (median difference -1.0, 95% CI -2.0 to -1.0, P=0.001 and median difference -2.0, 95% CI -3.0 to -1.0, P=0.005, respectively). However, they were not significantly different between the groups at 12, 24, and 48 hours postoperatively. Epidural ropivacaine consumption and additional analgesic requirements throughout 48 hours postoperatively were not significantly different between the groups. Conclusion Intraoperative epidural infusion of ropivacaine did not demonstrate preemptive analgesic efficacy within 48 hours postoperatively in children undergoing extensive lower limb orthopedic surgery.
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Affiliation(s)
- Do-Hyeong Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea,
| | - Namo Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea,
| | - Jae Hoon Lee
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea,
| | - Minju Jo
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea,
| | - Yong Seon Choi
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea,
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Mao Y, Zuo Y, Mei B, Chen L, Liu X, Zhang Z, Gu E. Efficacy of perineural dexamethasone with ropivacaine in thoracic paravertebral block for postoperative analgesia in elective thoracotomy: a randomized, double-blind, placebo-controlled trial. J Pain Res 2018; 11:1811-1819. [PMID: 30254483 PMCID: PMC6140743 DOI: 10.2147/jpr.s164225] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Purpose The purpose of this study was to assess the efficacy of perineural dexamethasone with ropivacaine in multimodal analgesia for thoracic paravertebral block (TPVB) in patients undergoing elective thoracotomy. Patients and methods Ninety-six patients undergoing thoracotomy were enrolled in this trial and randomized to adjuvant therapy for TPVB: group S (saline), group R (0.5% ropivacaine), or group RD (5 mg dexamethasone and 0.5% ropivacaine). Postoperative analgesia, recovery duration, and chronic pain were recorded. Results Groups R and RD spent less time in the postanaesthesia care unit, had earlier out-of-bed activity, and had shorter postoperative hospital stays compared with group S. The RD group regained consciousness faster and had lower acute pain scores and used less patient-controlled analgesia during the first 72 h after surgery compared with group S. Postthoracotomy pain was decreased in group RD (19.0%) compared with group S (47.6%) 3 months postoperatively, p = 0.050. Conclusion Perineural dexamethasone with ropivacaine for TPVB improves postoperative analgesia quality, reduces recovery time, and may decrease the incidence of chronic pain after thoracotomy with an opioid-based anesthetic regimen.
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Affiliation(s)
- Yu Mao
- Key Laboratory of Brain Function and Disease of Chinese Academy of Science, Department of Biophysics and Neurobiology, University of Science and Technology of China, Hefei City, Anhui 230027, People's Republic of China.,Department of Anaesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei City, Anhui 230031, People's Republic of China,
| | - Youmei Zuo
- Department of Anaesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei City, Anhui 230031, People's Republic of China,
| | - Bin Mei
- Department of Anaesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei City, Anhui 230031, People's Republic of China,
| | - Lijian Chen
- Department of Anaesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei City, Anhui 230031, People's Republic of China,
| | - Xuesheng Liu
- Department of Anaesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei City, Anhui 230031, People's Republic of China,
| | - Zhi Zhang
- Key Laboratory of Brain Function and Disease of Chinese Academy of Science, Department of Biophysics and Neurobiology, University of Science and Technology of China, Hefei City, Anhui 230027, People's Republic of China
| | - Erwei Gu
- Department of Anaesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei City, Anhui 230031, People's Republic of China,
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Corona D, Novello L. Segmental thoracic epidural anaesthesia in a dog undergoing intercostal thoracotomy and lung lobectomy. VETERINARY RECORD CASE REPORTS 2018. [DOI: 10.1136/vetreccr-2018-000598] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
A seven-year-old, 25-kg female crossbreed dog received segmental thoracic epidural anaesthesia for left lateral thoracotomy and lung lobectomy. At presentation mild exercise intolerance and weight loss were reported. A chest CT scan revealed a solitary soft tissue mass in the left caudal lobe. Lung lobectomy surgery was scheduled. Under isoflurane anaesthesia, an epidural catheter was threaded through T13–L1 and advanced 50 mm cranially. Bupivacaine and morphine were administered 30 minutes before incision and at 12-hour intervals thereafter. To minimise side effects, the postoperative dose was titrated to guarantee segmental analgesia. Purposeful movements and signs of sympathetic stimulation in response to surgery were not observed. Intraoperatively, a transient 13% increase in arterial blood pressure occurred, while heart rate remained stable compared with baseline. Although the intended postoperative dose was decreased to prevent side effects, pain scores were below the analgesic intervention score. The catheter was removed on the fourth postoperative day. Complications and neurological sequelae were not noticed.
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15
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Weinstein EJ, Levene JL, Cohen MS, Andreae DA, Chao JY, Johnson M, Hall CB, Andreae MH. Local anaesthetics and regional anaesthesia versus conventional analgesia for preventing persistent postoperative pain in adults and children. Cochrane Database Syst Rev 2018; 6:CD007105. [PMID: 29926477 PMCID: PMC6377212 DOI: 10.1002/14651858.cd007105.pub4] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Regional anaesthesia may reduce the rate of persistent postoperative pain (PPP), a frequent and debilitating condition. This review was originally published in 2012 and updated in 2017. OBJECTIVES To compare local anaesthetics and regional anaesthesia versus conventional analgesia for the prevention of PPP beyond three months in adults and children undergoing elective surgery. SEARCH METHODS We searched CENTRAL, MEDLINE, and Embase to December 2016 without any language restriction. We used a combination of free text search and controlled vocabulary search. We limited results to randomized controlled trials (RCTs). We updated this search in December 2017, but these results have not yet been incorporated in the review. We conducted a handsearch in reference lists of included studies, review articles and conference abstracts. We searched the PROSPERO systematic review registry for related systematic reviews. SELECTION CRITERIA We included RCTs comparing local or regional anaesthesia versus conventional analgesia with a pain outcome beyond three months after elective, non-orthopaedic surgery. DATA COLLECTION AND ANALYSIS At least two review authors independently assessed trial quality and extracted data and adverse events. We contacted study authors for additional information. We presented outcomes as pooled odds ratios (OR) with 95% confidence intervals (95% CI), based on random-effects models (inverse variance method). We analysed studies separately by surgical intervention, but pooled outcomes reported at different follow-up intervals. We compared our results to Bayesian and classical (frequentist) models. We investigated heterogeneity. We assessed the quality of evidence with GRADE. MAIN RESULTS In this updated review, we identified 40 new RCTs and seven ongoing studies. In total, we included 63 RCTs in the review, but we were only able to synthesize data on regional anaesthesia for the prevention of PPP beyond three months after surgery from 39 studies, enrolling a total of 3027 participants in our inclusive analysis.Evidence synthesis of seven RCTs favoured epidural anaesthesia for thoracotomy, suggesting the odds of having PPP three to 18 months following an epidural for thoracotomy were 0.52 compared to not having an epidural (OR 0.52 (95% CI 0.32 to 0.84, 499 participants, moderate-quality evidence). Simlarly, evidence synthesis of 18 RCTs favoured regional anaesthesia for the prevention of persistent pain three to 12 months after breast cancer surgery with an OR of 0.43 (95% CI 0.28 to 0.68, 1297 participants, low-quality evidence). Pooling data at three to 8 months after surgery from four RCTs favoured regional anaesthesia after caesarean section with an OR of 0.46, (95% CI 0.28 to 0.78; 551 participants, moderate-quality evidence). Evidence synthesis of three RCTs investigating continuous infusion with local anaesthetic for the prevention of PPP three to 55 months after iliac crest bone graft harvesting (ICBG) was inconclusive (OR 0.20, 95% CI 0.04 to 1.09; 123 participants, low-quality evidence). However, evidence synthesis of two RCTs also favoured the infusion of intravenous local anaesthetics for the prevention of PPP three to six months after breast cancer surgery with an OR of 0.24 (95% CI 0.08 to 0.69, 97 participants, moderate-quality evidence).We did not synthesize evidence for the surgical subgroups of limb amputation, hernia repair, cardiac surgery and laparotomy. We could not pool evidence for adverse effects because the included studies did not examine them systematically, and reported them sparsely. Clinical heterogeneity, attrition and sparse outcome data hampered evidence synthesis. High risk of bias from missing data and lack of blinding across a number of included studies reduced our confidence in the findings. Thus results must be interpreted with caution. AUTHORS' CONCLUSIONS We conclude that there is moderate-quality evidence that regional anaesthesia may reduce the risk of developing PPP after three to 18 months after thoracotomy and three to 12 months after caesarean section. There is low-quality evidence that regional anaesthesia may reduce the risk of developing PPP three to 12 months after breast cancer surgery. There is moderate evidence that intravenous infusion of local anaesthetics may reduce the risk of developing PPP three to six months after breast cancer surgery.Our conclusions are considerably weakened by the small size and number of studies, by performance bias, null bias, attrition and missing data. Larger, high-quality studies, including children, are needed. We caution that except for breast surgery, our evidence synthesis is based on only a few small studies. On a cautionary note, we cannot extend our conclusions to other surgical interventions or regional anaesthesia techniques, for example we cannot conclude that paravertebral block reduces the risk of PPP after thoracotomy. There are seven ongoing studies and 12 studies awaiting classification that may change the conclusions of the current review once they are published and incorporated.
