Effectiveness of non-pharmacological interventions in improving sleep quality after cardiac surgery: A systematic review and meta-analysis

BACKGROUND

Sleep disturbance is highly prevalent among post-operative cardiac patients, with negative impacts on surgical recovery and rehabilitation. Post-operative pain and anxiety commonly seen in cardiac surgery patients are associated with poor sleep. Sleep medications commonly used are not ideal with prolonged usage, and non-pharmacological interventions can be good alternatives or complements.

AIM

To examine effectiveness of non-pharmacological interventions in post-operative cardiac settings on sleep quality, pain intensity and anxiety.

DESIGN

Systematic review and meta-analysis.

METHODS

PubMed, CENTRAL, Embase, CINAHL, Scopus, CNKI and ProQuest Dissertations and Theses were searched on 12 October 2022. Randomised controlled trials of non-pharmacological interventions examining sleep quality for adult post-operative cardiac patients were included. Included studies were appraised using Cochrane Risk of Bias tool version 1. Meta-analysis was conducted using RevMan version 5.4.1, and heterogeneity was assessed using I2 statistics and Cochran Q's test.

RESULTS

Eighteen studies involving 1701 participants were identified. Coronary artery bypass graft was most common. Non-pharmacological interventions varied in types and duration. All intervention groups were compared to usual care, placebo, no interventions or active comparators. Statistically significant improvement in sleep quality (SMD = -.91, 95% CI = -1.17 to -.65) was found among intervention groups that explored cognitive behavioural therapy, relaxation techniques, exercise, massage, acupressure, aromatherapy, music, eye mask and earplugs. Pain intensity was reduced (SMD = -.63, 95% CI = -1.05 to -.20) with cognitive behavioural therapy, relaxation techniques, massage, music and eye mask. Anxiety was improved (SMD = -.21, 95% CI = -.38 to -.04) with exercise and music.

CONCLUSION

The overall use of non-pharmacological interventions can optimise sleep after cardiac surgery. Further research with greater methodological rigour is needed to investigate different intervention-related characteristics while considering potential confounders.

RELEVANCE TO CLINICAL PRACTICE

Post-operative cardiac settings can consider incorporating non-pharmacological interventions. Patients and healthcare providers can be better informed about the use of such interventions to improve sleep.

REGISTRATION

PROSPERO CRD42022384991.

Cryoanalgesia: Review with Respect to Peripheral Nerve

BACKGROUND

 Cryoanalgesia is a tool being used by interventional radiology to treat chronic pain. Within a certain cold temperature range, peripheral nerve function is interrupted and recovers, without neuroma formation. Cryoanalgesia has most often been applied to the intercostal nerve. Cryoanalgesia has applications to peripheral nerve surgery, yet is poorly understood by reconstructive microsurgeons.

METHODS

 Histopathology of nerve injury was reviewed to understand cold applied to peripheral nerve. Literature review was performed utilizing the PubMed and MEDLINE databases to identify comparative studies of the efficacy of intraoperative cryoanalgesia versus thoracic epidural anesthesia following thoracotomy. Data were analyzed using Fisher's exact and analysis of variance tests. A similar approach was used for pudendal cryoanalgesia.

RESULTS

 Application of inclusion and exclusion criteria resulted in 16 comparative clinical studies of intercostal nerve for this review. For thoracotomy, nine studies compared cryoanalgesia with pharmaceutical analgesia, with seven demonstrating significant reduction in postoperative opioid use or postoperative acute pain scores. In these nine studies, there was no association between the number of nerves treated and the reduction in acute postoperative pain. One study compared cryoanalgesia with local anesthetic and demonstrated a significant reduction in acute pain with cryoanalgesia. Three studies compared cryoanalgesia with epidural analgesia and demonstrated no significant difference in postoperative pain or postoperative opioid use. Interventional radiology targets pudendal nerves using computed tomography imaging with positive outcomes for the patient with pain of pudendal nerve origin.

CONCLUSION

 Cryoanalgesia is a term used for the treatment of peripheral nerve problems that would benefit from a proverbial reset of peripheral nerve function. It does not ablate the nerve. Intraoperative cryoanalgesia to intercostal nerves is a safe and effective means of postoperative analgesia following thoracotomy. For pudendal nerve injury, where an intrapelvic surgical approach may be difficult, cryoanalgesia may provide sufficient clinical relief, thereby preserving pudendal nerve function.

Nonpharmacologic Therapies for Postoperative Pain in Cardiac Surgery: A Systematic Review

OBJECTIVES

To search for studies that address the efficacy of nonpharmacologic methods for pain relief in adults undergoing cardiac surgeries.

DESIGN

A systematic review registered in the International Prospective Register of Systematic Reviews (PROSPERO) under number CRD42020168681.

DATA SOURCE

PubMed, LILACS, CINAHL, the Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials.

REVIEW/ANALYSIS METHODS

The review used a PRISMA guideline that selected primary randomized controlled trials on the efficacy of nonpharmacologic pain relief therapies in patients undergoing cardiac surgery, with no time or language restrictions. The Joanna Briggs Institute Critical Appraisal Checklist for Randomized Clinical Trials was used to assess methodological rigor.

RESULTS

After screening, 23 of the 140 studies found in the databases were selected. The studies examined the efficacy of 13 different nonpharmacologic therapies, as well as a combination of therapies, with massage therapy being the most commonly examined, followed by musical intervention and hypnosis.

CONCLUSIONS

Some interventions, when combined with pharmacologic therapy, were effective in relieving postoperative pain after cardiac surgeries, according to the studies analyzed. However, most studies had significant methodological flaws, and further studies with high methodological quality are needed.

Intercostal Nerve Cryoablation Reduces Opioid Use and Length of Stay Without Increasing Adverse Events: A Retrospective Cohort Study of 5442 Patients Undergoing Surgical Correction of Pectus Excavatum

OBJECTIVE

To examine differences in opioid use, length of stay, and adverse events after minimally invasive correction of pectus excavatum (MIRPE) with and without intercostal nerve cryoablation.

BACKGROUND

Small studies show that intraoperative intercostal nerve cryoablation provides effective analgesia with no large-scale evaluations of this technique.

METHODS

The pediatric health information system database was used to perform a retrospective cohort study comparing patients undergoing MIRPE at children's hospitals before and after the initiation of cryoablation. The association of cryoablation use with inpatient opioid use was determined using quantile regression with robust standard errors. Difference in risk-adjusted length of stay between the cohorts was estimated using negative binomial regression. Odds of adverse events between the two cohorts were compared using logistic regression with a generalized estimating equation.

RESULTS

A total of 5442 patients underwent MIRPE at 44 children's hospitals between 2016 and 2022 with 1592 patients treated after cryoablation was introduced at their hospital. Cryoablation use was associated with a median decrease of 80.8 (95% CI: 68.6-93.0) total oral morphine equivalents as well as a decrease in estimated median length of stay from 3.5 [3.2-3.9] days to 2.5 [2.2-2.9] days ( P value: 0.016). Cryoablation use was not significantly associated with an increase in any studied adverse events.

CONCLUSIONS

Introduction of cryoablation for perioperative analgesia was associated with decreased inpatient opioid use and length of stay in a large sample with no change in adverse events. This novel modality for perioperative analgesia offers a promising alternative to traditional pain management in thoracic surgery.

A Systematic Review of the Effectiveness of Non-Pharmacological Therapies Used by Nurses in Children Undergoing Surgery

OBJECTIVE

The aim of this study was to identify non-pharmacological pain relief therapies in children undergoing surgery.

DESIGN AND DATA SOURCES

Using keywords extracted from Medical Subject Headings and "Descriptores en Ciencias de la Salud" we searched for articles in the Web of Science, Scopus, Cuiden, PubMed, and CINHAL databases from the last five years, and performed a reverse search. We assessed the documentary quality of the articles using various standardized instruments.

RESULTS

The final review included eleven studies. In terms of cognitive-behavioral techniques, there is evidence that both music and video therapy are effective in reducing postoperative pain in children in seven studies, and therapeutic play in five studies. Other methods used less frequently but found to be effective included laughter therapy in one study and deep breathing in another. Regarding physical methods of pain relief, massage was found to be an effective non-pharmacological therapy for reducing pediatric postoperative pain in two studies and ineffective in another.

