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Chaves Junior ADJ, Avelino PS, Lopes JB. Comparison of the Effects of Full Median Sternotomy vs. Mini-Incision on Postoperative Pain in Cardiac Surgery: A Meta-Analysis. Braz J Cardiovasc Surg 2024; 39:e20230154. [PMID: 38748974 PMCID: PMC11095119 DOI: 10.21470/1678-9741-2023-0154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 09/12/2023] [Indexed: 05/19/2024] Open
Abstract
INTRODUCTION It is not yet clear whether cardiac surgery by mini-incision (minimally invasive cardiac surgery [MICS]) is overall less painful than the conventional approach by full sternotomy (FS). A meta-analysis is necessary to investigate polled results on this topic. METHODS PubMed®/MEDLINE, Cochrane CENTRAL, Latin American and Caribbean Health Sciences Literature (or LILACS), and Scientific Electronic Library Online (or SciELO) were searched for all clinical trials, reported until 2022, comparing FS with MICS in coronary artery bypass grafting (CABG), mitral valve surgery (MVS), and aortic valve replacement (AVR), and postoperative pain outcome was analyzed. Main summary measures were the method of standardized mean differences (SMD) with a 95% confidence interval (CI) and P-values (considered statistically significant when < 0.05). RESULTS In AVR, the general estimate of postoperative pain effect favored MICS (SMD 0.87 [95% CI 0.04 to 1.71], P=0.04). However, in the sensitivity analysis, there was no difference between the groups (SMD 0.70 [95% CI -0.69 to 2.09], P=0.32). For MVS, it was not possible to perform a meta-analysis with the included studies, because they had different methodologies. In CABG, the general estimate of the effect of postoperative pain did not favor any of the approaches (SMD -0.40 [95% CI -1.07 to 0.26], P=0.23), which was confirmed by sensitivity analysis (SMD -0.02 [95% CI -0.71 to 0.67], P=0.95). CONCLUSION MICS was not globally less painful than the FS approach. It seems that postoperative pain is more related to the degree of tissue retraction than to the size of the incision.
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Affiliation(s)
| | | | - Jackson Brandão Lopes
- Department of Anesthesiology and Surgery, Faculdade de Medicina da
Bahia, Universidade Federal da Bahia (FMB/UFBA), Salvador, Bahia, Brazil
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Türker Ö, Şanlı D. Surgical Patients' Evaluation of Pain Management Quality and Surgical Nurses' Pain-Related Knowledge and Attitudes. Pain Manag Nurs 2024:S1524-9042(24)00110-3. [PMID: 38600012 DOI: 10.1016/j.pmn.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 03/01/2024] [Accepted: 03/12/2024] [Indexed: 04/12/2024]
Abstract
PURPOSE The present study was aimed at investigating the quality of pain management evaluated by inpatients in surgical clinics, and pain-related knowledge and attitudes of nurses working in surgical clinics, surgical units, or emergency services. METHODS The study was conducted as a descriptive and cross-sectional study. The study data were collected from inpatients in surgical clinics (N = 306), and from nurses working in surgical clinics, surgical units, or emergency services (N = 57) between January 2020 and September 2020. The Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R) and Nurses' Knowledge and Attitudes Survey Regarding Pain (NKASRP) were the tools used for data collection. RESULTS The mean scores the participants obtained from the severity of worst pain, pain relief, and satisfaction with pain treatment components of the APS-POQ-R were 6.14 ± 2.59, 59.28 ± 22.26, and 8.99 ± 1.62, respectively. There were significant differences between many components of the APS-POQ-R in terms of such variables as age, sex, undergoing previous surgery, presence of pain before surgery, surgery performed, and type of anesthesia (p < .05). The mean score the participants obtained from the NKASRP was 15.35 ± 3.87. CONCLUSIONS It was concluded that the patients' pain was relieved moderately, that they were very highly satisfied with pain treatment, and that the nurses' pain-related knowledge and attitude levels were below the moderate level. CLINICAL IMPLICATIONS Nurses should support patients whose in-bed activities were prevented due to pain, involve them in pain treatment decisions, advise them about pain treatment options, and encourage them to use nonpharmacological methods.
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Affiliation(s)
- Özge Türker
- Izmir Alsancak Nevvar Salih Isgoren State Hospital, Konak, Izmir, Türkiye
| | - Deniz Şanlı
- Izmir Katip Celebi University, Faculty of Health Sciences, Nursing Department, Department of Surgical Nursing, Izmir, Türkiye.