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Affiliation(s)
- Erica J Weinstein
- Albert Einstein College of Medicine of Yeshiva University1300 Morris Park AveBronxNYUSA10461
| | - Jacob L Levene
- Albert Einstein College of Medicine of Yeshiva University1300 Morris Park AveBronxNYUSA10461
| | - Marc S Cohen
- Montefiore Medical Center, Albert Einstein College of MedicineDepartment of Anesthesiology111 E 210 StreetBronxNYUSA#N4‐005
| | - Doerthe A Andreae
- Milton S Hershey Medical CenterDepartment of Allergy/ Immunology500 University DrHersheyPAUSA17033
| | - Jerry Y Chao
- Montefiore Medical Center, Albert Einstein College of MedicineDepartment of Anesthesiology111 E 210 StreetBronxNYUSA#N4‐005
| | - Matthew Johnson
- Teachers College, Columbia UniversityHuman DevelopmentNew YorkNYUSA10027
| | - Charles B Hall
- Albert Einstein College of MedicineDivision of Biostatistics, Department of Epidemiology and Population Health1300 Morris Park AvenueBronxNYUSA10461
| | - Michael H Andreae
- Milton S Hershey Medical CentreDepartment of Anesthesiology & Perioperative Medicine500 University DriveH187HersheyPAUSA17033
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Weinstein EJ, Levene JL, Cohen MS, Andreae DA, Chao JY, Johnson M, Hall CB, Andreae MH. Local anaesthetics and regional anaesthesia versus conventional analgesia for preventing persistent postoperative pain in adults and children. Cochrane Database Syst Rev 2018; 4:CD007105. [PMID: 29694674 PMCID: PMC6080861 DOI: 10.1002/14651858.cd007105.pub3] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Regional anaesthesia may reduce the rate of persistent postoperative pain (PPP), a frequent and debilitating condition. This review was originally published in 2012 and updated in 2017. OBJECTIVES To compare local anaesthetics and regional anaesthesia versus conventional analgesia for the prevention of PPP beyond three months in adults and children undergoing elective surgery. SEARCH METHODS We searched CENTRAL, MEDLINE, and Embase to December 2016 without any language restriction. We used a combination of free text search and controlled vocabulary search. We limited results to randomized controlled trials (RCTs). We updated this search in December 2017, but these results have not yet been incorporated in the review. We conducted a handsearch in reference lists of included studies, review articles and conference abstracts. We searched the PROSPERO systematic review registry for related systematic reviews. SELECTION CRITERIA We included RCTs comparing local or regional anaesthesia versus conventional analgesia with a pain outcome beyond three months after elective, non-orthopaedic surgery. DATA COLLECTION AND ANALYSIS At least two review authors independently assessed trial quality and extracted data and adverse events. We contacted study authors for additional information. We presented outcomes as pooled odds ratios (OR) with 95% confidence intervals (95% CI), based on random-effects models (inverse variance method). We analysed studies separately by surgical intervention, but pooled outcomes reported at different follow-up intervals. We compared our results to Bayesian and classical (frequentist) models. We investigated heterogeneity. We assessed the quality of evidence with GRADE. MAIN RESULTS In this updated review, we identified 40 new RCTs and seven ongoing studies. In total, we included 63 RCTs in the review, but we were only able to synthesize data on regional anaesthesia for the prevention of PPP beyond three months after surgery from 41 studies, enrolling a total of 3143 participants in our inclusive analysis.Evidence synthesis of seven RCTs favoured epidural anaesthesia for thoracotomy, suggesting the odds of having PPP three to 18 months following an epidural for thoracotomy were 0.52 compared to not having an epidural (OR 0.52 (95% CI 0.32 to 0.84, 499 participants, moderate-quality evidence). Simlarly, evidence synthesis of 18 RCTs favoured regional anaesthesia for the prevention of persistent pain three to 12 months after breast cancer surgery with an OR of 0.43 (95% CI 0.28 to 0.68, 1297 participants, low-quality evidence). Pooling data at three to 8 months after surgery from four RCTs favoured regional anaesthesia after caesarean section with an OR of 0.46, (95% CI 0.28 to 0.78; 551 participants, moderate-quality evidence). Evidence synthesis of three RCTs investigating continuous infusion with local anaesthetic for the prevention of PPP three to 55 months after iliac crest bone graft harvesting (ICBG) was inconclusive (OR 0.20, 95% CI 0.04 to 1.09; 123 participants, low-quality evidence). However, evidence synthesis of two RCTs also favoured the infusion of intravenous local anaesthetics for the prevention of PPP three to six months after breast cancer surgery with an OR of 0.24 (95% CI 0.08 to 0.69, 97 participants, moderate-quality evidence).We did not synthesize evidence for the surgical subgroups of limb amputation, hernia repair, cardiac surgery and laparotomy. We could not pool evidence for adverse effects because the included studies did not examine them systematically, and reported them sparsely. Clinical heterogeneity, attrition and sparse outcome data hampered evidence synthesis. High risk of bias from missing data and lack of blinding across a number of included studies reduced our confidence in the findings. Thus results must be interpreted with caution. AUTHORS' CONCLUSIONS We conclude that there is moderate-quality evidence that regional anaesthesia may reduce the risk of developing PPP after three to 18 months after thoracotomy and three to 12 months after caesarean section. There is low-quality evidence that regional anaesthesia may reduce the risk of developing PPP three to 12 months after breast cancer surgery. There is moderate evidence that intravenous infusion of local anaesthetics may reduce the risk of developing PPP three to six months after breast cancer surgery.Our conclusions are considerably weakened by the small size and number of studies, by performance bias, null bias, attrition and missing data. Larger, high-quality studies, including children, are needed. We caution that except for breast surgery, our evidence synthesis is based on only a few small studies. On a cautionary note, we cannot extend our conclusions to other surgical interventions or regional anaesthesia techniques, for example we cannot conclude that paravertebral block reduces the risk of PPP after thoracotomy. There are seven ongoing studies and 12 studies awaiting classification that may change the conclusions of the current review once they are published and incorporated.