CONCLUSIONS

In this study, we highlight the importance of non-pharmacological therapies in pediatric postoperative pain management. Cognitive-behavioral techniques, especially music therapy, video therapy, and therapeutic play, reduce pediatric postoperative pain. They are therefore effective therapies that nurses can use in this area. Further research into the effectiveness of storytelling is necessary, as the evidence is not entirely conclusive. More evidence is also needed on physical methods of pain relief, particularly massage.

Outcomes of Pain Management Among Postoperative Patients: A Cross-sectional Study

PURPOSE

Postoperative pain management has always been a significant challenge for both hospital staff and surgical patients. Determination of pain management outcomes among surgically treated patients may help develop pain management strategies, improve health services that would yield better outcomes, and increase patient satisfaction. This study aimed to assess the outcomes of pain management among postoperative patients.

DESIGN

The study was a descriptive cross-sectional study.

METHODS

The research was performed on postoperative patients at two university hospitals in North Cyprus from July to September 2019. The study sample consisted of 90 patients from both hospitals. The Turkish Version of the revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R-TR) was used for data collection. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist was used to report the present study.

FINDINGS

This study showed that the overall mean for pain severity and the worst pain experienced by patients after 24 hours was slightly higher than medium. Examination of interference of the pain with functions demonstrated that patients experienced problems with physical activities and sleeping. The most experienced side effects were nausea and drowsiness, and the most common emotions were anxiety and helplessness during the postsurgery period. The satisfaction rate of the patients with postoperative pain management was relatively high.

CONCLUSIONS

A holistic approach with evidence-based practices is crucial for adequate postoperative pain management. The recommendations include the development of individual pain outcome strategies to improve overall satisfaction with pain management among postoperative patients.

Ultrasound-guided fascial plane blocks for post-breast surgery pain syndrome

INTRODUCTION

Persistent pain following breast surgery is common and may be challenging to treat. In patients refractory to conservative treatments, ultrasound-guided fascial plane blocks of thoracic nerves can be a useful option.

RESULTS

This type of neuro blockade technique provides advantages in terms of safety and efficacy that are convenient for physicians managing refractory and complex cases of post-breast surgery syndrome.

CONCLUSION

This technical review aims to present an up-to-date summary of the most common ultrasound-guided fascial plane blocks for chronic pain in post-breast surgery patients, provide a detailed technical description of each intervention, and propose preferred injections based on the anatomical location of the pain.

Complementary and alternative therapies for managing postoperative pain after lower third molar surgery: a systematic review and network meta-analysis

OBJECTIVE

The objective of this study was to evaluate the impact of complementary and alternative treatments on postoperative pain following lower third molar surgeries.

METHODS

A comprehensive search of Electronic databases (Embase, MEDLINE via PubMed, and Cochrane Library) and grey literature was conducted up until May 2022. Randomized clinical trials investigating the effect of acupuncture, ozone therapy, laser (LLLT), drainage tube, kinesio-taping, ice therapy, and compressions on pain after LTM surgeries were included. The estimated mean differences (MD) for alternative therapies were pooled using the frequentist approach to random-model network meta-analysis NMA.

RESULTS

Eighty-two papers were included in the qualitative analysis; 33 of them were included in the quantitative analyzes. NMA revealed that drainage tube and kinesio-taping were superior in controlling pain 24-hours postoperatively than no-treatment. At 48-hours follow-up, kinesio-taping and LLLT more effective than placebo and drainage tube; and kinesio-taping and LLLT were superior to no treatment. At 72 h postoperatively, ozone therapy was superior to placebo; and drainage tube, kinesio-taping, and LLLT were better than no treatment. At 7-days follow-up, ozone and LLLT were superior to placebo; and LLLT and kinesio-taping were superior to no treatment. The SUCRA-ranking placed drainage tube as top-ranking intervention at 48-hours (98.2%) and 72-hours (96%) follow-ups, and ozone (83.5%) at 7-days follow-up.

CONCLUSION

The study findings suggest that these alternative and complementary therapies may be useful in reducing postoperative pain after LTM surgeries, and may offer advantages when combined to traditional pain management methods.

CLINICAL RELEVANCE

Non-pharmacological therapies are gaining popularity among healthcare professionals and patients. This study found that some of these therapies, specifically kinesio-taping and drainage tube were effective in controlling postoperative pain after third molar surgeries. These findings have important implications for clinical practice, as they highlight the potential benefits of incorporating these therapies into postoperative pain management plans.

Evaluating a targeted person-centred pain management intervention programme in lumbar spine surgery - a controlled segment-specific before-and-after interventional design

BACKGROUND

Postoperative pain management in lumbar spine surgery care remains a challenge. The aim of this study was to evaluate the impact of a person-centred postoperative pain management intervention programme on lumbar spine surgery patients on postoperative pain, shared decision-making, and satisfaction with postoperative pain management.

METHODS

The study was performed with a controlled before-and-after interventional design in an orthopaedic unit at a university hospital. Person-centred pain management for patients undergoing spine surgery was developed in co-creation by a multi-professional team and implemented throughout the care pathway. The usual care group (pre-intervention) served as a comparison to the intervention group. Pain intensity, shared decision-making in pain management, and patient satisfaction with results of pain management, served as patient-reported measures, collected using the International Pain Outcomes questionnaire and analysed using descriptive statistics.

RESULTS

The intervention showed no benefit for patients' pain and satisfaction, while shared decision-making in pain management was significant lower in the intervention group than in the conventional group. The per-protocol analysis showed no significant differences between groups.

CONCLUSION

The initial assumption of the study, that the implementation of a co-created structured person-centred care pathway would improve patient-reported outcomes, was not confirmed. The periodically low fidelity to the intervention due to organizational constraints (due to sub-optimal organizational conditions and managerial support) may have affected the results.

Cognitive behavioral therapy achieves better benefits in relieving postoperative pain and improving joint function: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Cognitive behavioral therapy (CBT) is a structured, short-term psychotherapy approach that may have positive effects in terms of relieving postoperative pain. The main objective of this study was to determine the effect of CBT on pain and joint function in patients after total joint arthroplasty.

METHODS

We searched 3 electronic databases including randomized controlled studies (RCTs) using CBT as an intervention. The main results of this study were to determine pain intensity by NRS, VAS, WOMAC pain Scale, PCS, and joint function by HHS, OKS, EQ-5D, ROM. Data extraction and quality assessment of included RCTs were independently performed by the authors and date analysis was performed by RevMan V.5.4.

RESULTS

Among the 605 studies, 9 RCTS were included in this systematic review and meta-analysis. The study showed that the difference between CBT and usual care groups in PCS (≤3months), NRS, VAS (≤3months) were statistically significant (P < 0.05); the difference between CBT and usual care groups in PCS (≥12months), WOMAC Pain Scale, and VAS (≥12months) were not statistically significant (P > 0.05), indicating that CBT can improve pain in patients after arthroplasty in the early term. In addition, the difference between CBT and usual care groups in OKS (≤3months), HSS, ROM (≤3months), EQ-5D (≤3months) were not statistically significant (P > 0.05); the difference between CBT and usual care groups in EQ-5D (≥12months) were statistically significant (P < 0.05), indicating that the quality of life in patients after total joint arthroplasty were improved with the extension of follow-up time.

CONCLUSIONS

This study shows that CBT can relieve pain in patients with total joint arthroplasty in the early postoperative period and improve quality of life to some extent over time.

Effects of evidence-based nursing care interventions on wound pain and wound complications following surgery for finger tendon injury

We conducted this study aimed to examine the impact of evidence-based nursing interventions on postoperative wound pain and complications after surgery for finger tendon injury. A total of 86 patients treated for finger tendon injuries at our hospital from January 2021 to October 2023 were selected and randomly divided into an experimental group and a control group. The control group received conventional nursing care, while the experimental group received evidence-based nursing interventions. The study compared the postoperative wound pain intensity, incidence of complications and patient satisfaction with nursing care between the two groups. The analysis revealed that compared with conventional care, evidence-based nursing interventions significantly reduced the level of wound pain (p = 0.034) and the incidence of complications (4.65% vs. 18.60%, p = 0.043). It also increased patient satisfaction with the nursing care (97.67% vs. 83.72%, p = 0.026). The study indicates that the application of evidence-based nursing interventions for patients with finger tendon injuries can reduce postoperative wound pain, decrease the incidence of complications and enhance patient satisfaction with nursing care.