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Topan C, Karakaya M, Demirbaş AE, Bilge S, Canpolat DG. PREEMPTIVE INTRAVENOUS IBUPROFEN AND LOCAL KETAMINE IMPROVE POSTOPERATIVE ANALGESIA FOLLOWING THIRD MOLAR SURGERY: A DOUBLE-BLIND, RANDOMIZED, PLACEBO-CONTROLLED CLINICAL STUDY. J Evid Based Dent Pract 2024; 24:101957. [PMID: 38448122 DOI: 10.1016/j.jebdp.2023.101957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/11/2023] [Accepted: 12/18/2023] [Indexed: 03/08/2024]
Abstract
OBJECTIVE To compare the efficacy of preemptive ibuprofen, local ketamine, and their combination in managing postoperative pain and trismus following third molar surgery. MATERIALS AND METHODS One hundred patients were randomly divided into 4 groups. The Intrafen Group had their impacted third molars surgically removed under local anesthesia after receiving intravenous (IV) ibuprofen for preemptive effect. The Ketamine Group received an IV placebo before the surgery, and the extraction process was completed with a local anesthetic-ketamine combination. The Combined Group received preemptive IV ibuprofen before the procedure, and the surgery was performed with a local anesthetic-ketamine combination. The Control Group received an IV placebo before the procedure and then had their impacted third molars removed under local anesthesia. The Visual Analogue Scale (VAS) values, corresponding to the patients' pain levels at the 2nd and 12th postoperative hours and the total amount of analgesic dose used in the first 24 hours, were recorded, and evaluated. The maximum mouth opening of the patients was measured immediately before the procedure, and on the second and seventh postoperative days. The level of patient satisfaction in all groups was assessed during the procedure. RESULTS The mean VAS value corresponding to the second-hour pain level of the combined group was statistically significantly lower than the other groups (P = .003). A statistically significant difference was found in the mean VAS values corresponding to the pain levels of the groups, favoring the combined group compared to the other groups (P ≤ .001). A significant difference was observed between the VAS difference values corresponding to the pain levels of the Intrafen group and the Ketamine group, favoring the Intrafen group (P = .038). The Ketamine group consumed the most analgesic on average over the first 24 hours, whereas the Combined group consumed the least. No statistically significant difference was found between the mean trismus levels of the groups on days 0-2 (P = .528) and days 0-7 (P = .129). The intraoperative patient satisfaction level of the combined group was significantly higher than that of the other groups (P = .030). CONCLUSION Preemptive Intrafen is an effective regimen for postoperative pain management and is superior to the local anesthetic-ketamine regimen. The most effective method to reduce postoperative pain following third molar surgery is to use a combination of these 2 regimens. However, none of the treatment methods used in the study had a positive effect on postoperative trismus.
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Affiliation(s)
- Cihan Topan
- Department of Oral and Maxillofacial Surgery, Erciyes University Faculty of Dentistry, Kayseri, Turkey.
| | - Mustafa Karakaya
- Department of Oral and Maxillofacial Surgery, Erciyes University Faculty of Dentistry, Kayseri, Turkey
| | - Ahmet Emin Demirbaş
- Department of Oral and Maxillofacial Surgery, Erciyes University Faculty of Dentistry, Kayseri, Turkey
| | - Suheyb Bilge
- Department of Oral and Maxillofacial Surgery, Erciyes University Faculty of Dentistry, Kayseri, Turkey
| | - Dilek Günay Canpolat
- Department of Oral and Maxillofacial Surgery, Erciyes University Faculty of Dentistry, Kayseri, Turkey
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Xu W, Xia G, Dong L, Zhu Y. Effect of lidocaine on postoperative analgesia of endoscopic rubber band ligation combined with injection sclerotherapy for treatment of internal hemorrhoids: A retrospective study (with video). Arab J Gastroenterol 2024:S1687-1979(24)00007-8. [PMID: 38403495 DOI: 10.1016/j.ajg.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 10/28/2023] [Accepted: 01/06/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND AND STUDY AIMS Endoscopic minimally invasive treatment of internal hemorrhoids may cause postoperative pain. The aim of the study is to investigate the analgesic effect of lidocaine plus lauromacrogol on postoperative pain caused by endoscopic rubber band ligation (ERBL) combined with injection sclerotherapy (IS) for internal hemorrhoids treatment. PATIENTS AND METHODS Clinical data of grade Ⅲ internal hemorrhoids patients who underwent ERBL combined with IS in department of Digestive Medicine, Shenzhen Hospital of Southern Medical University, were retrospectively analyzed. According to difference in the composition of sclerosing solution, the patients were divided into control group (lauromacrogol group, 46 patients) and study group (lidocaine plus lauromacrogol group, 20 patients). Postoperative pain (quantized by Visual Analogue Scale, VAS), pain relief time and postoperative adverse reactions were compared. The therapeutic effect was followed up 1 month after operation. RESULTS VAS of postoperative pain was 0.80 ± 0.42 points and pain relief time was 0.90 ± 0.56 days in the study group, while VAS of postoperative pain was 4.11 ± 1.37 points and pain relief time was 2.57 ± 0.83 days in the control group, there was statistical difference between them (P < 0.05). There was no significant difference in the incidence of postoperative adverse reactions and follow-up therapeutic effect between the control group and the study group. CONCLUSION Lidocaine plus lauromacrogol is useful for pain alleviation on ERBL combined with IS for internal hemorrhoids treatment because of its convenient procedure, low adverse reaction incidence and good therapeutic effect, which is worthy of promotion.
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Affiliation(s)
- Wen Xu
- Department of Gastroenterology, Shenzhen Hospital of Southern Medical University, Shenzhen 518000, Guangdong, China
| | - Guili Xia
- Department of Gastroenterology, Shenzhen Hospital of Southern Medical University, Shenzhen 518000, Guangdong, China
| | - Ling Dong
- Department of Gastroenterology, Shenzhen Hospital of Southern Medical University, Shenzhen 518000, Guangdong, China
| | - Ying Zhu
- Department of Gastroenterology, Shenzhen Hospital of Southern Medical University, Shenzhen 518000, Guangdong, China.