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Affiliation(s)
- Erica J Weinstein
- Albert Einstein College of Medicine of Yeshiva University1300 Morris Park AveBronxUSA10461
| | - Jacob L Levene
- Albert Einstein College of Medicine of Yeshiva University1300 Morris Park AveBronxUSA10461
| | - Marc S Cohen
- Montefiore Medical Center, Albert Einstein College of MedicineDepartment of Anesthesiology111 E 210 StreetBronxUSA#N4‐005
| | - Doerthe A Andreae
- Milton S Hershey Medical CenterDepartment of Allergy/ Immunology500 University DrHersheyUSA17033
| | - Jerry Y Chao
- Montefiore Medical Center, Albert Einstein College of MedicineDepartment of Anesthesiology111 E 210 StreetBronxUSA#N4‐005
| | - Matthew Johnson
- Teachers College, Columbia UniversityHuman DevelopmentNew YorkUSA10027
| | - Charles B Hall
- Albert Einstein College of MedicineDivision of Biostatistics, Department of Epidemiology and Population Health1300 Morris Park AvenueBronxUSA10461
| | - Michael H Andreae
- Milton S Hershey Medical CentreDepartment of Anesthesiology & Perioperative Medicine500 University DriveH187HersheyUSA17033
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17
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Mallick-Searle T, Fillman M. The pathophysiology, incidence, impact, and treatment of opioid-induced nausea and vomiting. J Am Assoc Nurse Pract 2018; 29:704-710. [PMID: 29131554 DOI: 10.1002/2327-6924.12532] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/02/2017] [Accepted: 10/03/2017] [Indexed: 12/11/2022]
Abstract
PURPOSE Opioid medications are integral in managing acute moderate-to-severe pain. Opioid analgesics bind to μ (mu), κ (kappa), or δ (delta) opioid receptors in the brain, spinal cord, and digestive tract. However, opioids cause adverse effects that may interfere with their therapeutic use. Some adverse effects wane over time, but patients using opioids for acute pain struggle with opioid-induced nausea and vomiting (OINV) the entire time they take the opioid. This article discusses the underlying mechanisms, clinical implications, and treatment strategies of OINV. DATA SOURCES Systematic search and review of Medline, PubMed, and Google Scholar for articles relating to OINV. In addition, package inserts provided pharmacologic data and dose recommendations as needed. CONCLUSIONS Research suggests approximately 40% of patients may experience nausea and 15%-25% of patients may experience vomiting after opioid administration. Nausea often precedes vomiting, although they can occur separately. Many patients receiving opioids rate the nausea and vomiting as worse than their pain. Nausea and vomiting can lead to complications including electrolyte imbalances, malnutrition, and volume depletion, and can also negatively affect quality of life and postoperative recovery. IMPLICATIONS FOR PRACTICE There are several medications that can be used to treat OINV including serotonin receptor antagonists, dopamine receptor antagonists, and neurokinin-1 receptor antagonists. Healthcare providers should be proactive about discussing OINV with patients, as this may improve patient outcomes and pain relief.
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Affiliation(s)
| | - Mechele Fillman
- Division Pain Medicine, Stanford Health Care, Stanford, California
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18
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Kim JC, Byun S, Kim S, Lee SY, Lee JH, Ahn S. Effect of preoperative pregabalin as an adjunct to a multimodal analgesic regimen in video-assisted thoracoscopic surgery: A randomized controlled trial. Medicine (Baltimore) 2017; 96:e8644. [PMID: 29245223 PMCID: PMC5728838 DOI: 10.1097/md.0000000000008644] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Depending on the type of injury, the pain mechanisms are multifactorial. Preoperative pregabalin administrations as an adjunct to a multimodal postoperative pain management strategy have been tested in various surgical settings. The purpose of current study was to evaluate the effects of preoperative pregabalin administration on postoperative pain intensity and rescue analgesic requirement following video-assisted thoracoscopic surgery (VATS). METHODS Sixty adult patients undergoing VATS were randomly assigned either to receive pregabalin 150 mg (Pregabalin group) or placebo (Control group) 1 hour before anesthesia. Primary efficacy variable was pain intensity. Secondary efficacy variables were the requirement of rescue analgesics, total volume of intravenous patient-controlled analgesia (IV-PCA), and adverse effects induced by pregabalin or IV-PCA. RESULTS Pain intensity scores at post-anesthesia care unit (PACU), 6 and 24 hours were lower significantly in the Pregabalin group compared with the Control group (mean [SD]; 5.6 [2.0] vs 6.8 [1.8]; mean difference: 1.2, 95% CI of difference: 0.2166-2.1835, P = .018, mean [SD]; 3.8 [1.9] vs 5.6 [1.4]; mean difference: 1.8, 95% CI of difference: 1.0074-2.7260, P = .001 and mean [SD]; 2.6 [1.6] vs 3.5 [1.5]; mean difference: 0.9, 95% CI of difference: 0.0946-1.7054, P = .029, respectively]. Also, the frequency of additional rescue drug administered at PACU (median [interquartile range]; 2 [2-3] vs 1 [1-2], P = .027) was significantly less in the Pregabalin group. The incidences of adverse effects related to pregabalin or IV-PCA were not different between the groups. CONCLUSION A single administration of pregabalin 150 mg before VATS decreased postoperative pain scores and incidence of additional rescue analgesics in the immediate postoperative period without increased risk of adverse effects.
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Affiliation(s)
- Jong Chan Kim
- Department of Anesthesiology and Pain Medicine, Hando General Hospital, Ansan-si
| | - Sunghye Byun
- Department of Anesthesiology and Pain Medicine, School of Medicine, Catholic University of Daegu, Daegu
| | - Seongsu Kim
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam-si, South Korea
| | - Seon-Yi Lee
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam-si, South Korea
| | - Joo Hyung Lee
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam-si, South Korea
| | - Sowoon Ahn
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam-si, South Korea
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19
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Anwar S, O'Brien B. The role of intraoperative interventions to minimise chronic postsurgical pain. Br J Pain 2017; 11:186-191. [PMID: 29123663 DOI: 10.1177/2049463717720640] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Chronic postsurgical pain (CPSP) is the most common complication following surgery, with increasing evidence of both its prevalence and severity. While awareness of the various risk factors for this long-term condition is also increasing, effective prevention remains elusive. In this review, we describe the increasing evidence for preventive or 'protective' strategies. Controversies and conflicting human data are presented along with suggestions for improved future study.
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Affiliation(s)
- Sibtain Anwar
- Department of Perioperative Medicine, Barts Heart Centre, London, UK.,NIHR Biomedical Research Centre at Barts, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, London, UK
| | - Ben O'Brien
- Department of Perioperative Medicine, Barts Heart Centre, London, UK.,NIHR Biomedical Research Centre at Barts, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, London, UK
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20
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Saxena AK, Chilkoti GT, Chopra AK, Banerjee BD, Sharma T. Chronic persistent post-surgical pain following staging laparotomy for carcinoma of ovary and its relationship to signal transduction genes. Korean J Pain 2016; 29:239-248. [PMID: 27738502 PMCID: PMC5061640 DOI: 10.3344/kjp.2016.29.4.239] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 07/01/2016] [Accepted: 07/04/2016] [Indexed: 12/18/2022] Open
Abstract
Background The present study was undertaken to evaluate the incidence of chronic persistent post-surgical pain (CPPP) and the role of signal transduction genes in patients undergoing staging laparotomy for carcinoma ovary. Methods The present observational study was undertaken following institutional ethical committee approval and informed consent from all the participants. A total 21 patients of ASA grade I to III with age 20−70 years, scheduled for elective staging laparotomy for carcinoma ovary were included. Patients were excluded if had other causes of pain, cognitive dysfunction or chronic neurological disorders. Statistical analysis of pool data was done using SPSS version-17. For various scales like GPE, PDQ, NPSI, the visual analogue scale (VAS), global perceived effect (GPE), the pain DETECT questionnaire (PDQ), and neuropathic pain symptoms inventory (NPSI), one factor repaeted measure ANOVA applied with simple contrast with baseline as on post-operative day 1 (considered as reference and compared with subsequent time-interval), and the P values were adjusted according to "Bonferroni adjustments". In patients with CPPP, the Δct values of mRNA expressions of genes at the end of postoperative day 90 were compared with the baseline control values by one factor repeated ANOVA. P value < 0.005 significant. Results The present study demonstrates 38.1% (8 out of 21 patients) incidence of CPPP. The functional status and quality of life as were observed to be significantly diminished in all patients with chronic pain. An up-regulation in the mRNA expression of signal transduction and a positive correlation was noted between the mRNA expression of signal transduction genes and VAS score in all patients with CPPP at the end of postoperative day 90. Conclusions The reported incidence of CPPP in patients with carcinoma ovary was 38.1%. An up-regulation and positive correlation between mRNA expression of signal transduction genes and VAS score depicts its potential role in the pathogenesis of CPPP.