Long-Term Sensory Function 3 years after Minimally Invasive Repair of Pectus Excavatum with Cryoablation

INTRODUCTION

Minimally invasive repair of pectus excavatum (MIRPE) with intercostal nerve cryoablation (Cryo) decreases length of hospitalization and opioid use, but long-term recovery of sensation has been poorly described. The purpose of this study was to quantify long-term hypoesthesia and neuropathic pain after MIRPE with Cryo.

METHODS

A prospective cohort study was conducted single-institution of patients ≤21 years who presented for bar removal. Consented patients underwent chest wall sensory testing and completed neuropathic pain screening. Chest wall hypoesthesia to cold, soft touch, and pinprick were measured as the percent of the treated anterior chest wall surface area (TACWSA); neuropathic pain was evaluated by questionnaire.

RESULTS

The study enrolled 47 patients; 87% male; median age 18.4 years. The median bar dwell time was 2.9 years. A median of 2 bars were placed; 80.9% were secured with pericostal sutures. At enrollment, 46.8% of patients had identifiable chest wall hypoesthesia. The mean percentage of TACWSA with hypoesthesia was 4.7 ± 9.3% (cold), 3.9 ± 7.7% (soft touch), and 5.9 ± 11.8% (pinprick). Hypoesthesia to cold was found in 0 dermatomes in 62%, 1 dermatome in 11%, 2 dermatomes in 17% and ≥3 dermatomes in 11%. T5 was the most common dermatome with hypoesthesia. Neuropathic symptoms were identified by 13% of patients; none required treatment.

CONCLUSION

In long-term follow up after MIRPE with Cryo, 46.8% of patients experienced some chest wall hypoesthesia; the average TACWSA with hypoesthesia was 4-6%. Hypoesthesia was mostly limited to 1-2 dermatomes, most commonly T5. Chronic symptomatic neuropathic pain was rare.

LEVEL OF EVIDENCE

Level IV.

The effect of cryotherapy on pain in patients with total knee replacement surgery: a meta-analysis

Cryotherapy is used to reduce edema and pain after total knee replacement surgery. This study was conducted as a meta-analysis study to determine the effect of cryotherapy on pain in patients undergoing total knee arthroplasty. The words 'total knee prosthesis,' 'pain,' 'cryotherapy,' 'cold application,' and 'orthopedic surgery' were searched in Turkish and English in scientific articles in the last 20 years from Scopus, Science Direct, Google Scholar, Pubmed databases. As a result of the research, a total of 8.406 studies were identified. Funnel Plot, Rosenthal's Secure N, and Orwin's Secure N methods were used to demonstrate that the meta-analysis study was reliable and valid and to determine publication bias. The sample size of the studies included in the analysis was 1462. The total effect size was 2.929, with a lower bound of 1.641 and an upper bound of 5.223 at a 95% confidence interval. The study determined that patients who underwent cryotherapy in total knee replacement surgery had 2.9 times less pain than patients who did not undergo cryotherapy.

Percutaneous electrical nerve stimulation in post-mastectomy neuropathic pain: A case report

Post-mastectomy pain syndrome (PMPS) is a type of chronic postsurgical pain that can be severe, debilitating and frequently encountered in clinical practice. Multiple studies have focused on prevention, identifying risk factors and treating this condition. Nonetheless, PMPS remains a complex condition to treat effectively. In this case report, we describe the use of percutaneous electrical nerve stimulation in a breast cancer patient who experienced PMPS refractory to conventional treatments.

Outcomes and outcome measures utilised in randomised controlled trials of postoperative caesarean delivery pain: a scoping review

BACKGROUND

Inadequately treated postoperative pain following caesarean delivery can delay recovery and the ability to care for a newborn. Effectiveness studies of interventions to treat postoperative caesarean delivery pain measure different outcomes, limiting data pooling for meta-analysis. We performed a comprehensive review of existing outcomes with the aim of recommending core outcomes for future research.

METHODS

A scoping review to identify all outcomes reported in randomised controlled trials (RCTs) and clinical trial registries of interventions to treat or prevent postoperative caesarean delivery pain, with postoperative pain as a primary outcome measure. We searched PubMed, Web of Science, CINAHL, LILACS, Embase, CDSR and CRCT for studies from May 2016 to 2021. Outcomes were extracted and frequencies tabulated.

RESULTS

Ninety RCTs and 11 trial registries were included. In total, 392 outcomes (375 inpatient and 17 outpatient) were identified and categorised. The most reported outcome domain was analgesia (n = 242/375, 64.5%), reported in 96% of inpatient studies, with analgesic consumption accounting for 108/375, 28.8% of analgesia outcomes. The second most common domain was pain intensity (n = 120/375, 32%), reported in 97% of inpatient studies, using the visual analogue scale (68/120, 59%) and the numerical reporting scale (37/120, 25%). Maternal and neonatal adverse effects accounted for 65/375 (17.3%) and 19/375 (5.1%) of inpatient outcomes, respectively.

CONCLUSIONS

Outcomes reported in RCTs for postoperative caesarean delivery pain vary widely. The results of this review suggest that standardisation is needed to promote research efficiency and aid future meta-analyses to identify optimal postoperative caesarean delivery pain management.

Pain relief effect of angiopuncture therapy on patients with postoperative pain: A clinical trial

BACKGROUND

The objective of this study is to study the pain relief effects of angiopuncture therapy in patients with postoperative pain.

METHODS

Forty-one patients were randomly selected based on the inclusion and exclusion criteria. Doppler imaging was performed to locate the cutaneous perforator. Angiopuncture was performed on the first postoperative day. A Numerical Rating Scale was used to evaluate the degree of pain before and after angiopuncture. Utilizing the paired t test or Wilcoxon signed rank test, all pre- and post-data were examined, and further subgroup analysis based on time was performed.

RESULTS

Variance analysis revealed a significant difference before and after angiopuncture (P < .05). The results of the subgroup analysis showed the pain-relieving effect of angiopuncture for postoperative pain patients at the time points of 6 hours, 12 hours, 24 hours, 48 hours, and 72 hours was apparent (P < .05).

CONCLUSION

The angiopuncture therapy approach may assist in pain relief in patients with postoperative pain.

The impact of preoperative interview and prospective nursing on perioperative psychological stress and postoperative complications in patients undergoing TACE intervention for hepatocellular carcinoma

TACE has become one of the main methods for the treatment of liver cancer. The study aimed to investigate the effects of preoperative interview and prospective nursing in patients with hepatic carcinoma undergoing transcatheter chemoembolization (TACE). Eighty-six patients with hepatocellular carcinoma who underwent TACE intervention treatment at our hospital between 2020 and 2023 were selected and randomly assigned to 2 groups using computerized randomization. The control group (n = 43) received routine nursing care, while the study group (n = 43) received preoperative interviews in combination with prospective nursing during the procedure. The patients' heart rate, mean arterial pressure, and blood pressure variations were recorded, along with their mood changes after intervention. The postoperative pain and satisfaction levels were compared between the 2 groups of patients, and the incidence of postoperative complications was observed. The heart rate, systolic blood pressure, and diastolic blood pressure of the 2 groups of patients were compared 1 day before the operation (P > .05). Compared to 1 day before the operation, there was no significant change for the study group at 10 minutes after entering the room. However, the control group showed an increase. Both groups showed an increase in heart rate, systolic blood pressure, and diastolic blood pressure after the operation, with the study group having lower values than the control group (P < .05). The levels of tension, fatigue, anxiety, energy, anger, depression, self-esteem, and POMS index were compared between the 2 groups before intervention (P > .05). After intervention, there were significant differences between the 2 groups(P < .05). Immediately after the operation, the NRS scores of the 2 groups of patients were compared (P > .05). Compared to the control group, the study group showed a decrease in NRS scores at 12, 24, and 48 hours after the operation (P < .05). The nursing satisfaction rate of the study group patients was 97.67% (42/43), which was higher than the nursing satisfaction rate of the control group of 76.74% (33/43) (P < .05). Compared to routine nursing, preoperative visits and prospective nursing interventions can effectively alleviate patients' psychological stress reactions, relieve pain, reduce the incidence of complications, and improve patients' satisfaction with nursing care.