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Ilfeld BM, Finneran JJ, Alexander B, Abramson WB, Sztain JF, Ball ST, Gonzales FB, Abdullah B, Cha BJ, Said ET. Percutaneous auricular neuromodulation (nerve stimulation) for the treatment of pain following total knee arthroplasty: a randomized, double-masked, sham-controlled pilot study. Reg Anesth Pain Med 2024:rapm-2023-105028. [PMID: 38388019 DOI: 10.1136/rapm-2023-105028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/08/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND Percutaneous auricular nerve stimulation (neuromodulation) is an analgesic technique involving the percutaneous implantation of multiple leads at various points on/around the ear followed by the delivery of electric current using an external pulse generator. A device is currently available within the USA cleared to treat symptoms from opioid withdrawal, and multiple reports suggest a possible postoperative analgesic effect. The current randomized, controlled pilot study was undertaken to (1) determine the feasibility and optimize the protocol for a subsequent definitive clinical trial and (2) estimate the treatment effect of auricular neuromodulation on postoperative pain and opioid consumption following total knee arthroplasty. METHODS Within the recovery room following primary, unilateral, total knee arthroplasty, an auricular neuromodulation device (NSS-2 Bridge, Masimo, Irvine, California, USA) was applied using three percutaneous leads and one ground electrode. Participants were randomized to 5 days of either electrical stimulation or sham stimulation in a double-masked fashion. Participants were discharged with the stimulator in situ and removed the disposable devices at home. The dual primary treatment effect outcome measures were the cumulative opioid use (oral oxycodone) and the mean of the "average" daily pain measured with the Numeric Rating Scale for the first 5 postoperative days. RESULTS During the first five postoperative days, oxycodone consumption in participants given active stimulation (n=15) was a median (IQR) of 4 mg (2-12) vs 13 mg (5-23) in patients given sham (n=15) treatment (p=0.039). During this same period, the average pain intensity in patients given active stimulation was a median (IQR) of 2.5 (1.5-3.3) vs 4.0 (3.6-4.8) in those given sham (p=0.014). Awakenings due to pain over all eight postoperative nights in participants given active stimulation was a median (IQR) of 5 (3-8) vs 11 (4-14) in those given sham (p<0.001). No device-related localized cutaneous irritation, systemic side effects, or other adverse events were identified. CONCLUSIONS Percutaneous auricular neuromodulation reduced pain scores and opioid requirements during the initial week after total knee arthroplasty. Given the ease of application as well as the lack of systemic side effects and reported complications, a definitive clinical trial appears warranted. TRIAL REGISTRATION NUMBER NCT05521516.
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Affiliation(s)
- Brian M Ilfeld
- Department of Anesthesiology, University of California San Diego, La Jolla, California, USA
- Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA
| | - John J Finneran
- Department of Anesthesiology, University of California San Diego, La Jolla, California, USA
- Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA
| | - Brenton Alexander
- Department of Anesthesiology, University of California San Diego, La Jolla, California, USA
| | - Wendy B Abramson
- Department of Anesthesiology, University of California San Diego, La Jolla, California, USA
| | - Jacklynn F Sztain
- Department of Anesthesiology, University of California San Diego, La Jolla, California, USA
| | - Scott T Ball
- Department of Orthopedic Surgery, University California San Diego, San Diego, California, USA
| | - Francis B Gonzales
- Department of Orthopedic Surgery, University California San Diego, San Diego, California, USA
| | - Baharin Abdullah
- Department of Anesthesiology, University of California San Diego, La Jolla, California, USA
| | - Brannon J Cha
- Department of Anesthesiology, University of California San Diego, La Jolla, California, USA
| | - Engy T Said
- Department of Anesthesiology, University of California San Diego, La Jolla, California, USA
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Mahyar L, Missair A, Buys MJ, Kou A, Benedetti de Marrero E, Sandbrink F, Matadial CM, Mariano ER. National review of acute pain service utilization, models of care, and clinical practices within the Veterans Health Administration. Reg Anesth Pain Med 2024; 49:117-121. [PMID: 37286296 DOI: 10.1136/rapm-2023-104610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 05/30/2023] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The Veterans Health Administration (VHA) is the largest healthcare network in the USA and has been a national leader in opioid safety for acute pain management. However, detailed information on the availability and characteristics of acute pain services within its facilities is lacking. We designed this project to assess the current state of acute pain services within the VHA. METHODS A 50-question electronic survey developed by the VHA national acute pain medicine committee was emailed to anesthesiology service chiefs at 140 VHA surgical facilities within the USA. Data collected were analyzed by facility complexity level and service characteristics. RESULTS Of the 140 VHA surgical facilities contacted, 84 (60%) completed the survey. Thirty-nine (46%) responding facilities had an acute pain service. The presence of an acute pain service was associated with higher facility complexity level designation. The most common staffing model was 2.0 full-time equivalents, which typically included at least one physician. Services performed most by formal acute pain programs included peripheral nerve catheters, inpatient consult services, and ward ketamine infusions. CONCLUSIONS Despite widespread efforts to promote opioid safety and improve pain management, the availability of dedicated acute pain services within the VHA is not universal. Higher complexity programs are more likely to have acute pain services, which may reflect differential resource distribution, but the barriers to implementation have not yet been fully explored.