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Affiliation(s)
- Ashok Kumar Saxena
- Department of Anesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahdara, Delhi, India
| | - Geetanjali T Chilkoti
- Department of Anesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahdara, Delhi, India
| | - Anand K Chopra
- Department of Anesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahdara, Delhi, India
| | - Basu Dev Banerjee
- Department of Biochemistry, University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahdara, Delhi, India
| | - Tusha Sharma
- Department of Biochemistry, University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahdara, Delhi, India
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21
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Dor crônica persistente pós‐operatória: o que sabemos sobre prevenção, fatores de risco e tratamento? Braz J Anesthesiol 2016; 66:505-12. [DOI: 10.1016/j.bjan.2014.12.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 12/11/2014] [Indexed: 11/21/2022] Open
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22
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Postoperative persistent chronic pain: what do we know about prevention, risk factors, and treatment. Braz J Anesthesiol 2016; 66:505-12. [PMID: 27591465 DOI: 10.1016/j.bjane.2014.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 12/11/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Postoperative persistent chronic pain (POCP) is a serious health problem, disabling, undermining the quality of life of affected patients. Although more studies and research have addressed the possible mechanisms of the evolution from acute pain to chronic postoperatively, there are still no consistent data about the risk factors and prevention. This article aims to bring what is in the panorama of the current literature available. CONTENT This review describes the definition, risk factors, and mechanisms of POCD, its prevention and treatment. The main drugs and techniques are exposed comprehensively. CONCLUSION Postoperative persistent chronic pain is a complex and still unclear etiology entity, which interferes heavily in the life of the subject. Neuropathic pain resulting from surgical trauma is still the most common expression of this entity. Techniques to prevent nerve injury are recommended and should be used whenever possible. Despite efforts to understand and select risk patients, the management and prevention of this syndrome remain challenging and inappropriate.
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23
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Impact of Perioperative Epidural Placement on Postdischarge Opioid Use in Patients Undergoing Abdominal Surgery. Anesthesiology 2016; 124:396-403. [PMID: 26575145 DOI: 10.1097/aln.0000000000000952] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Opioids play a crucial role in providing analgesia throughout the perioperative period; however, patients may become persistent users of these medications months after surgery. Epidurals have been posited to prevent the development of persistent pain, but there are little data on the effect of epidurals on persistent opioid use. METHODS This study was conducted using a claims database of a large, nationwide commercial health insurer. Opioid-naive patients who underwent open abdominal surgery from January 2004 to December 2013 were included in the study. Propensity scores for epidural placement were calculated accounting for demographic characteristics, resource utilization, and comorbid conditions (including medical, psychiatric, and pain conditions). Time-to-event analysis was used with the primary outcome defined as 30 days without filling an opioid prescription after discharge. In addition, total morphine equivalents dispensed within 90 days of discharge were also calculated for each patient. RESULTS A total of 6,432 patients were included in the final propensity score-matched cohort. The Cox proportional hazards ratio was 0.96 (95% CI, 0.91 to 1.01; P = 0.0910) for the relation between epidural placement and time till a 30-day gap without filling an opioid prescription. There was no difference in the total morphine equivalents dispensed within 90 days of discharge between the groups (P = 0.7670). CONCLUSIONS Epidural placement was not protective against persistent opioid use in a large cohort of opioid-naive patients undergoing abdominal surgery. This finding does not detract from the other potential benefits of epidural placement. More research is needed to understand the mechanism of persistent opioid use after surgery and its prevention.
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24
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Pozek JPJ, Beausang D, Baratta JL, Viscusi ER. The Acute to Chronic Pain Transition: Can Chronic Pain Be Prevented? Med Clin North Am 2016; 100:17-30. [PMID: 26614716 DOI: 10.1016/j.mcna.2015.08.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Chronic postsurgical pain (CPSP) is a distressing disease process that can lead to long-term disability, reduced quality of life, and increased health care spending. Although the exact mechanism of development of CPSP is unknown, nerve injury and inflammation may lead to peripheral and central sensitization. Given the complexity of the disease process, no novel treatment has been identified. The preoperative use of multimodal analgesia has been shown to decrease acute postoperative pain, but it has no proven efficacy in preventing development of CPSP.
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Affiliation(s)
- John-Paul J Pozek
- Department of Anesthesiology, Thomas Jefferson University, Gibbon Building, Suite 8280, 111 South 11th Street, Philadelphia, PA 19107, USA.
| | - David Beausang
- Department of Anesthesiology, Thomas Jefferson University, Gibbon Building, Suite 8490, 111 South 11th Street, Philadelphia, PA 19107, USA
| | - Jaime L Baratta
- Department of Anesthesiology, Thomas Jefferson University, Gibbon Building, Suite 8280, 111 South 11th Street, Philadelphia, PA 19107, USA
| | - Eugene R Viscusi
- Department of Anesthesiology, Thomas Jefferson University, Gibbon Building, Suite 8490, 111 South 11th Street, Philadelphia, PA 19107, USA
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25
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Konstantatos AH, Howard W, Story D, Mok LYH, Boyd D, Chan MTV. A randomised controlled trial of peri-operative pregabalin vs. placebo for video-assisted thoracoscopic surgery. Anaesthesia 2015; 71:192-7. [DOI: 10.1111/anae.13292] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2015] [Indexed: 12/31/2022]
Affiliation(s)
- A. H. Konstantatos
- Department of Anaesthesia and Peri-operative Medicine; Alfred Hospital; Melbourne Victoria Australia
| | - W. Howard
- Department of Anaesthesia; Austin Hospital; Melbourne Victoria Australia
| | - D. Story
- Anaesthesia, Peri-operative and Pain Medicine Unit; Melbourne Medical School; The University of Melbourne; Melbourne Victoria Australia
| | - L. Y. H. Mok
- Department of Anaesthesia and Intensive Care; The Chinese University of Hong Kong; Prince of Wales Hospital; Shatin Hong Kong China
| | - D. Boyd
- Department of Anaesthesia and Peri-operative Medicine; Alfred Hospital; Melbourne Victoria Australia
| | - M. T. V. Chan
- Department of Anaesthesia and Intensive Care; The Chinese University of Hong Kong; Prince of Wales Hospital; Shatin Hong Kong China
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Analgesic efficacy of preemptive pregabalin administration in arthroscopic shoulder surgery: a randomized controlled trial. Can J Anaesth 2015; 63:283-9. [DOI: 10.1007/s12630-015-0510-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 08/20/2015] [Accepted: 10/05/2015] [Indexed: 12/12/2022] Open
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Clifford JL, Mares A, Hansen J, Averitt DL. Preemptive perineural bupivacaine attenuates the maintenance of mechanical and cold allodynia in a rat spinal nerve ligation model. BMC Anesthesiol 2015; 15:135. [PMID: 26444970 PMCID: PMC4596364 DOI: 10.1186/s12871-015-0113-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 09/23/2015] [Indexed: 01/25/2023] Open
Abstract
Background Neuropathic pain is evasive to treat once developed, however evidence suggests that local administration of anesthetics near the time of injury reduces the development of neuropathic pain. As abnormal electrical signaling in the damaged nerve contributes to the initiation and maintenance of neuropathic pain, local administration of anesthetics prior to injury may reduce its development. We hypothesized that local treatment with bupivacaine prior to nerve injury in a rat model of spinal nerve ligation (SNL) would attenuate the initiation and/or maintenance of neuropathic pain behaviors. Methods On the day prior to SNL, baseline measures of pre-injury mechanical, thermal, and/or cold sensitivity were recorded in adult male Sprague–Dawley rats. Immediately prior to SNL or sham treatment, the right L5 nerve was perineurally bathed in either 0.05 mL bupivacaine (0.5 %) or sterile saline (0.9 %) for 30 min. Mechanical allodynia, thermal hyperalgesia, and/or cold allodynia were then examined at 3, 7, 10, 14 and 21 days following SNL. Results Rats exhibited both mechanical and cold allodynia, but not thermal hyperalgesia, within 3 days and up to 21 days post-SNL. No significant pain behaviors were observed in sham controls. Preemptive local bupivacaine significantly attenuated both mechanical and cold allodynia as early as 10 days following SNL compared to saline controls and were not significantly different from sham controls. Conclusions These data indicate that local treatment with bupivacaine prior to surgical manipulations that are known to cause nerve damage may protect against the maintenance of chronic neuropathic pain.
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Affiliation(s)
- John L Clifford
- Pain Management Research Area, United States Army Institute of Surgical Research, Fort Sam Houston, TX, USA
| | - Alberto Mares
- Pain Management Research Area, United States Army Institute of Surgical Research, Fort Sam Houston, TX, USA
| | - Jacob Hansen
- Pain Management Research Area, United States Army Institute of Surgical Research, Fort Sam Houston, TX, USA
| | - Dayna L Averitt
- Department of Biology, Texas Woman's University, PO Box 425799, Denton, TX, 76204-5799, USA.