The Impact of Dorsal Root Ganglion Stimulation on Pain Levels and Functionality in Patients With Chronic Postsurgical Knee Pain

BACKGROUND

Chronic postsurgical pain is a considerable source of disabling neuropathic pain. Rates of knee replacement surgeries are increasing, and many patients report chronic postsurgical pain in their wake. When conventional therapies prove ineffective, neuromodulation options such as dorsal root ganglion stimulation (DRGS) may be used. However, little is known about the effect of DRGS on improvements in quantitative functional outcome parameters.

MATERIALS AND METHODS

In a prospective observational study at two pain centers, patients with chronic postsurgical knee pain underwent implantation with a DRGS system after an interdisciplinary multimodal pain program. Ratings of pain, mood, quality of life, and function were captured at baseline and through 12 months of treatment. Quantitative measures (range of motion, walking distance, and pain medication usage) were also recorded.

RESULTS

Visual analog scale ratings of pain decreased from 8.6 to 3.0 (p < 0.0001; N = 11), and other pain measures agreed. Quality of life on the 36-Item Short Form Health Survey questionnaire improved from 69.3 to 87.6 (p < 0.0001), whereas the improvement in depression ratings was nonsignificant. International Knee Documentation Committee questionnaire ratings of function improved from 27.7 to 51.7 (p < 0.0001), which aligned with other functional measures. On average, knee range of motion improved by 24.5°, and walking distance dramatically increased from 125 meters to 1481. Cessation of opioids, antidepressants, and/or anticonvulsants was achieved by 73% of participants.

CONCLUSIONS

Both subjective-based questionnaire and quantitative examination-based variables were in broad agreement on the value of DRGS in improving functionality and chronic postsurgical pain in the knee. Although this finding is limited by the small sample size, this intervention may have utility in the many cases in which pain becomes problematic after orthopedic knee surgery.

Transcutaneous electrical acupoint stimulation benefits postoperative pain relief of oocyte retrieval: A randomized controlled trial

BACKGROUND

Transvaginal oocyte retrieval is frequently followed by adverse events related to anesthesia and the procedure. Some research showed that transcutaneous electrical acupoint stimulation (TEAS) can relieve intraoperative pain and postoperative nausea.

OBJECTIVE

This study examined whether TEAS can alleviate pain and relieve adverse symptoms after oocyte retrieval.

DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS

Altogether 128 patients were randomly divided into the TEAS group and the mock TEAS group. The two groups received a 30-minute-long TEAS or mock TEAS treatment that began 30 min after oocyte retrieval.

MAIN OUTCOME MEASURES

The primary outcome was the visual analog scale (VAS) pain score. Secondary outcomes were pressure pain threshold, McGill score, pain rating index (PRI), present pain intensity (PPI), VAS stress score, VAS anxiety score, and postoperative adverse symptoms.

RESULTS

The baseline characteristics of the two groups were comparable (P > 0.05). The VAS pain scores of the TEAS group were lower than those of the mock TEAS group at 60 and 90 min after oocyte retrieval (P < 0.05). The McGill score, PRI and PPI in the TEAS group were significantly lower than those in the control group at 60 min after oocyte retrieval (P < 0.05). However, the two groups had equivalent beneficial effects regarding the negative emotions, such as nervousness and anxiety (P > 0.05). The TEAS group was superior to the mock TEAS group for relieving postoperative adverse symptoms (P < 0.05).

CONCLUSION

TEAS treatment can relieve postoperative pain and postoperative adverse symptoms for patients undergoing oocyte retrieval. Please cite this article as: Liu LY, Su Y, Wang RR, Lai YY, Huang L, Li YT, Tao XY, Su MH, Zheng XY, Huang SC, Wu YN, Yu SY, Liang FR, Yang J. Transcutaneous electrical acupoint stimulation benefits postoperative pain relief of oocyte retrieval: A randomized controlled trial. J Integr Med. 2024; 22(1): 32-38.

Peripheral nerve blocks in advanced cancer pain: retrospective case series

OBJECTIVES

Patients with cancer often suffer severe pain that is not relieved with systemic analgesics and requires further treatment options. This study aims to investigate whether peripheral nerve blocks are a feasible treatment option in patients with incurable cancer who suffer from severe pain.

METHODS

All patients with advanced cancer who received a peripheral nerve block for the management of pain at the Tampere University Hospital between January 2015 and December 2018 were included in this retrospective study. The characteristics of the patients' features of the nerve blocks, opioid dosing (daily morphine equivalent) before and after the blocks, and patient-reported pain relief following peripheral block were assessed from the medical records.

RESULTS

Sixteen of the 17 patients included in this study received pain relief through a nerve block. Daily opioid dose was decreased with the block in 12 (71%) patients with a median change in daily morphine equivalent of -20 mg (IQR: -180 to 9). One infection of the catheter and two other transient adverse events occurred, but none was serious or fatal.

CONCLUSIONS

Peripheral nerve blocks seem safe and may provide considerable analgesia and decrease the need for opioids in patients with advanced cancer.

Comparing the Efficacy of Dorsal Root Ganglion Stimulation With Conventional Medical Management in Patients With Chronic Postsurgical Inguinal Pain: Post Hoc Analyzed Results of the SMASHING Study

OBJECTIVES

Approximately 10% of patients who undergo inguinal hernia repair or Pfannenstiel incision develop chronic (> three months) postsurgical inguinal pain (PSIP). If medication or peripheral nerve blocks fail, a neurectomy is the treatment of choice. However, some patients do not respond to this treatment. In such cases, stimulation of the dorsal root ganglion (DRG) appears to significantly reduce chronic PSIP in selected patients.

MATERIALS AND METHODS

In this multicenter, randomized controlled study, DRG stimulation was compared with conventional medical management (CMM) (noninvasive treatments, such as medication, transcutaneous electric neurostimulation, and rehabilitation therapy) in patients with PSIP that was resistant to a neurectomy. Patients were recruited at a tertiary referral center for groin pain (SolviMáx, Eindhoven, The Netherlands) between March 2015 and November 2016. Suitability for implantation was assessed according to the Dutch Neuromodulation Association guidelines. The sponsor discontinued the study early owing to slow enrollment. Of 78 planned patients, 18 were randomized (DRG and CMM groups each had nine patients). Six patients with CMM (67%) crossed over to DRG stimulation at the six-month mark.

RESULTS

Fifteen of the 18 patients met the six-month primary end point with a complete data set for a per-protocol analysis. Three patients with DRG stimulation had a negative trial and were lost to follow-up. The average pain reduction was 50% in the DRG stimulation and crossover group (from 6.60 ± 1.24 to 3.28 ± 2.30, p = 0.0029). Conversely, a 13% increase in pain was observed in patients with CMM (from 6.13 ± 2.24 to 6.89 ± 1.24, p = 0.42). Nine patients with DRG stimulation experienced a total of 19 adverse events, such as lead dislocation and pain at the implantation site.

CONCLUSIONS

DRG stimulation is a promising effective therapy for pain relief in patients with PSIP resistant to conventional treatment modalities; larger studies should confirm this. The frequency of side effects should be a concern in a new study.

CLINICAL TRIAL REGISTRATION

The Clinicaltrials.gov registration number for the study is NCT02349659.

Investigating the safety and efficacy of nerve stimulation for management of groin pain after surgical herniorrhaphy: a systematic review and meta-analysis

PURPOSE

Chronic post-operative inguinal pain (CPIP) following inguinal hernia repair has been a major sequela affecting 4000-48000 patients annually. Optimal management of CPIP has been a challenge, and pharmacological management particularly with opioids has shown unsatisfactory results. The main objective of this systematic review is to investigate the safety and efficacy of neuromodulation as an alternative intervention for the management of post-operative inguinal pain.

METHODS

A literature search was conducted by three reviewers to identify all relevant studies on the use of neuromodulatory interventions for treating post-operative inguinal pain. Data on study characteristics, neuromodulatory modalities, and patient's clinical data such as pre/post-interventional pain scores and analgesic requirements were extracted and reported.

RESULTS

A total of 389 patients with 357 (95.9%) males and 15 (4.1%) females were evaluated. The mean age of study participants was 47.9 ± 10.4 years. There were 187 (48.1%) and 202 (51.9%) patients allocated to the control and trial groups, respectively. The most common neuromodulation modality was TENS (4, 36.4%), followed by SCS (3, 27.3%), PNS (3, 27.3%), and acupuncture-assisted (2, 18.2%). The overall mean follow-up duration of the entire cohort was 3.8 months. The mean difference between pre-operative and post-operative VAS scores in the trial groups was 4.65 (95% Confidence Interval [CI], 2.97, 6.33), which was statistically significant (P value < 0.05). Patient-reported outcome measures showed significant responsiveness toward their treatments.