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Affiliation(s)
- Lauren Mahyar
- Anesthesiology Service, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
| | - Andres Missair
- Anesthesiology Service, Bruce W Carter Department of Veterans Affairs Medical Center, Miami, Florida, USA
| | - Michael J Buys
- Anesthesiology Service, Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah, USA
| | - Alex Kou
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
- Anesthesiology, Perioperative and Pain Medicine Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | | | - Friedhelm Sandbrink
- Washington DC Veterans Affairs Medical Center, Washington, District of Columbia, USA
| | - Christina M Matadial
- Anesthesiology Service, Bruce W Carter Department of Veterans Affairs Medical Center, Miami, Florida, USA
| | - Edward R Mariano
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
- Anesthesiology, Perioperative and Pain Medicine Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
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Rashidi M, Mahmoodi K, Akhondzadeh R, Baghbanian R, Jahangiri Mehr F, Safaei Semnani N. Comparison of Dexmedetomidine and Ketamine in Serratus Anterior Plane Block for Postoperative Pain Control in Thoracotomy Patients: A Randomized Clinical Trial. Anesth Pain Med 2024; 14:e137664. [PMID: 38725920 PMCID: PMC11078229 DOI: 10.5812/aapm-137664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 01/10/2024] [Accepted: 01/31/2024] [Indexed: 05/12/2024] Open
Abstract
Background Postoperative pain control after thoracotomy is very important, and if not controlled, it can cause severe complications. Objectives This study aimed to compare dexmedetomidine and ketamine in serratus anterior plane block (SAPB) in pain control after thoracotomy. Methods This randomized clinical trial was conducted on 74 patients aged 18 to 60 years old with American Society of Anesthesiologists (ASA) class I or II who were referred to Imam Khomeini hospital in Ahvaz, Iran, for thoracotomy and randomly divided into two groups. After surgery, the SAPB with ultrasound-guided was performed. In the ropivacaine-ketamine (RK) group, ketamine 0.5 mg/kg and 0.4 cc/kg ropivacaine solution 0.25% and in the ropivacaine-dexmedetomidine (RD) group, in addition to 0.4 cc/kg ropivacaine 0.25%, dexmedetomidine 0.5 µg/kg was added. Verbal Numeric Scale (VNS), systolic blood pressure (SBP), diastolic blood pressure (DBP), respiratory rate (RR), heart rate (HR), and mean arterial blood pressure (MAP) were recorded. Results There was no significant difference in both groups in terms of demographic information (P < 0.05). The average VNS was lower in the ketamine group than in the dexmedetomidine group; however, there was a significant difference only at 1, 12, and 24 hours after surgery (P < 0.05). There was no statistically significant difference between the two groups in terms of SBP and DBP, HR, and MAP. There was a significant difference in the RR in the two groups at 12 and 24 hours after the operation (P < 0.05). Conclusions Dexmedetomidine and ketamine, which were used as supplements to ropivacaine for SAPB in patients undergoing elective thoracotomy, reduced the pain intensity after thoracotomy; nevertheless, the intensity of pain reduction was more and more effective in the group receiving ketamine.
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Affiliation(s)
- Mahbobeh Rashidi
- Department of Anesthesiology and Pain Medicine, Pain Research Center, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Kamran Mahmoodi
- Department of Anesthesiology and Pain Medicine, Pain Research Center, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Reza Akhondzadeh
- Department of Anesthesiology and Pain Medicine, Pain Research Center, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Reza Baghbanian
- Department of Anesthesiology and Pain Medicine, Pain Research Center, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fatemeh Jahangiri Mehr
- Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Niloofar Safaei Semnani
- Department of Anesthesiology and Pain Medicine, Pain Research Center, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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van den Broek RJC, Postema JMC, Koopman JSHA, van Rossem CC, Olsthoorn JR, van Brakel TJ, Houterman S, Bouwman RA, Versyck B. Continuous erector spinae plane block versus thoracic epidural analgesia in video-assisted thoracoscopic surgery: a prospective randomized open-label non-inferiority trial. Reg Anesth Pain Med 2024:rapm-2023-105047. [PMID: 38212049 DOI: 10.1136/rapm-2023-105047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/22/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND AND OBJECTIVES The evolving surgical techniques in thoracoscopic surgery necessitate the exploration of anesthesiological techniques. This study aimed to investigate whether incorporating a continuous erector spinae plane (ESP) block into a multimodal analgesia regimen is non-inferior to continuous thoracic epidural analgesia (TEA) in terms of quality of postoperative recovery for patients undergoing elective unilateral video-assisted thoracoscopic surgery. METHODS We conducted a multicenter, prospective, randomized, open-label non-inferiority trial between July 2020 and December 2022. Ninety patients were randomly assigned to receive either continuous ESP block or TEA. The primary outcome parameter was the Quality of Recovery-15 (QoR-15) score, measured before surgery as a baseline and on postoperative days 0, 1, and 2. Secondary outcome parameters included pain scores, length of hospital stay, morphine consumption, nausea and vomiting, itching, speed of mobilization, and urinary catheterization. RESULTS Analysis of the primary outcome showed a mean QoR-15 difference between the groups ESP block versus TEA of 1 (95% CI -9 to -12, p=0.79) on day 0, -1 (95% CI -11 to -8, p=0.81) on day 1 and -2 (95% CI -14 to -11, p=0.79) on day 2. CONCLUSIONS The continuous ESP block is non-inferior to TEA in video-assisted thoracoscopic surgery. TRIAL REGISTRATION NUMBER Dutch Trial Register (NL6433).