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Hung CH, Wang JCF, Strichartz GR. Spontaneous Chronic Pain After Experimental Thoracotomy Revealed by Conditioned Place Preference: Morphine Differentiates Tactile Evoked Pain From Spontaneous Pain. THE JOURNAL OF PAIN 2015; 16:903-12. [PMID: 26116369 DOI: 10.1016/j.jpain.2015.06.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 06/03/2015] [Accepted: 06/14/2015] [Indexed: 01/19/2023]
Abstract
Chronic pain after surgery limits social activity, interferes with work, and causes emotional suffering. A major component of such pain is reported as resting or spontaneous pain with no apparent external stimulus. Although experimental animal models can simulate the stimulus-evoked chronic pain that occurs after surgery, there have been no studies of spontaneous chronic pain in such models. Here the conditioned place preference (CPP) paradigm was used to reveal resting pain after experimental thoracotomy. Male Sprague Dawley rats received a thoracotomy with 1-hour rib retraction, resulting in evoked tactile hypersensitivity, previously shown to last for at least 9 weeks. Intraperitoneal injections of morphine (2.5 mg/kg) or gabapentin (40 mg/kg) gave equivalent 2- to 3-hour-long relief of tactile hypersensitivity when tested 12 to 14 days postoperatively. In separate experiments, single trial CPP was conducted 1 week before thoracotomy and then 12 days (gabapentin) or 14 days (morphine) after surgery, followed the next day by 1 conditioning session with morphine or gabapentin, both versus saline. The gabapentin-conditioned but not the morphine-conditioned rats showed a significant preference for the analgesia-paired chamber, despite the equivalent effect of the 2 agents in relieving tactile allodynia. These results show that experimental thoracotomy in rats causes spontaneous pain and that some analgesics, such as morphine, that reduce evoked pain do not also relieve resting pain, suggesting that pathophysiological mechanisms differ between these 2 aspects of long-term postoperative pain. Perspective: Spontaneous pain, a hallmark of chronic postoperative pain, is demonstrated here in a rat model of experimental postthoracotomy pain, further validating the use of this model for the development of analgesics to treat such symptoms. Although stimulus-evoked pain was sensitive to systemic morphine, spontaneous pain was not, suggesting different mechanistic underpinnings.
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Affiliation(s)
- Ching-Hsia Hung
- Pain Research Center, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jeffrey Chi-Fei Wang
- Pain Research Center, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gary R Strichartz
- Pain Research Center, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Strichartz GR, Wang JCF, Blaskovich P, Ohri R. Mitigation of Experimental, Chronic Post-Thoracotomy Pain by Preoperative Infiltration of Local Slow-Release Bupivacaine Microspheres. Anesth Analg 2015; 120:1375-84. [DOI: 10.1213/ane.0000000000000768] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Comparing the DN4 tool with the IASP grading system for chronic neuropathic pain screening after breast tumor resection with and without paravertebral blocks. Pain 2015; 156:740-749. [DOI: 10.1097/j.pain.0000000000000108] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Kolettas A, Lazaridis G, Baka S, Mpoukovinas I, Karavasilis V, Kioumis I, Pitsiou G, Papaiwannou A, Lampaki S, Karavergou A, Pataka A, Machairiotis N, Katsikogiannis N, Mpakas A, Tsakiridis K, Fassiadis N, Zarogoulidis K, Zarogoulidis P. Postoperative pain management. J Thorac Dis 2015; 7:S62-72. [PMID: 25774311 DOI: 10.3978/j.issn.2072-1439.2015.01.15] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 01/11/2015] [Indexed: 01/18/2023]
Abstract
Postoperative pain is a very important issue for several patients. Indifferent of the surgery type or method, pain management is very necessary. The relief from suffering leads to early mobilization, less hospital stay, reduced hospital costs, and increased patient satisfaction. An individual approach should be applied for pain control, rather than a fix dose or drugs. Additionally, medical, psychological, and physical condition, age, level of fear or anxiety, surgical procedure, personal preference, and response to agents given should be taken into account. The major goal in the management of postoperative pain is minimizing the dose of medications to lessen side effects while still providing adequate analgesia. Again a multidisciplinary team approach should be pursued planning and formulating a plan for pain relief, particularly in complicated patients, such as those who have medical comorbidities. These patients might appear increase for analgesia-related complications or side effects.
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Affiliation(s)
- Alexandros Kolettas
- 1 Anesthisiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thomas' Hospitals, UK
| | - George Lazaridis
- 1 Anesthisiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thomas' Hospitals, UK
| | - Sofia Baka
- 1 Anesthisiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thomas' Hospitals, UK
| | - Ioannis Mpoukovinas
- 1 Anesthisiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thomas' Hospitals, UK
| | - Vasilis Karavasilis
- 1 Anesthisiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thomas' Hospitals, UK
| | - Ioannis Kioumis
- 1 Anesthisiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thomas' Hospitals, UK
| | - Georgia Pitsiou
- 1 Anesthisiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thomas' Hospitals, UK
| | - Antonis Papaiwannou
- 1 Anesthisiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thomas' Hospitals, UK
| | - Sofia Lampaki
- 1 Anesthisiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thomas' Hospitals, UK
| | - Anastasia Karavergou
- 1 Anesthisiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thomas' Hospitals, UK
| | - Athanasia Pataka
- 1 Anesthisiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thomas' Hospitals, UK
| | - Nikolaos Machairiotis
- 1 Anesthisiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thomas' Hospitals, UK
| | - Nikolaos Katsikogiannis
- 1 Anesthisiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thomas' Hospitals, UK
| | - Andreas Mpakas
- 1 Anesthisiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thomas' Hospitals, UK
| | - Kosmas Tsakiridis
- 1 Anesthisiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thomas' Hospitals, UK
| | - Nikolaos Fassiadis
- 1 Anesthisiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thomas' Hospitals, UK
| | - Konstantinos Zarogoulidis
- 1 Anesthisiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thomas' Hospitals, UK
| | - Paul Zarogoulidis
- 1 Anesthisiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thomas' Hospitals, UK
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Analgesic therapy for major spine surgery. Neurosurg Rev 2015; 38:407-18; discussion 419. [DOI: 10.1007/s10143-015-0605-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 07/13/2014] [Accepted: 11/16/2014] [Indexed: 12/11/2022]
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Humble SR, Dalton AJ, Li L. A systematic review of therapeutic interventions to reduce acute and chronic post-surgical pain after amputation, thoracotomy or mastectomy. Eur J Pain 2014; 19:451-65. [PMID: 25088289 PMCID: PMC4405062 DOI: 10.1002/ejp.567] [Citation(s) in RCA: 142] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2014] [Indexed: 11/15/2022]
Abstract
Background Perioperative neuropathic pain is under-recognized and often undertreated. Chronic pain may develop after any routine surgery, but it can have a far greater incidence after amputation, thoracotomy or mastectomy. The peak noxious barrage due to the neural trauma associated with these operations may be reduced in the perioperative period with the potential to reduce the risk of chronic pain. Databases and data treatment A systematic review of the evidence for perioperative interventions reducing acute and chronic pain associated with amputation, mastectomy or thoracotomy. Results Thirty-two randomized controlled trials met the inclusion criteria. Gabapentinoids reduced pain after mastectomy, but a single dose was ineffective for thoracotomy patients who had an epidural. Gabapentinoids were ineffective for vascular amputees with pre-existing chronic pain. Venlafaxine was associated with less chronic pain after mastectomy. Intravenous and topical lidocaine and perioperative EMLA (eutectic mixture of local anaesthetic) cream reduced the incidence of chronic pain after mastectomy, whereas local anaesthetic infiltration appeared ineffective. The majority of the trials investigating regional analgesia found it to be beneficial for chronic symptoms. Ketamine and intercostal cryoanalgesia offered no reduction in chronic pain. Total intravenous anaesthesia (TIVA) reduced the incidence of post-thoracotomy pain in one study, whereas high-dose remifentanil exacerbated chronic pain in another. Conclusions Appropriate dose regimes of gabapentinoids, antidepressants, local anaesthetics and regional anaesthesia may potentially reduce the severity of both acute and chronic pain for patients. Ketamine was not effective at reducing chronic pain. Intercostal cryoanalgesia was not effective and has the potential to increase the risk of chronic pain. TIVA may be beneficial but the effects of opioids are unclear.