CONCLUSION

Nerve stimulation, in its many forms, is a safe and feasible option for the management of post-operative inguinal pain.

Application of behavioral economic strategies to enhance recruitment into a pediatric randomized clinical trial for postoperative pain relief: A randomized clinical trial

INTRODUCTION

A major challenge in conducting clinical trials is recruitment. Trial under-enrollment leads to underpowered studies. Behavioral economics offers strategies that may enhance trial recruitment. This study assessed the impact of behavioral economic strategies versus a standard biological approach to recruit children into a randomized clinical trial assessing a biofeedback-based virtual reality intervention for postoperative pain management. We hypothesized the behavioral economics-informed approach would increase enrollment into the future trial, intention to adhere to therapy, acceptability of the intervention, and perceived efficacy while decreasing perception of treatment burden and risk.

METHODS

This single-center, prospective, randomized trial recruited patients 12-18 years old undergoing surgery requiring postoperative admission and narcotic administration. Patient-parent dyads were randomized to watch a behavioral economics-informed (n = 64) or standard biological (n = 66) recruitment video about a study designed to assess impact of a virtual reality pain management intervention.

RESULTS

There was no difference in rates of intention to enroll in the study between groups (behavioral economics: 75%, control: 79%, p = 0.744) or in median response scores to questions regarding intention to adhere to therapy (4.0 [3.0, 4.0] vs. 4.0 [3.0, 4.0], p=0.084), acceptability of therapy (4.0 [3.0, 4.0] vs. 4.0 [3.0, 4.0], p = 0.376), perceptions of treatment burden (3.0 [3.0, 4.0] vs. 4.0 [3.0, 4.0], p=0.251), and efficacy (3.0 [3.0, 4.0] vs. 3.0 [3.0, 4.0], p = 0.914). Patients in the behavioral economics group were less likely to perceive risk associated with virtual reality versus the control group (behavioral economics: 2.0 [1.0, 2.0], control: 2.0 [2.0, 3.0], p = 0.023).

DISCUSSION

A behavioral economics-informed video did not increase patients' intentions to enroll into a clinical trial assessing the impact of virtual reality intervention for postoperative pain management.

CONCLUSION

Either approach would be sufficient for patient recruitment for this type of clinical trial since the overall intention to enroll rate was 77%.

Mechanisms inherent in acute-to-chronic pain after surgery - risk, diagnostic, predictive, and prognostic factors

PURPOSE OF REVIEW

Pain is an expected consequence of a surgery, but it is far from being well controlled. One major complication of acute pain is its risk of persistency beyond healing. This so-called chronic post-surgical pain (CPSP) is defined as new or increased pain due to surgery that lasts for at least 3 months after surgery. CPSP is frequent, underlies a complex bio-psycho-social process and constitutes an important socioeconomic challenge with significant impact on patients' quality of life. Its importance has been recognized by its inclusion in the eleventh version of the ICD (International Classification of Diseases).

RECENT FINDINGS

Evidence for most pharmacological and non-pharmacological interventions preventing CPSP is inconsistent. Identification of associated patient-related factors, such as psychosocial aspects, comorbidities, surgical factors, pain trajectories, or biomarkers may allow stratification and selection of treatment options based on underlying individual mechanisms. Consequently, the identification of patients at risk and implementation of individually tailored, preventive, multimodal treatment to reduce the risk of transition from acute to chronic pain is facilitated.

SUMMARY

This review will give an update on current knowledge on mechanism-based risk, prognostic and predictive factors for CPSP in adults, and preventive and therapeutic approaches, and how to use them for patient stratification in the future.

Robot-assisted laparoscopic triple neurectomy for chronic inguinal pain: Description of the technique, our experience and preliminary results

INTRODUCTION

Chronic inguinal pain or inguinodynia following hernioplasty is a relatively common complication that can be very incapacitating. Surgical treatment by triple neurectomy is a therapeutic option when previous treatments (oral/local therapy or neuromodulation) have failed.

OBJECTIVE

Retrospective description of the surgical technique and results of laparoscopic and robot-assisted triple neurectomy for chronic inguinodynia.

MATERIAL AND METHODS

We describe the inclusion/exclusion criteria as well as the surgical technique applied in 7 patients operated on at the University Health Care Complex of León (Urology Department) after failure of other treatment options.

RESULTS

The patients presented chronic groin pain, reporting a preoperative pain VAS of 7.43 out of 10. After surgery, this score was reduced to 3.71 on the first postoperative day and to 4.2 points one year after surgery. Hospital discharge occurred 24 h after surgery with no relevant complications being reported.

CONCLUSIONS

Laparoscopic or robot-assisted triple neurectomy is a safe, reproducible, and effective technique for the treatment of chronic groin pain refractory to other treatments.

Kidney Donor Perspectives on Acute Postoperative Pain Management

This study employed a qualitative descriptive approach to examine living kidney donor's experience of postoperative pain. Thirteen living kidney donors aged 46.5 (±14.4) years participated in this study. Semi-structured interviews were conducted and transcribed. Transcripts were inductively coded and reviewed for trends, patterns, and insights into donor's experience of postoperative pain. Donors experienced postoperative pain from a variety of sources that hindered recovery and created anxiety and fear in some. Donors managed pain with opioid and non-opioid medications, social support, and ambulation. Donor's past experiences with and expectations about pain, relationships with intended recipients, social support, as well as motivations for and meaning of donation informed their experience of postoperative pain. Prompt pharmacologic intervention for pain, as well as further coaching and education about pain management should be emphasized for nurses caring for living kidney donors. Further study of how donor's motivation might mediate their pain experience is needed.

Research hotspots and trends on post-cesarean section analgesia: A scientometric analysis from 2001 to 2021

This study aims to demonstrate current research priorities and predict future trends of post-cesarean section analgesia by scientometric analysis. We collected nearly 20 years (2002-2021) of publications related to post-cesarean section analgesia in the web of science database. Citespace was applied to evaluate the knowledge mapping. There are 2735 manuscripts about the post-cesarean section in total. The country, institution, and author posted the most separately are the USA, Univ Calif Irvine, and BRENDAN CARVALHO. INTERNATIONAL JOURNAL OF OBSTETRIC ANESTHESIA (21) publishes the most articles of this type, and ANESTHESIOLOGY has the greatest impact (1496 co-citations). In addition, the most key cited reference is McDonnell, J.G (43). Post-cesarean section analgesia research, including spinal anesthesia, postoperative pain, and epidural analgesia, has been a research hotspot in recent years. Through scientometric analysis of the past 20 years, we know the TAP blocks and drug selection in patient-controlled analgesia are the focus of future research. The USA, China, and Turkey have become the main research forces in this field, with high publication rates and centrality. This is important for accurately and quickly locating trends in this field.

Influence of transcutaneous electrical nerve stimulation on pain intensity and functional activities following lower segment cesarean section

BACKGROUND

Postoperative incisional pain following lower segment cesarean section (LSCS) is one of the commonly reported complaints which may affect mother-infant bonding, and restrict mobility and functional activities.

PURPOSE

To study the influence of transcutaneous electrical nerve stimulation (TENS) on pain intensity and functional activities using the Numerical Pain Rating Scale (NPRS) and the Patient Specific Functional Scale (PSFS) following LSCS from the postoperative day (POD) 1 to POD 4.

METHODS

This quasi-experimental study consisted of 50 postpartum women who underwent LSCS and were assigned to an intervention group (IG) that received TENS and a control group (CG) that received routine hospital care.

RESULTS

NPRS scores between CG and IG (pre-TENS application) showed a statistically significant difference (ηp2 = 0.542, p < .001) from POD 1 to POD 4. Study participants showed an improvement in PSFS scores (ηp2 = 0.412, 0.488, 0.661, 0.304, 0.262, and 0.395, p < .001) in IG compared to CG for bed transitions, bed transfers, sitting, sit to stand, walking, and toileting activities respectively from POD 1 to POD 4 which was statistically significant.