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Affiliation(s)
- Renee J C van den Broek
- Department of Anesthesiology and Pain medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - Jonne M C Postema
- Department of Anesthesiology and Pain Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | - Joseph S H A Koopman
- Department of Anesthesiology and Pain Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | | | - Jules R Olsthoorn
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Thomas J van Brakel
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Saskia Houterman
- Department of Education and Research, Catharina Hospital, Eindhoven, The Netherlands
| | - R Arthur Bouwman
- Department of Anesthesiology and Pain medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - Barbara Versyck
- Department of Anaesthesiology and Pain Medicine, General Hospital Turnhout Campus Saint Elisabeth, Turnhout, Belgium
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Ilyas AM, Sundaram P, Plusch K, Kasper A, Jones CM. Multimodal Pain Management After Outpatient Orthopedic Hand Surgery: A Prospective Randomized Trial. J Hand Surg Glob Online 2024; 6:16-20. [PMID: 38313605 PMCID: PMC10837162 DOI: 10.1016/j.jhsg.2023.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 07/29/2023] [Indexed: 02/06/2024] Open
Abstract
Purpose Opioid stewardship ensures effective pain management while avoiding overprescribing of opioids after surgery. This prospective randomized study investigates the efficacy of a multimodal postoperative pain regimen compared to a traditional opioid-only pain regimen following elective outpatient orthopedic hand surgery. We hypothesized that patients receiving multimodal pain management would consume fewer opioids and report greater satisfaction than patients receiving only opioids. Methods Consecutive patients undergoing outpatient hand and upper extremity surgery performed by two board-certified fellowship-trained orthopedic hand surgeons at one institution were recruited and randomized into either a study or control group. The study group received a standing multimodal postoperative regimen consisting of scheduled oral acetaminophen and naproxen as well as oxycodone to be taken as needed. The control group received only oxycodone to be taken as needed. Postoperatively, daily pain levels, medication usage, refills, satisfaction, and adverse events were recorded. Descriptive statistics were performed. Results Of the 112 patients enrolled, 54 were randomized to the control group, and 58 were randomized to the study group. Study and control group patients did not differ significantly based on daily average pain scores or daily worst pain scores. However, study group patients reported fewer average daily oxycodone intake and total oxycodone pill count (7.0 vs 2.4 total pills, P <.005). In addition, the study group patients were more likely to report satisfaction with their postoperative pain control than control regimen patient's and were more likely to use the same pain regimen again if required. Conclusion A multimodal postoperative pain regimen reduces opioid usage and has higher patient satisfaction rates in comparison to traditional opioid-only regimens. Use of multimodal pain regimens that use nonopioids, such as acetaminophen and naproxen, over an opioid should be considered for postoperative pain after orthopedic hand surgery. Level of Evidence Therapeutic II.
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Affiliation(s)
- Asif M Ilyas
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA USA
| | - Padmaja Sundaram
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA USA
| | - Kyle Plusch
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA USA
| | - Alexis Kasper
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA USA
| | - Christopher M Jones
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA USA
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Suarez-Roca H, Mamoun N, Watkins LL, Bortsov AV, Mathew JP. Higher Cardiovagal Baroreflex Sensitivity Predicts Increased Pain Outcomes After Cardiothoracic Surgery. J Pain 2024; 25:187-201. [PMID: 37567546 PMCID: PMC10841280 DOI: 10.1016/j.jpain.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/05/2023] [Accepted: 08/06/2023] [Indexed: 08/13/2023]
Abstract
Excessive postoperative pain can lead to extended hospitalization and increased expenses, but factors that predict its severity are still unclear. Baroreceptor function could influence postoperative pain by modulating nociceptive processing and vagal-mediated anti-inflammatory reflexes. To investigate this relationship, we conducted a study with 55 patients undergoing minimally invasive cardiothoracic surgery to evaluate whether cardiovagal baroreflex sensitivity (BRS) can predict postoperative pain. We assessed the spontaneous cardiovagal BRS under resting pain-free conditions before surgery. We estimated postoperative pain outcomes with the Pain, Enjoyment, and General Activity scale and pressure pain thresholds on the first (POD1) and second (POD2) postoperative days and persistent pain 3 and 6 months after hospital discharge. We also measured circulating levels of relevant inflammatory biomarkers (C-reactive protein, albumin, cytokines) at baseline, POD1, and POD2 to assess the contribution of inflammation to the relationship between BRS and postoperative pain. Our mixed-effects model analysis showed a significant main effect of preoperative BRS on postoperative pain (P = .013). Linear regression analysis revealed a significant positive association between preoperative BRS and postoperative pain on POD2, even after adjusting for demographic, surgical, analgesic treatment, and psychological factors. Moreover, preoperative BRS was linked to pain interfering with general activity and enjoyment but not with other pain parameters (pain intensity and pressure pain thresholds). Preoperative BRS had modest associations with postoperative C-reactive protein and IL-10 levels, but they did not mediate its relationship with postoperative pain. These findings indicate that preoperative BRS can independently predict postoperative pain, which could serve as a modifiable criterion for optimizing postoperative pain management. PERSPECTIVE: This article shows that preoperative BRS predicts postoperative pain outcomes independently of the inflammatory response and pain sensitivity to noxious pressure stimulation. These results provide valuable insights into the role of baroreceptors in pain and suggest a helpful tool for improving postoperative pain management.