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Affiliation(s)
- S R Humble
- Department of Anaesthetics and Pain Management, Charing Cross Hospital, London, UK; Peripheral Neuropathy Unit, Hammersmith Hospital Campus, Imperial College London, Du Cane Road, London, UK
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Haroutounian S, Nikolajsen L, Bendtsen TF, Finnerup NB, Kristensen AD, Hasselstrøm JB, Jensen TS. Primary afferent input critical for maintaining spontaneous pain in peripheral neuropathy. Pain 2014; 155:1272-1279. [DOI: 10.1016/j.pain.2014.03.022] [Citation(s) in RCA: 149] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 03/21/2014] [Accepted: 03/27/2014] [Indexed: 12/29/2022]
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Bayman EO, Brennan TJ. Incidence and severity of chronic pain at 3 and 6 months after thoracotomy: meta-analysis. THE JOURNAL OF PAIN 2014; 15:887-97. [PMID: 24968967 DOI: 10.1016/j.jpain.2014.06.005] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 06/06/2014] [Accepted: 06/12/2014] [Indexed: 12/31/2022]
Abstract
UNLABELLED This systematic review was performed to determine the incidence and the severity of chronic pain at 3 and 6 months after thoracotomy based on meta-analyses. We conducted MEDLINE, Web of Science, and Google Scholar searches of databases and references for English articles; 858 articles were reviewed. Meta-regression analysis based on the publication year was used to examine if the chronic pain rates changed over time. Event rates and confidence intervals with random effect models and Freeman-Tukey double arcsine variance-stabilizing transformation were obtained separately for the incidence of chronic pain based on 1,439 patients from 17 studies at 3 months and 1,354 patients from 15 studies at 6 months. The incidences of chronic pain at 3 and 6 months after thoracotomy were 57% (95% confidence interval [CI], 51-64%) and 47% (95% CI, 39-56%), respectively. The average severity of pain ratings on a 0 to 100 scale at these times were 30 ± 2 (95% CI, 26-35) and 32 ± 7 (95% CI, 17-46), respectively. Reported chronic pain rates have been largely stable at both 3 and 6 months from the 1990s to the present. PERSPECTIVE This systematic review's findings suggest that reported chronic pain rates are approximately 50% at 3 and 6 months and have been largely stable from the 1990s to the present. The severity of this pain is not consistently reported. Chronic pain after thoracotomy continues to be a significant problem despite advancing perioperative care.
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Affiliation(s)
- Emine Ozgur Bayman
- Departments of Anesthesia and Biostatistics, University of Iowa, Iowa City, Iowa.
| | - Timothy J Brennan
- Departments of Anesthesia and Biostatistics, University of Iowa, Iowa City, Iowa
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A refined technique for sciatic denervation in a golden-mantled ground squirrel (Callospermophilus lateralis) model of disuse atrophy. Lab Anim (NY) 2014; 43:203-6. [DOI: 10.1038/laban.493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 02/04/2014] [Indexed: 12/16/2022]
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Simanski CJ, Althaus A, Hoederath S, Kreutz KW, Hoederath P, Lefering R, Pape-Köhler C, Neugebauer EA. Incidence of Chronic Postsurgical Pain (CPSP) after General Surgery. PAIN MEDICINE 2014; 15:1222-9. [DOI: 10.1111/pme.12434] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Christian J.P. Simanski
- Department of Trauma and Orthopaedic Surgery, Cologne-Merheim Medical Center (CMMC); University of Witten/Herdecke; Cologne Germany
| | - Astrid Althaus
- Institute for Research in Operative Medicine (IFOM); University of Witten/Herdecke; Cologne Germany
| | - Sascha Hoederath
- Clinic of Surgery and Orthopaedics; Kantonales Spital Grabs; Grabs Switzerland
| | - Kerry W. Kreutz
- Institute for Research in Operative Medicine (IFOM); University of Witten/Herdecke; Cologne Germany
| | - Petra Hoederath
- Clinic of Neurosurgery; Kantonsspital St. Gallen; St. Gallen Switzerland
| | - Rolf Lefering
- Biometrics and Statistics; Institute for Research in Operative Medicine (IFOM); University of Witten/Herdecke; Cologne Germany
| | - Carolina Pape-Köhler
- Department of Abdominal, Vascular, and Transplant Surgery; Cologne Merheim Medical Center (CMMC); University of Witten/Herdecke; Cologne Germany
| | - Edmund A.M. Neugebauer
- Institute for Research in Operative Medicine (IFOM); University of Witten/Herdecke; Cologne Germany
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Erturk E, Aydogdu Kaya F, Kutanis D, Besir A, Akdogan A, Geze S, Tugcugil E. The effectiveness of preemptive thoracic epidural analgesia in thoracic surgery. BIOMED RESEARCH INTERNATIONAL 2014; 2014:673682. [PMID: 24745020 PMCID: PMC3972946 DOI: 10.1155/2014/673682] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 02/10/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND The aim of this study is to investigate the effectiveness of preemptive thoracic epidural analgesia (TEA) comparing conventional postoperative epidural analgesia on thoracotomy. MATERIAL AND METHODS Forty-four patients were randomized in to two groups (preemptive: Group P, control: Group C). Epidural catheter was inserted in all patients preoperatively. In Group P, epidural analgesic solution was administered as a bolus before the surgical incision and was continued until the end of the surgery. Postoperative patient controlled epidural analgesia infusion pumps were prepared for all patients. Respiratory rates (RR) were recorded. Patient's analgesia was evaluated with visual analog scale at rest (VASr) and coughing (VASc). Number of patient's demands from the pump, pump's delivery, and additional analgesic requirement were also recorded. RESULTS RR in Group C was higher than in Group P at postoperative 1st and 2nd hours. Both VASr and VASc scores in Group P were lower than in Group C at postoperative 1st, 2nd, and 4th hours. Patient's demand and pump's delivery count for bolus dose in Group P were lower than in Group C in all measurement times. Total analgesic requirements on postoperative 1st and 24th hours in Group P were lower than in Group C. CONCLUSION We consider that preemptive TEA may offer better analgesia after thoracotomy.
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Affiliation(s)
- Engin Erturk
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Karadeniz Technical University, 61080 Trabzon, Turkey
| | - Ferdane Aydogdu Kaya
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Karadeniz Technical University, 61080 Trabzon, Turkey
| | - Dilek Kutanis
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Karadeniz Technical University, 61080 Trabzon, Turkey
| | - Ahmet Besir
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Karadeniz Technical University, 61080 Trabzon, Turkey
| | - Ali Akdogan
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Karadeniz Technical University, 61080 Trabzon, Turkey
| | - Sükran Geze
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Karadeniz Technical University, 61080 Trabzon, Turkey
| | - Ersagun Tugcugil
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Recep Tayyip Erdoğan University, 53100 Rize, Turkey
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Abstract
PURPOSE OF REVIEW Persistent postsurgical pain (PPP) is an important cause of pain morbidity following surgery for almost any cause, but there is a greater evidence base for pain after cancer surgery. Historically, both patients and practitioners have struggled to recognize and accept this growing problem. This review will seek to highlight the awareness of this increasing epidemic and will discuss evidence base for diagnosis, risk factors and current strategies for prevention and treatment, especially after cancer surgery. RECENT FINDINGS Given the potential size of the problems of PPP, there is a relative paucity of recent data, especially as regards effective treatments. The review will synthesize current and existing evidence to give a balanced up-to-date view. There is a clear need for more high-quality randomized trials. SUMMARY An estimated 40,000 patients in the UK will develop PPP, of whom at least 5-10% will have severe pain. Lack of clear definition and lack of awareness have been barriers to diagnosis and access to treatment. Several risk factors associated with PPP have been identified and reduction of these factors may prevent its development. At present, there are large gaps in the evidence base and more large controlled trials are warranted.