CONCLUSIONS

Our study results suggest that administration of TENS following LSCS shows an improvement in pain intensity and functional activities as reported on NPRS and PSFS respectively.

Advances in the management of persistent pain after total knee arthroplasty

PURPOSE OF REVIEW

Total knee arthroplasty (TKA) is one of the most commonly performed surgical procedures, with additional growth anticipated as the US population ages. Because the prevalence of chronic postsurgical pain ranges from 15 to 25%, identifying persons at risk for persistent pain following surgery allows for preoperative optimization of risk factors as well as early identification and intervention in the postsurgical period.

RECENT FINDINGS

Clinical understanding of available management techniques is critical to management, which should focus on improving patient mobility and satisfaction while reducing patient disability and healthcare costs. Current evidence supports a multimodal management strategy. This includes pharmacologic and nonpharmacologic interventions, procedural techniques, and identification and optimization of psychosocial and behavioral contributors to chronic pain. Procedural techniques known to confer analgesia include radiofrequency and watercooled neurotomy techniques. More recently, case reports have been published describing analgesic benefit with central or peripheral neuromodulation as a novel, though more invasive analgesic therapy.

SUMMARY

Identification and early intervention to address persistent pain after TKA is important to optimize patient outcomes. The anticipated growth in TKA underscores the need for future investigations to more fully define potential therapies for chronic pain following TKA.

The Emerging Role of Peripheral Nerve Stimulation in Postoperative Analgesia

PURPOSE OF REVIEW

Though peripheral nerve stimulation has long been utilized in the field of chronic pain management, its use in acute pain management in the postoperative period is relatively novel and warrants further consideration.

RECENT FINDINGS

In the postsurgical period, peripheral nerve stimulation may offer an additional low-risk, opioid-sparing analgesic option, which is particularly pertinent in the setting of the ongoing opioid epidemic, as inadequate postsurgical analgesia has been shown to increase the risk of developing persistent or chronic postsurgical pain. In this review, we discuss the current literature that illustrate the emerging role of peripheral nerve stimulation as an effective treatment modality in the postoperative period for the management of acute pain, as various studies have recently been conducted evaluating the feasibility of utilizing percutaneous peripheral nerve stimulation as an adjunct in postsurgical analgesia. Nonetheless, future studies are necessary to continue to elucidate the short- and long-term impacts of peripheral nerve stimulation use in acute postsurgical analgesia.

Prognostic models for chronic postsurgical pain-Current developments, trends, and challenges

PURPOSE OF REVIEW

Prognostic models for chronic postsurgical pain (CPSP) aim to predict the likelihood for development and severity of CPSP in individual patients undergoing surgical procedures. Such models might provide valuable information for healthcare providers, allowing them to identify patients at higher risk and implement targeted interventions to prevent or manage CPSP effectively. This review discusses the latest developments of prognostic models for CPSP, their challenges, limitations, and future directions.

RECENT FINDINGS

Numerous studies have been conducted aiming to develop prognostic models for CPSP using various perioperative factors. These include patient-related factors like demographic variables, preexisting pain conditions, psychosocial aspects, procedure-specific characteristics, perioperative analgesic strategies, postoperative complications and, as indicated most recently, biomarkers. Model generation, however, varies and performance and accuracy differ between prognostic models for several reasons and validation of models is rather scarce.

SUMMARY

Precise methodology of prognostic model development needs advancements in the field of CPSP. Development of more accurate, validated and refined models in large-scale cohorts is needed to improve reliability and applicability in clinical practice and validation studies are necessary to further refine and improve the performance of prognostic models for CPSP.

The effect of implementation of pain neuroscience education and rehabilitation exercise on post-operative pain and recovery after laparoscopic colorectal surgery: a prospective randomized controlled trial

PURPOSES

To optimize the efficacy of analgesia and post-operative recovery for patients undergoing laparoscopic colorectal surgery by integrating a composite psycho-somatic analgesia algorithm involving peri-operative rehabilitation exercise and pain neuroscience education into multi-modal analgesia.

METHODS

A prospective randomized controlled trial was conducted to compare conventional peri-operative analgesia (group CA) and the addition of rehabilitation exercise and pain neuroscience education into it (group REPNE) for patients undergoing laparoscopic colorectal surgery. Acute and chronic post-operative pain, characteristics of pain (pain catastrophizing, sensitization, and trends of neuropathic transformation), and quality of post-operative recovery calibrated with EuroQol Five Dimensions Questionnaire (EQ-5D-5L) were investigated and compared between two groups.

RESULTS

A total of 175 patients consented to participate in this study. Compared with those receiving conventional analgesia (group CA, N = 89), patients in group REPNE (N = 86) reported reduced intensity of pain 24 h after surgery, less risk of pain catastrophizing and sensitization, and better quality of life during hospitalization recovery till 1 month after surgery (p < 0.05). No statistical difference was found for neuropathic transformation of post-operative pain or for the incidence of chronic post-operative pain (p > 0.05).

CONCLUSIONS

The addition of peri-operative rehabilitation exercise and pain neuroscience education into multi-modal analgesia provided better analgesic effect compared with routine practice for patients receiving laparoscopic colorectal surgery and also facilitated better post-operative recovery. This composite psycho-somatic algorithm for peri-operative analgesia merits further application in clinical practice.

Interventional Treatment Options for Post-mastectomy Pain

PURPOSE OF REVIEW

Breast cancer is currently the most prevalent cancer diagnosed globally, and there is a significant gap in the availability of effective first-line treatment options. In addition to a cancer diagnosis, breast cancer patients face additional pain and morbidity after treatment. Radiation fibrosis, muscle spasms, muscle pain, neuropathy, and limited shoulder function are all potential side effects of breast cancer treatment and breast reconstruction. Post-mastectomy pain syndrome affects 25-60% of people after breast surgery. The current review moves forward to explain interventional pain management options that can be used to supplement conservative measures (physical therapy, medication, topical ointments) to help these patients.

RECENT FINDINGS

There are many new interventional procedures to treat chest wall pain, neuropathic pain, and spasticity after breast surgery. Currently, the most commonly performed procedures are botulinum toxin injections, serratus anterior plane blocks, intercostobrachial nerve blocks, thoracic paravertebral nerve blocks, pectoralis nerve blocks, and erector spinae nerve blocks. Utilizing one of these interventional procedures, along with physical therapy and pharmacologic interventions, can help manage post-mastectomy pain syndrome in the millions of breast cancer patients diagnosed and treated every year.

Comparison of ıntracanal ozone and low-level laser therapy on postoperative pain in vital teeth with symptomatic apical periodontitis:placebo-controlled randomize trial

The aim of this study was to compare the effect of ozone and low-level-laser therapy (LLLT) on postoperative pain after root canal treatment in symptomatic apical periodontitis on vital teeth. Eighty patients were divided into four groups using a web program as follows: LLLT placebo (mock laser therapy), LLLT, Ozone placebo (mock ozonated water irrigation), and Ozone. Postoperative pain levels for 7 days after treatment and percussion pain levels at the 7th day were recorded on the visual analog scale. A regression analysis, Cochran's Q test, Chi-square test, Kruskal-Wallis tests were performed to analyze the data (P=.05). A regression analysis demonstrated that the most effective variables are "group" and "jaw" (P=0.01). Pain in the lower jaw is higher than the upper jaw. There was difference between the groups on postoperative pain at the days 1, 2, and 3; however, there was no significant difference on other days. LLLT and ozone groups had less postoperative pain and pain on percussion. Low-level laser and ozone therapy are useful methods on postoperative-pain in vital symptomatic teeth ,but they don't have superiority to each other.

[Retrospective cohort study on application of acupuncture-aided anesthesia technique to patients undergoing thoracoscopic lobectomy]

OBJECTIVE

To compare the clinical effect of "initial scheme" and "improved scheme" of acupuncture-aided anesthesia for patients undergoing thoracoscopic lobectomy.