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Affiliation(s)
- Heberto Suarez-Roca
- Center for Translational Pain Medicine, Duke University Medical Center, Durham, North Carolina
| | - Negmeldeen Mamoun
- Division of Cardiothoracic Anesthesia and Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Lana L Watkins
- Psychiatry and Behavioral Sciences Department, Duke University Medical Center, Durham, North Carolina
| | - Andrey V Bortsov
- Center for Translational Pain Medicine, Duke University Medical Center, Durham, North Carolina
| | - Joseph P Mathew
- Division of Cardiothoracic Anesthesia and Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
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Demirci S, Kara D, Yıldız Tİ, Eraslan L, Uysal Ö, Sevinç C, Ulusoy B, Gazeloğlu AO, Turgut E, Huri G, Turhan E, Düzgün İ. Effects of Different Frequencies of Physical Therapy Visits on Shoulder Function After Arthroscopic Rotator Cuff Repair. Phys Ther 2023; 103:pzad066. [PMID: 37341580 DOI: 10.1093/ptj/pzad066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/15/2023] [Accepted: 02/24/2023] [Indexed: 06/22/2023]
Abstract
OBJECTIVE There is no consensus about the optimal frequency of patient visits during the rehabilitation program after arthroscopic rotator cuff repair (ARCR). This study aimed to investigate the short- and long-term effects of high-frequency (HF) and low-frequency (LF) visits of the patients in the first 12 weeks of rehabilitation after ARCR. METHODS This was a quasi-randomized study with 2 parallel groups. Forty-seven patients with ARCR were included in 2 different patient visit frequency protocols (HF = 23, LF = 24) in 12 weeks of postoperative rehabilitation. Patients in the HF group visited the clinic twice a week, whereas patients in the LF group visited once every 2 weeks for the first 6 weeks and once a week for the following 6 weeks. Both groups performed the same exercise protocol. Outcome measurements were pain and range of motion measured at baseline; at the 3rd, 5th, 8th, 12th, and 24th weeks; and at 1-year follow-up. Shoulder function was assessed at the 12th and 24th weeks and at 1-year follow-up with an American Shoulder and Elbow Surgeons score. RESULTS There was a significant group × time interaction in pain intensity during the activity between the groups. The activity pain intensity was higher in the LF group (4.2 points) at 8 weeks post surgery than in the HF group (2.7 points) (mean difference: 1.5 points, P < .05), whereas it was similar in both groups at other time periods. The interaction term was not significant between the groups for pain intensity during rest and night through the 1-year follow-up. No group × time interactions were observed in shoulder range of motion and American Shoulder and Elbow Surgeons score over the postoperative period. CONCLUSION Both rehabilitation programs at different visit frequencies after ARCR showed similar clinical results in the long term. A supervised, controlled rehabilitation program with LF visits in the first 12 weeks after surgery can be sufficient to achieve optimal clinical results and reduce rehabilitation-related costs after ARCR. IMPACT This study highlights that LF treatment protocols under the supervision of the therapist can be adopted after the arthroscopic rotator cuff repair to achieve successful results while decreasing the treatment costs. Physical therapists should plan the treatment sessions efficiently for the compliance of the patients to the exercise treatment. LAY SUMMARY If you are a patient with arthroscopic rotator cuff repair, a supervised, controlled rehabilitation program with low-frequency visits in the first 12 weeks after surgery could help you achieve the best outcome and help lower the costs of rehabilitation. A total of 3 visits in the first 6 weeks might be sufficient (once every 2 weeks). More frequent visits (1-2 visits a week) should happen 6 to 12 weeks after the surgery.
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Affiliation(s)
- Serdar Demirci
- Balıkesir University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Balıkesir, Turkey
| | - Dilara Kara
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Department of Physiotherapy and Rehabilitation in Sports, Ankara, Turkey
| | - Taha İbrahim Yıldız
- Afyonkarahisar University of Health Sciences, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Afyonkarahisar, Turkey
| | - Leyla Eraslan
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Department of Physiotherapy and Rehabilitation in Sports, Ankara, Turkey
| | - Özgün Uysal
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Department of Physiotherapy and Rehabilitation in Sports, Ankara, Turkey
| | - Ceyda Sevinç
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Department of Physiotherapy and Rehabilitation in Sports, Ankara, Turkey
| | - Burak Ulusoy
- Cankiri Karatekin University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Çankırı, Turkey
| | - Ali Okan Gazeloğlu
- Hacettepe University, Faculty of Medicine, Department of Orthopedics and Traumatology, Ankara, Turkey
| | - Elif Turgut
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Department of Physiotherapy and Rehabilitation in Sports, Ankara, Turkey
| | - Gazi Huri
- Hacettepe University, Faculty of Medicine, Department of Orthopedics and Traumatology, Ankara, Turkey
| | - Egemen Turhan
- Hacettepe University, Faculty of Medicine, Department of Orthopedics and Traumatology, Ankara, Turkey
| | - İrem Düzgün
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Department of Physiotherapy and Rehabilitation in Sports, Ankara, Turkey
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Jamil A, Hameed HA, Sidiqqui AH, Farrukh MS. Comparison of complete nasal packing with and without integrated airways. Pak J Med Sci 2023; 39:1317-1320. [PMID: 37680792 PMCID: PMC10480746 DOI: 10.12669/pjms.39.5.7478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 06/01/2023] [Accepted: 06/06/2023] [Indexed: 09/09/2023] Open
Abstract
Objective To compare the effects of nasal packing using a Nasopore nasal packing with and without an airway tube on postoperative pain, SpO2, nasal obstruction, and difficulty in breathing complaints. Methods This comparative study was conducted at Dow University of Health Sciences (DUHS), DMC Civil Hospital Karachi between September 18, 2021, to May 19, 2022. A total of 70 patients who underwent septoplasty for septal deviation and chronic hypertrophic rhinitis were equally divided into two groups. Group-A patients received nasal packing using a Nasopore nasal packing with an airway tube, and Group-B patients received nasal packing using a Nasopore nasal packing without an airway tube. Post-operation Nasal pain sensations were measured using the Wong-Baker Faces Pain Rating Scale at 2 and 12 hours. SpO2 was measured at 30 minutes pre-operatively with an O2 saturation monitor and 12 hours post-operatively during sleep. Results The postoperative pain at two hours and 12 hours was compared between the two groups, and a significant difference was observed. In Group-A, the average SpO2 decreased > 4% from baseline in 5.7% patients, and 37% in Group-B. A significant difference was observed in the severity of nasal obstruction and difficulty breathing, P-value < 0.05. Conclusion It is concluded that septoplasty followed by applying nasal packing with integrated airway reduces postoperative pain and improves oxygen saturation compared to nasal packing without integrated airways.