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Preoperatıve ultrasound-guıded suprascapular nerve block for postthoracotomy shoulder paın. Curr Ther Res Clin Exp 2014; 74:44-8. [PMID: 24385221 PMCID: PMC3862194 DOI: 10.1016/j.curtheres.2012.12.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2012] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Acute postthoracotomy pain is a well-known potential problem, with pulmonary complications, ineffective respiratory rehabilitation, and delayed mobilization in the initial postoperative period, and it is followed by chronic pain. The type of thoracotomy, intercostal nerve damage, muscle retraction, costal fractures, pleural irritation, and incision scar are the most responsible mechanisms. OBJECTIVE Our aim was to assess whether preoperative ultrasound suprascapular nerve block with thoracic epidural analgesia was effective for postthoracotomy shoulder pain relief. METHODS Thirty-six American Society of Anesthesiologist classification physical status I-III patients (2011-2012), with a diagnosis of lung cancer and scheduled for elective open-lung surgery, were prospectively included in the study. Eighteen of the patients received an ultrasound-guided suprascapular nerve block with 10-mL 0.5% levobupivacaine, using a 22-gauge spinal needle, 1 hour before operation (group S); 18 other patients had thoracic epidural analgesia only, and no nerve block was performed. Standard general anesthesia was administered. Degree of shoulder pain was assessed by a blinded observer when discharging patients from the recovery room, and thereafter at 1, 3, 6, 12, 24, 36, 48, and 72 hours on infusion at rest and 12, 24, 36, 48, and 72 hours on coughing. The same blinded observer also recorded the total amount of epidural levobupivacaine and fentanyl used by the 2 groups. RESULTS In the suprascapular block group, the total amount of levobupivacaine (P = 0.0001) and fentanyl (P = 0.005) used postoperatively was statistically lower than in the epidural group. Visual analogue scale measurements in the suprascapular group were statistically significantly lower at 0, 1, 3, 6, 12, 24, 36, and 48 hours than those in the epidural group, both at rest and coughing. CONCLUSION Postthoracotomy shoulder pain reduces patient function and postsurgical rehabilitation potential after thoracotomy, and various studies on explaining the etiology and management of postthoracotomy shoulder pain have been conducted. Theories of the etiology involved either musculoskeletal origin or referred pain. In this study, we concluded that preoperative ultrasound-guided suprascapular nerve block with thoracic epidural analgesia could achieve effective shoulder pain relief for 72 hours postoperatively, both at rest and coughing.
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Sapkota R, Shrestha UK, Sayami P. Intercostal muscle flap and intracostal suture to reduce post-thoracotomy pain. Asian Cardiovasc Thorac Ann 2013; 22:706-11. [PMID: 24887922 DOI: 10.1177/0218492313515498] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Thoracotomy is considered to be the most painful surgical access, the main culprit being intercostal nerve injury. Despite the use of many techniques, this remains a major problem, pointing towards prevention as a better strategy. The effect of protecting both the upper and lower intercostal nerves during surgery has attracted many researchers. METHOD A prospective study spanning 15 months was undertaken in 48 patients randomized to a conventional group (n = 25) and a study group (n = 23). Pericostal sutures in the former and intracostal sutures in the latter were used for closure. An intercostal muscle flap was harvested at the start of the operation in the study group only. The groups were comparable in terms of baseline characteristics. With a similar pain protocol, pain scores and analgesic consumption were recorded and analyzed. RESULTS Times for pedicle harvest, intracostal suture, and pericostal suture were 5.2 ± 1.56, 3.65 ± 0.71, and 6.4 ± 1.20 min, respectively, in the study group. Total operative time was similar in both groups. Postoperative pain scores and the overall frequency of pain were consistently lower in the study group. CONCLUSION these techniques lead to a reduction in the acute and chronic post-thoracotomy pain, without increasing complications.
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Affiliation(s)
- Ranjan Sapkota
- Department of Cardiothoracic and Vascular Surgery, Manmohan Cardiothoracic Vascular and Transplant Center, Kathmandu, Nepal
| | - Uttam Krishna Shrestha
- Department of Cardiothoracic and Vascular Surgery, Manmohan Cardiothoracic Vascular and Transplant Center, Kathmandu, Nepal
| | - Prakash Sayami
- Department of Cardiothoracic and Vascular Surgery, Manmohan Cardiothoracic Vascular and Transplant Center, Kathmandu, Nepal
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Chi-Fei Wang J, Hung CH, Gerner P, Ji RR, Strichartz GR. The Qualitative Hyperalgesia Profile: A New Metric to Assess Chronic Post-Thoracotomy Pain. ACTA ACUST UNITED AC 2013; 6:190-198. [PMID: 24567767 PMCID: PMC3932053 DOI: 10.2174/1876386301306010190] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Thoracotomy often results in chronic pain, characterized by resting pain and elevated mechano-sensitivity. This paper defines complex behavioral responses to tactile stimulation in rats after thoracotomy, shown to be reversibly relieved by systemic morphine, in order to develop a novel qualitative "pain" score. A deep incision and 1 hour of rib retraction in male Sprague-Dawley rats resulted in reduced threshold and a change in the locus of greatest tactile (von Frey filament) sensitivity, from the lower back to a more rostral location around the wound site, and extending bilaterally. The fraction of rats showing nocifensive responses to mild stimulation (10 gm) increased after thoracotomy (from a pre-operative value of 0/10 to 8/10 at 10 days post-op), and the average threshold decreased correspondingly, from 15 gm to ∼4 gm. The nature of the nocifensive responses to tactile stimulation, composed pre-operatively only of no response (Grade 0) or brief contractions of the local subcutaneous muscles (Grade I), changed markedly after thoracotomy, with the appearance of new behaviors including a brisk lateral "escape" movement and/or a 180° rotation of the trunk (both included as Grade II), and whole body shuddering, and scratching and squealing (Grade III). Systemic morphine (2.5 mg/kg, i.p.) transiently raised the threshold for response and reduced the frequency of Grade II and III responses, supporting the interpretation that these represent pain. The findings support the development of a Qualitative Hyperalgesic Profile to assess the complex behavior that indicates a central integration of hyperalgesia.
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Affiliation(s)
| | - Ching-Hsia Hung
- Pain Research Center, Brigham & Women's Hospital, Boston MA 02115, USA ; Department of Physical Therapy, Medical College, National Cheng Kung University, Tainan, R.O.C. Taiwan
| | - Peter Gerner
- Department of Anesthesia, University of Salzburg, Salzburg, Austria
| | - Ru-Rong Ji
- Department of Anesthesiology, Duke University, Durham, NC, UK
| | - Gary R Strichartz
- Pain Research Center, Brigham & Women's Hospital, Boston MA 02115, USA
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Hitt JM, Demmy TL. Managing pain after thoracic surgery. Lung Cancer Manag 2013. [DOI: 10.2217/lmt.13.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY It is generally accepted that thoracic surgery for lung cancer produces some of the most intense and difficult perioperative and chronic pain challenges. In the acute period of recovery, practitioners must optimize patient comfort and pulmonary function. This can be achieved through a combination of systemic treatment and regional analgesic options. Thoracic surgery also causes relatively high levels of persistent postsurgical pain. Many of the cases of persistent pain have a clear neuropathic pain mechanism, but a significant number of cases do not. While persistent pain correlates directly with the extent of operative trauma, even video-assisted thoracoscopic surgery approaches can cause chronic pain. Persistent pain is treated with medical and interventional therapies customized to an individual patient’s complaints and medication tolerance.
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Affiliation(s)
- James M Hitt
- Roswell Park Cancer Institute, Buffalo, NY, USA
- Department of Anesthesiology, University at Buffalo, Buffalo, NY, USA
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Abstract
Chronic pain affects quality of life and adversely affects functional outcomes. Chronic postoperative pain is a frustrating problem for the surgeon because it ruins a technically perfect procedure, and the surgeon may be unsure of treatment strategies. There is much information on chronic pain and its treatment, but it is often published outside of surgery and diffusion of this information across disciplines is slow. This article synthesizes some of this literature and provides a systematic presentation of the evidence on pain associated with peripheral nerve injury. It highlights the use of perioperative and early intervention to decrease this debilitating problem.