METHODS

A retrospective analysis about 2 groups ("initial scheme" and "improved scheme") of patients (40 cases in each group) who underwent thoracoscopic lobectomy was conducted in the present paper. Patients of the "initial scheme" group received thoracoscopic operation with three incisions under acupuncture-aided anesthesia i.e., electroacupuncture (EA) stimulation of bilateral Hegu (LI4), Neiguan (PC6), Houxi (SI3) and Zhigou (SJ6), combined with Lidocaine and ropivacaine epidural anesthesia and propofol intravenous anesthesia from January of 2013 to December of 2017. Patients of the "improved scheme" group received thoracoscopic operation with single incision under acupuncture-aided anesthesia by EA, combined with ropivacaine paravertevinal block and lidocaine and remifentanil intravenous anesthesia from August 2018 to August 2021. The incidence of intraoperative deep breathing, resuscitation time, ambulatory rate on day after surgery and postoperative incision pain of the two schemes were compared.

RESULTS

The incidence of intraoperative deep breathing and the degree of postoperative incision pain were significantly lower (P<0.05), the postoperative resuscitation time was obviously shorter (P<0.05), and the ambulatory rate on day after surgery was higher (P<0.05) in the "improved scheme" group than in the "initial scheme" group.

CONCLUSION

The "improved scheme" is better than the "initial scheme" in stabilizing the patient's breathing during thoracoscopic lobectomy operation, shortening the resuscitation time, and ameliorating the postoperative recovery state and pain reaction, thus being a better technical solution in clinical practice.

The Acute Perioperative Pain Service: Impact, Organization, and Future Directions

PURPOSE OF REVIEW

The Acute Perioperative Pain Service has been established as a relatively new but important concept and service in clinical patient care. Many surgical institutions have dedicated inpatient acute pain services with variable compositions. This review aims to investigate the purpose, clinical and economic implications, and future direction of the Acute Perioperative Pain Service (APPS).

RECENT FINDINGS

There is growing evidence of the multiple benefits of a dedicated APPS, especially pertaining to patients at higher risk of poorly controlled postoperative pain. Healthcare providers furthermore realize the importance of the perioperative pain management continuity of care, consisting of preoperative pain evaluations and post-discharge follow-up in an outpatient pain management setting, in coordination with the primary teams. The Transitional Pain Service (TPS) has emerged as the next step in this evolution and has been successfully implemented at various medical centers. With the growing number of surgical procedures and the increasing complexity of the patient population, effective management of acute postoperative pain continues to be challenging, despite ongoing advances in clinical care, analgesic modalities, and research. The APPS is becoming the clinical standard of care for managing postoperative pain, and its role continues to expand worldwide.

Addressing Bias in Acute Postoperative Pain Management

PURPOSE OF REVIEW

This review evaluates disparities in acute postoperative pain management with regard to gender, race, socioeconomic status, age, and language. Strategies for addressing bias are also discussed.

RECENT FINDINGS

Inequities in acute postoperative pain management may lead to longer hospital stays and adverse health outcomes. Recent literature suggests that there are disparities in acute pain management related to patient gender, race, and age. Interventions to address these disparities are reviewed but require further investigation. Recent literature highlights inequities in postoperative pain management, particularly in relation to gender, race, and age. There is a need for continued research in this area. Strategies such as implicit bias training and using culturally competent pain measurement scales may help reduce these disparities. Continued efforts by both providers and institutions to address and eliminate biases in postoperative pain management are needed to ensure better health outcomes.

Investigation of the Effects of Acupuncture on Post-Operative Chest Pain after Open Heart Surgery

Background

Coronary artery bypass grafting (CABG) accounts for more than half of all adult cardiac surgeries worldwide. Post-operative chest pain is a common CABG complication and can cause significant discomfort.

Objectives

Because taking large amounts of analgesics can have many side effects, we evaluated whether acupuncture effectively reduces pain and the use of analgesics by CABG patients.

Methods

In this clinical trial, 30 patients who had recently undergone CABG were randomly allocated to two groups. For both groups, exercise therapy and routine analgesics were recommended. The intervention group underwent bilateral acupuncture in distinct acupoints, including the HT3, HT4, HT5, HT6, HT7, PC3, PC5, PC6, and PC7 for 10 daily sessions constantly. Visual analog scale (VAS) and analgesic use were evaluated in both groups at baseline and after completing the 10-day treatment.

Results

Our analysis revealed significant decreases in the mean VAS scores in both the intervention and the control group, and that the reduction was more significant in the acupuncture group (p < 0.001). Moreover, analgesic use was significantly lower in the acupuncture group when compared with the control group (p < 0.001).

Conclusion

Our findings highlight acupuncture as an alternative method of controlling CABG-associated post-operative chest pain and reducing the use of analgesics, which might have many side effects.

Pre- and post-operative comprehensive nursing care versus conventional nursing care: An evaluation of quality of life, postoperative pain, adverse effects, and treatment satisfaction of patients who underwent surgeries and interventional therapies for liver cancer

Interventional therapies including chemotherapies and radiotherapies are the most preferred treatment for liver cancer. However, these therapies have adverse effects. Therefore, careful care is required to relieve these adverse effects. The objectives of this study were to evaluate the quality of life, pain, anxiety, depression, adverse effects, and satisfaction of patients with liver cancer who received pre- and post-operative comprehensive nursing care against those of patients who received conventional nursing care. Patients with liver cancer who underwent surgeries and interventional therapies for liver cancer received pre- and post-operative comprehensive nursing care (CMN cohort, n = 105) or conventional nursing care (CNN cohort, n = 135), or did not receive any kind of nursing care (NNC cohort, n = 175). Before the non-treatment intervention(s) (BL), none of the patients had absent post-operative pain, all patients had mild or moderate anxiety and depression, and patients had ≤70 overall quality of life score. In the NNC cohort, a few of the patients reported being completely dissatisfied with overall personal satisfaction, and anxiety, depression, and overall the quality of life of patients were clinically worse during the follow-up period generally after completion of all doses of chemo radiotherapies (EL) as compared to BL. Hospital stays due to surgery, visual analog scale (VAS) score, Zung Self-rating Anxiety Scale score, the Self-rating Depression Scale score, and rehospitalization due to any reason(s) in follow-up were fewer and overall quality of life score and overall personal satisfaction score were higher for patients of the CMN cohort than those of patients at BL and those of patients of the CNN and the NNC cohorts at EL (P < .05 for all). Fever, bleeding, urinary retention, gastrointestinal disturbance, and hepatic and renal impairments reported in patients of the NNC cohort. Fever, bleeding, and urinary retention reported in patients of the CNN cohort (P < .05 for all). Nursing non-treatment intervention(s) is necessary for liver cancer patients after surgery, in the follow-up, and between 2 doses of chemoradiotherapies. Pre- and post-operative comprehensive nursing care relieves postoperative pain, psychological burden and improves quality of life in the follow-up period in patients who underwent surgeries and interventional therapies for liver cancer (Level of Evidence: IV; Technical Efficacy: Stage 5).

Nd:YAG laser therapy on postoperative pain, swelling, and trismus after mandibular third molar surgery: a randomized double-blinded clinical study

This study aims to evaluate the effect of Nd:YAG laser therapy (NdLT) on postoperative pain, swelling, and trismus after mandibular third molar (M3) surgery. Three hundred patients were randomly divided into the Nd group (n = 100), medication group (n = 100), and Nd+medication (Nd+m) group (n = 100). The WHARFE classification system was used to assess surgical difficulty. After surgery, the Nd group was irradiated by the Nd:YAG laser in very long-pulsed mode (VLP, pulse duration 1 ms, 20 Hz, 4 W, R21-C3) in 6 regions of the extraction socket with a total energy of 300 J. For the medication group, dexamethasone 0.75 mg and loxoprofen 60 mg were prescribed immediately and every 12 h thereafter for 3 days. The Nd+m group received both treatments mentioned above. Pain assessment was performed at 6, 24, 48, and 72 h postoperatively using the visual analog scale (VAS). Swelling was evaluated by changes in the distance from (1) the tragus to the labial commissure, (2) the tragus to the pogonion, and (3) the mandibular angle to the lateral canthus preoperatively and 72 h postoperatively. Trismus was assessed by the change in maximum mouth opening. Groups Nd and Nd+m had lower VAS scores at 6 h, 24 h, and 48 h (F = 13.80, p = 0.00), but the difference between the two groups was not significant (F = 1.34, p = 0.11). However, no significant difference was observed at 72 h (p = 0.10). There was no significant difference in swelling or trismus among the three groups (p > 0.05). NdLT is an effective approach to improve complications after M3 surgery.