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Affiliation(s)
- Afifa Jamil
- Afifa Jamil, MBBS. ENT Unit-1, Dr Ruth K.M. PFAU, Civil Hospital, DUHS, Karachi, Pakistan
| | - Hira Abdul Hameed
- Hira Abdul Hameed, DLO, RMO. ENT Unit-1, Dr Ruth K.M. PFAU, Civil Hospital, DUHS, Karachi, Pakistan
| | - Atif Hafeez Sidiqqui
- Atif Hafeez Sidiqqui, FCPS. ENT Unit-1, Dr Ruth K.M. PFAU, Civil Hospital, DUHS, Karachi, Pakistan
| | - M. Shuja Farrukh
- M. Shuja Farrukh, FCPS. ENT Unit-1, Dr Ruth K.M. PFAU, Civil Hospital, DUHS, Karachi, Pakistan
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Bilge A, Başaran B, Altıparmak B, Et T, Korkusuz M, Yarımoğlu R. Comparing ultrasound-guided modified thoracoabdominal nerves block through perichondrial approach with oblique subcostal transversus abdominis plane block for patients undergoing laparoscopic cholecystectomy: a randomized, controlled trial. BMC Anesthesiol 2023; 23:139. [PMID: 37106319 PMCID: PMC10134575 DOI: 10.1186/s12871-023-02106-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 04/23/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Laparoscopic cholecystectomy(LC) causes significant postoperative pain. Oblique subcostal transversus abdominis plane(OSTAP) block was described for postoperative analgesia, especially for upper abdominal surgeries. Modified thoracoabdominal nerves block through perichondrial approach(M-TAPA) block is a new technique defined by the modification of the thoracoabdominal nerves through perichondrial approach (TAPA) block, in which local anesthetics are delivered only to the underside of the perichondral surface. The primary aim of this study was to evaluate the effect of M-TAPA and OSTAP blocks as part of multimodal analgesia on postoperative opioid consumption in patients undergoing LC. METHOD The present study was designed as a randomized, controlled, prospective study. Seventy-six adult patients undergoing LC were randomly assigned to receive either bilaterally M-TAPA or OSTAP block after the induction of anesthesia and before surgery using bupivacaine 0.25%, 25 ml. The primary outcome was assessed as postoperative 24 h opioid consumption, between groups were compared. Secondary outcomes were Numerical Rational scale(NRS) scores, time to first opioid analgesia, patient recovery, using the Quality of Recovery-15 (QoR-15) scale, nausea and vomiting, sedation score, metoclopramide consumption, and evaluating the analgesic range of dermatome. RESULTS The mean tramadol consumption at the postoperative 24th hour was higher in the group OSTAP than in group M-TAPA (P = 0.047). NRS movement score at 12th hour was statistically significantly lower in group M-TAPA than in group OSTAP (P = 0.044). Dermatomes showed intense sensory analgesia between T7-11 in both groups, and it was determined that there was proportionally more involvement in the group M-TAPA. There were no differences between the groups in terms of other results. CONCLUSIONS After the LC surgery, ultrasound-guided M-TAPA block effectively reduced opioid consumption, postoperative pain, and QoR-15 scores similar to OSTAP block. CLINICAL TRIAL REGISTRATION The study was registered prospectively at clinicaltrials.gov (trial ID: NCT05108129 on 4/11/2021).
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Affiliation(s)
- Ayşegül Bilge
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Karamanoğlu Mehmetbey University, Üniversite Mh. Şehit Ömer Halis Demir Caddesi Blok No:7, Karaman, Turkey.
| | - Betül Başaran
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Karamanoğlu Mehmetbey University, Üniversite Mh. Şehit Ömer Halis Demir Caddesi Blok No:7, Karaman, Turkey
| | - Başak Altıparmak
- Department of Anesthesiology and Reanimation, Muğla Sıtkı Koçman University, Menteşe Muğla, Turkey
| | - Tayfun Et
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Karamanoğlu Mehmetbey University, Üniversite Mh. Şehit Ömer Halis Demir Caddesi Blok No:7, Karaman, Turkey
| | - Muhammet Korkusuz
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Karamanoğlu Mehmetbey University, Üniversite Mh. Şehit Ömer Halis Demir Caddesi Blok No:7, Karaman, Turkey
| | - Rafet Yarımoğlu
- Department of Anesthesiology and Reanimation, Karaman Training and Research Hospital, Karaman, Turkey
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Li Y, Wulamu W, Yushan N, Guo X, Gu W, Cao L, Zhang X. Effects of Adding Morphine to Periarticular Infiltration Analgesia Combined with Single Dose Epidural Morphine in Total Knee Arthroplasty: A Randomized Controlled Study. Orthop Surg 2023; 15:1021-1027. [PMID: 36793155 PMCID: PMC10102286 DOI: 10.1111/os.13637] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 11/18/2022] [Accepted: 11/26/2022] [Indexed: 02/17/2023] Open
Abstract
OBJECTIVE Morphine plays an important role in postoperative analgesia after total knee arthroplasty (TKA). However, there are limited data that investigate the administration ways of morphine. To evaluate the efficacy and safety of adding morphine to periarticular infiltration analgesia (PIA) combined with single-dose epidural morphine for the patients undergoing TKA. METHODS In total, 120 patients with knee osteoarthritis who underwent the primary TKA from April 2021 and March 2022 were randomized into three groups (a cocktail containing morphine with single-dose epidural morphine [Group A]; a cocktail containing morphine [Group B]; and a cocktail free of morphine [Group C]). The three groups were compared based on the Visual Analog Score at rest and during motion, requirement of tramadol, functional recovery including quadriceps strength and range of motion, and adverse events including nausea and vomiting and local and systemic adverse events. The repetitive measure analysis of variance and chi-square test among three groups were used to analyze the results. RESULTS Analgesia strategy in Group A (0.4 ± 0.8, and 0.9 ± 1.0 points, respectively) significantly reduced rest pain at 6 and 12 h after surgery relative to Group B (1.6 ± 1.2, and 2.2 ± 1.4 points, respectively) (p < 0.001), and the analgesic effect of Group B was stronger than that of Group C (2.1 ± 0.9, and 2.6 ± 0.9 points, respectively) (p < 0.05). Rest pain at 24 h after surgery was significantly lower in Group A (2.5 ± 0.8 points) and B (1.9 ± 1.0 points) than in Group C (2.5 ± 0.8) (p < 0.05). Within 24 h after surgery, the requirements for tramadol in Group A (0.25 g) and Group B (0.35 g) were significantly lower than those in Group C (0.75 g) (p < 0.05). Within 4 days of surgery, the quadriceps strength in the three groups increased gradually, and no statistical significance was noted among the three groups (p > 0.05). From the second day to the fourth day after surgery, although the three groups showed no statistical difference in the range of motion, the result of Group C was inferior to that of the other two groups. There were no significant differences in the incidence of postoperative nausea and vomiting and metoclopramide consumption among the three groups (p > 0.05). CONCLUSION PIA combined with single-dose epidural morphine effectively reduces early postoperative pain and tramadol requirement as well as few complications, which can become a safe and effective measure to improve postoperative pain after TKA.