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Affiliation(s)
- Ian Carroll
- Department of Anesthesia, Stanford University, 450 Broadway, Redwood City, CA 94603, USA
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Chaparro LE, Smith SA, Moore RA, Wiffen PJ, Gilron I. Pharmacotherapy for the prevention of chronic pain after surgery in adults. Cochrane Database Syst Rev 2013; 2013:CD008307. [PMID: 23881791 PMCID: PMC6481826 DOI: 10.1002/14651858.cd008307.pub2] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Chronic pain can often occur after surgery, substantially impairing patients' health and quality of life. It is caused by complex mechanisms that are not yet well understood. The predictable nature of most surgical procedures has allowed for the conduct of randomized controlled trials of pharmacological interventions aimed at preventing chronic postsurgical pain. OBJECTIVES The primary objective was to evaluate the efficacy of systemic drugs for the prevention of chronic pain after surgery by examining the proportion of patients reporting pain three months or more after surgery. The secondary objective was to evaluate the safety of drugs administered for the prevention of chronic pain after surgery. SEARCH METHODS We identified randomized controlled trials (RCTs) of various systemically administered drugs for the prevention of chronic pain after surgery from CENTRAL, MEDLINE, EMBASE and handsearches of other reviews and trial registries. The most recent search was performed on 17 July 2013. SELECTION CRITERIA Included studies were double-blind, placebo-controlled, randomized trials involving adults and evaluating one or more drugs administered systemically before, during or after surgery, or both, which measured pain three months or more after surgery. DATA COLLECTION AND ANALYSIS Data collected from each study included the study drug name, dose, route, timing and duration of dosing; surgical procedure; proportion of patients reporting any pain three months or more after surgery, reporting at least 4/10 or moderate to severe pain three months or more after surgery; and proportion of participants dropping out of the study due to treatment-emergent adverse effects. MAIN RESULTS We identified 40 RCTs of various pharmacological interventions including intravenous ketamine (14 RCTs), oral gabapentin (10 RCTs), oral pregabalin (5 RCTs), non-steroidal anti-inflammatories (3 RCTs), intravenous steroids (3 RCTs), oral N-methyl-D-aspartate (NMDA) blockers (3 RCTs), oral mexiletine (2 RCTs), intravenous fentanyl (1 RCT), intravenous lidocaine (1 RCT), oral venlafaxine (1 RCT) and inhaled nitrous oxide (1 RCT). Meta-analysis suggested a modest but statistically significant reduction in the incidence of chronic pain after surgery following treatment with ketamine but not gabapentin or pregabalin. Results with ketamine should be viewed with caution since most of the included trials were small (that is < 100 participants per treatment arm), which could lead to the overestimation of treatment effect. AUTHORS' CONCLUSIONS Additional evidence from better, well designed, large-scale trials is needed in order to more rigorously evaluate pharmacological interventions for the prevention of chronic pain after surgery. Furthermore, available evidence does not support the efficacy of gabapentin, pregabalin, non-steroidal anti-inflammatories, intravenous steroids, oral NMDA blockers, oral mexiletine, intravenous fentanyl, intravenous lidocaine, oral venlafaxine or inhaled nitrous oxide for the prevention of chronic postoperative pain.
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De Pinto M, Cahana A. Medical management of acute pain in patients with chronic pain. Expert Rev Neurother 2013; 12:1325-38. [PMID: 23234394 DOI: 10.1586/ern.12.123] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The number of patients with chronic pain has increased over the years, as well as the number of patients who manage chronic pain with opioids. As prescribed opioid use has increased, so has its abuse and misuse. It has also been estimated that the number of people using opioids illicitly has doubled worldwide over the last 20 years. Management of chronic pain with opioids is associated with pathophysiological phenomena such as tolerance, dependence and hyperalgesia. They can become a problem when chronic pain patients present for a surgical procedure. Furthermore, patients who are on opioids on a regular basis require higher amounts during the perioperative period. The perioperative management of the chronic pain patient is difficult and complex. Developing an appropriate plan that can fulfill patients' and surgical team's needs requires skills and experience. The aim of this review is to describe the options available for the optimal perioperative management of acute pain in patients with a history of chronic pain.
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Affiliation(s)
- Mario De Pinto
- Department of Anesthesiology and Pain Medicine, University of Washington, Pain Relief Service, Harborview Medical Center, 325 9th Avenue, Seattle, WA 98104, Box 359724, USA.
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Bouman EA, Theunissen M, Bons SA, van Mook WN, Gramke HF, van Kleef M, Marcus MA. Reduced Incidence of Chronic Postsurgical Pain after Epidural Analgesia for Abdominal Surgery. Pain Pract 2013; 14:E76-84. [DOI: 10.1111/papr.12091] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 05/06/2013] [Indexed: 12/17/2022]
Affiliation(s)
- Esther A. Bouman
- Department of Anaesthesiology; Maastricht University Medical Center+; Maastricht The Netherlands
| | - Maurice Theunissen
- Department of Anaesthesiology; Maastricht University Medical Center+; Maastricht The Netherlands
| | - Sabrina A. Bons
- Department of Anaesthesiology; Maastricht University Medical Center+; Maastricht The Netherlands
| | - Walther N. van Mook
- Department of Intensive Care; Maastricht University Medical Center+; Maastricht The Netherlands
| | - Hans-F. Gramke
- Department of Anaesthesiology; Maastricht University Medical Center+; Maastricht The Netherlands
| | - Maarten van Kleef
- Department of Anaesthesiology; Maastricht University Medical Center+; Maastricht The Netherlands
| | - Marco A. Marcus
- Department of Anaesthesiology; Maastricht University Medical Center+; Maastricht The Netherlands
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Comparison of continuous local anaesthetic and systemic pain treatment after axillary lymphadenectomy in breast carcinoma patients - a prospective randomized study. Radiol Oncol 2013; 47:145-53. [PMID: 23801911 PMCID: PMC3691083 DOI: 10.2478/raon-2013-0018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Accepted: 12/22/2012] [Indexed: 11/20/2022] Open
Abstract
Background Acute pain after axillary lymphadenectomy is often related mainly to axillary surgery. The aim of the prospective randomized study was to find out if continuous wound infusion of local anaesthetic reduces postoperative pain, consumption of opioids and the incidence of chronic pain compared to the standard intravenous piritramide analgesia after axillary lymphadenectomy in breast carcinoma patients. Methods Altogether 60 patients were enrolled in the prospective randomized study; half in wound infusion of local anaesthetic and half in the standard (piritramide) group. Results In the recovery room and on the first day after surgical procedure, the wound infusion of local anaesthetic group reported less acute and chronic pain, a lower consumption of piritramide and metoclopramide, but their alertness after the surgical procedure was higher compared to the standard group. Conclusions After axillary lymphadenectomy in breast carcinoma patients, wound infusion of local anaesthetic reduces acute pain and enables reduced opioid consumption, resulting in less postoperative sedation and a reduced need for antiemetic drugs. After wound infusion of local anaesthetic there is a statistical trend for reduction of chronic pain.
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Analgesic efficacy of bilateral superficial cervical plexus block in robot-assisted endoscopic thyroidectomy using a transaxillary approach. World J Surg 2013; 36:2831-7. [PMID: 22956016 DOI: 10.1007/s00268-012-1780-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Nerve blocks and infiltration with local anesthetics are commonly employed methods for postoperative pain control. This prospective, randomized trial was conducted to determine whether bilateral superficial cervical plexus block (BSCPB) is effective for reducing acute postoperative pain after robot-assisted endoscopic thyroidectomy (RAET) and to compare its effects with that of local wound infiltration (LWI). METHODS Ninety-seven patients who were to undergo RAET were randomly assigned to one of three groups to receive BSCPB with either 20 mL of 0.525% ropivacaine (BSCPB group, n=32) or 20 mL of isotonic sodium chloride solution (Control group, n=32) or LWI with 20 mL of 0.525% ropivacaine (LWI group, n=33). Postoperative pain scores were assessed at the postoperative anesthesia care unit (PACU) and at 6, 24, and 48 h postoperatively using a visual analog scale (VAS). Patients with VAS scores of ≥40 were administered rescue analgesics according to a standardized protocol. The main outcome variables were pain scores during the first postoperative 24 h and the number of patients requiring postoperative analgesic rescue. RESULTS The BSCBP and LWI groups showed lower pain scores compared with the Control group at the PACU. The BSCPB group continued to show significantly lower pain scores compared with the LWI and Control groups at postoperative 6 and 24 h. The number of patients requiring analgesic rescue at the PACU was lower in the BSCPB and LWI groups than in the Control group. The number of patients requiring additional rescue analgesics after discharge from the PACU until the first 24 postoperative h was lower in the BSCPB group than in the LWI group. CONCLUSIONS BSCPB and LWI are effective for reducing pain scores and analgesic requirements during the immediate postoperative period in patients who undergo RAET, with BSCPB being superior to LWI at postoperative 6-24 h.
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