Photobiomodulation in dental extraction therapy: Postsurgical pain reduction and wound healing

BACKGROUND

This scoping review and analysis were designed to assess the amount of time spent delivering photobiomodulation (PBM) light therapy after dental extraction to improve postoperative pain and wound healing.

TYPES OF STUDIES REVIEWED

The scoping review was performed according to the Cochrane Collaboration and Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Publications were specific for human randomized controlled clinical trials, PBM after dental extraction therapy, and related clinical outcomes. Online databases searched included PubMed, Embase, Scopus, and Web of Science. Analyses were conducted to analyze the prescribed intervals of time (seconds) per application of PBM.

RESULTS

Of the 632 studies initially identified, 22 studies fulfilled the inclusion criteria. Postoperative pain and PBM were reported in 20 articles for 24 treatment groups, with treatment times ranging from 17 through 900 seconds and wavelengths from 550 through 1,064 nm. Clinical wound healing outcomes were reported in 6 articles for 7 groups with treatment times ranging from 30 through 120 seconds and wavelengths from 660 through 808 nm. PBM therapy was not associated with adverse events.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

There is future potential to integrate PBM after dental extraction therapy to improve postoperative pain and clinical wound healing. The amount of time spent delivering PBM will vary by wavelength and the type of device. Further investigation is needed to translate PBM therapy into human clinical care.

Effect of Peripheral Magnetic Stimulation on Acute and Chronic Pain After Surgery: A Systematic Review and Meta-Analysis

Peripheral magnetic stimulation (PMS) is a potentially promising modality to help manage postoperative pain. We systematically reviewed the effect of PMS on acute and chronic postoperative pain. MEDLINE, Cochrane CENTRAL, EMBASE, ProQuest Dissertations, and clinical trials.gov were searched from inception until May 2021. We included studies of any study design that included patients ≥18 years of age undergoing any type of surgery that administered PMS within the perioperative period and evaluated postoperative pain. Seventeen randomized controlled trials and 1 nonrandomized clinical trial were included into the review. Thirteen out of the 18 studies found a positive effect with PMS on postoperative pain scores. In our meta-analysis, peripheral magnetic stimulation was more efficacious than sham or no intervention within the first 7 postoperative days (mean difference [MD] -1.64 on a 0 to 10 numerical rating score, 95% confidence interval [CI] -2.08 to -1.20, I2 = 77%, 6 studies, 231 patients). This was also true at 1 and 2 months after surgery (MD -1.82, 95% CI -2.48 to -1.17, I2 = 0%, 3 studies, 104 patients; and MD -1.96, 95% CI -3.67 to -.26, I2 = 84%, 3 studies, 104 patients, respectively). A difference was not seen with persistent pain at 6 and 12-months after surgery, acute postoperative opioid consumption, or adverse events between groups. Results are limited by heterogeneity and generally low-quality studies, as well as low or very low quality of evidence. High-quality and adequately blinded trials are needed to definitively confirm the benefits of peripheral magnetic stimulation administered in the perioperative period. PERSPECTIVE: This review evaluates the efficacy and safety of PMS on postoperative pain. The results help elucidate PMS' role in postoperative pain management and identify gaps where more research is required.

Patients' satisfaction with post-operative pain management in Ayder Comprehensive Specialized Hospital, Ethiopia: a cross-sectional study

Introduction

surgical patients often suffer from inadequate treatment of post-operative pain which potentially results in numerous adverse medical consequences and is a recurring source of patients' dissatisfaction. Thus, this study aimed to investigate patient's satisfaction with their post-operative pain management and its determinants among surgically treated patients in a specialized hospital within Ethiopia.

Methods

an institutional-based prospective cross-sectional study was conducted in the surgical ward of Ayder Comprehensive Specialized Hospital. Data were collected using a semi-structured questionnaire, which was an adoption of the 2010 version of the American Pain Society Patient Outcome Questionnaire, and by reviewing the medical charts of the patients. A stepwise linear regression model was used to analyze the data.

Results

among the 144 patients approached in this study, 112 (77.8%) of them categorized their postoperative pain as moderate to severe. The mean patient satisfaction with their pain management was 7±2.3 on 0-10 numerical rating scale. Despite high levels of pain, the majority of patients (90.3%, n=131) were moderately or completely satisfied with their pain management. Stepwise linear regression analysis found that the determinants of patients' satisfaction were prior chronic pain, prior surgical history, and substance use (F (3,140) = 5.364, adjusted R2= 0.084, P=0.02).

Conclusion

the patients were moderately and completely satisfied with their pain management in spite of expressing moderate and severe level of pain intensity. Pain still remains a concern among surgical patients, and effective pain management strategies should be practiced to manage pain and its functional interferences more effectively.

Single-injection serratus anterior plane block for cardiothoracic surgery via thoracotomy in children: a systematic review and meta-analysis of randomised controlled trials

BACKGROUND

Serratus anterior plane block (SAPB) has gained popularity in cardiothoracic surgery due to its feasibility and simplicity. However, the efficacy of ultrasound-guided single-injection SAPB in the paediatric population has not been well evaluated, as only a few studies with small sample sizes are available.

METHODS

We searched PubMed, Embase (Ovid), Cochrane Central Register of Controlled Trials, Wanfang databases and China National Knowledge Infrastructure from their inception to 31 September 2022 for randomised comparative clinical trials that compared single-injection SAPB with systemic analgesia or different forms of regional analgesia in children. The primary outcomes included postoperative opioid consumption and pain scores within 24 hours. The secondary outcomes included postoperative adverse events, the need for rescue analgesia and the time from the end of surgery to endotracheal tube removal.

RESULTS

Five randomised controlled trials with 418 children meeting the inclusion criteria were included. SAPB markedly reduced postoperative opioid consumption up to 24 hours compared with controls (mean difference (MD): -0.29 mg/kg, 95% CI -0.38 to -0.20, I 2 =67%]. The postoperative pain scores were reduced compared with controls: 1 hour (MD -0.6, 95% CI -1.17 to -0.04, I 2 =92%), 4-6 hours (MD -1.16, 95% CI -1.87 to -0.45, I 2 =90%) and 12 hours (MD -0.71, 95% CI -1.35 to -0.08, I 2 =86%). The incidence of postoperative nausea and vomiting was comparable between SAPB and controls. One trial suggested that the analgesic effect of SAPB was comparable to that of ICNB (intercostal nerve block).

CONCLUSION

Single-injection SAPB is associated with a reduction in opioid consumption and pain intensity after cardiothoracic surgery via thoracotomy in children. Due to the high heterogeneity, the Grading of Recommendations Assessment, Development and Evaluation scores were low. Clinical trials with rigorous methodological approaches as well as safety endpoints are needed to confirm these preliminary findings.

PROSPERO REGISTRATION NUMBER

CRD42021241691.

Analgesic effects of combined transversus abdominis plane block and intramuscular electrical stimulation in patients undergoing cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy: a randomized controlled trial

BACKGROUND

To evaluate the analgesic efficacy of a four-quadrant transversus abdominis plane (4QTAP) block and a combination of 4QTAP block with needle electrical twitch and intramuscular electrical stimulation (NETOIMS) in patients undergoing cytoreductive surgery (CRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC).

MATERIALS AND METHODS

Eighty-one patients who underwent CRS followed by HIPEC were included in this study. Patients were randomly assigned to one of three groups: group 1 (intravenous patient-controlled analgesia, control group), group 2 (preoperative 4QTAP block), and group 3 (preoperative 4QTAP block and postoperative NETOIMS). The primary study endpoint was the pain score assessed by the visual analog scale (VAS: 0, no pain; 10, worst imaginable pain) on postoperative day (POD) 1.

RESULTS

The VAS pain score on POD 1 was significantly lower in group 2 than in group 1 (6.0±1.7 and 7.6±1.9, P =0.004), whereas that in group 3 was significantly lower than that in groups 1 and 2 ( P <0.001 and P =0.004, respectively). Opioid consumption and nausea and vomiting incidence during POD 7 were significantly lower in group 3 than in groups 1 and 2. Gait speed and peak cough flow on POD 4 and 7, as well as the quality of recovery (QoR)-40 score on POD 4, were significantly higher in group 3 than in groups 1 and 2.

CONCLUSIONS

The combination of a 4QTAP block with NETOIMS provided more effective analgesia than a 4QTAP block alone after CRS, followed by HIPEC, and enhanced functional restoration and quality of recovery.