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Affiliation(s)
- Yicheng Li
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
| | - Wuhuzi Wulamu
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
| | - Nuerailijiang Yushan
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
| | - Xiaobin Guo
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
| | - Wenchao Gu
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
| | - Li Cao
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
| | - Xiaogang Zhang
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
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Heffernan JM, McLaren AC, Glass CM, Overstreet DJ. Extended Release of Bupivacaine from Temperature-responsive Hydrogels Provides Multi-day Analgesia for Postoperative Pain. Pain Med 2023; 24:113-121. [PMID: 35944219 DOI: 10.1093/pm/pnac119] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 07/29/2022] [Accepted: 08/01/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE A local anesthetic that provides analgesia lasting at least three days could significantly improve postoperative pain management. This study evaluated the analgesic efficacy and safety of an extended-release formulation of bupivacaine based on the injectable hydrogel carrier poly(N-isopropylacrylamide-co-dimethylbutyrolactone acrylamide-co-Jeffamine M-1000 acrylamide) (PNDJ). METHODS The efficacy of PNDJ containing 4% bupivacaine (SBG004) given by peri-incisional subcutaneous injection (SBG004 SC) or wound filling instillation (SBG004 WF) was evaluated compared to saline, liposomal bupivacaine, bupivacaine collagen sponge, bupivacaine-meloxicam polyorthoester, and bupivacaine HCl in a porcine skin and muscle incision model. Mechanical allodynia was assessed by withdrawal from application of von Frey filaments, and local tolerance was evaluated by histology. Bupivacaine pharmacokinetics for SBG004 SC were measured in rabbits (16.5 mg bupivacaine/kg). RESULTS Animals demonstrated less mechanical allodynia at incisions receiving SBG004 SC for up to 96 hours postoperatively. Incisions treated with SBG004 SC tolerated more force without a withdrawal indicative of pain compared to saline for 96 hours, and compared to SBG004 WF and all active controls at 24, 48, and 72 hours except bupivacaine-meloxicam polyorthoester at 72 hours. By 49 days, SBG004 was histologically absent and was replaced with granulation tissue infiltrated with immune cells in some areas. In rabbits, Cmax was 41.6 ± 9.7 ng/mL with t1/2 82.0 ± 35.8 hours (mean ± SD). CONCLUSIONS Peri-incisional SBG004 SC provided extended release of bupivacaine sufficient to reduce sensation of incisional pain for 96 hours, in vivo bupivacaine delivery for at least 7 days, and a favorable local and systemic toxicity profile.
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Affiliation(s)
| | - Alex C McLaren
- Sonoran Biosciences, Tempe, Arizona, USA.,Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Christopher M Glass
- School of Biological & Health Systems Engineering, Arizona State University, Tempe, Arizona, USA
| | - Derek J Overstreet
- Sonoran Biosciences, Tempe, Arizona, USA.,School of Biological & Health Systems Engineering, Arizona State University, Tempe, Arizona, USA
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Imani F, Emami A, Alimian M, Nikoubakht N, Khosravi N, Rajabi M, Hertling AC. Comparison of Perioperative Pregabalin and Duloxetine for Pain Management After Total Knee Arthroplasty: A Double-Blind Clinical Trial. Anesth Pain Med 2023; 13:e127017. [PMID: 37529346 PMCID: PMC10389034 DOI: 10.5812/aapm-127017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/01/2023] [Accepted: 01/08/2023] [Indexed: 08/03/2023] Open
Abstract
Background Chronic residual pain after total knee arthroplasty (TKA) is one of the challenges of postoperative pain management. Duloxetine, by controlling neuropathic pain, and pregabalin, by affecting nociceptors, can effectively manage postoperative pain. Objectives This study aimed to compare the effect of perioperative oral duloxetine and pregabalin in pain management after knee arthroplasty. Methods In this clinical trial, 60 patients scheduled for TKA under spinal anesthesia were randomly assigned to one of three groups A (pregabalin 75 mg), B (duloxetine 30 mg), and C (placebo). Drugs were administered 90 minutes before, 12, and 24 hours after surgery. The visual analog scale (VAS) score for pain, the first analgesic request time, postoperative analgesic consumption (i.v. paracetamol), and WOMAC score six months after surgery were recorded. Results The VAS score and analgesic consumption 48 hours after TKA in groups A and B significantly decreased compared to the placebo (P < 0.05). The first analgesic request time was longer in groups A and B than in group C (P < 0.05). While the differences were statistically significant, they are most likely not clinically significant. The WOMAC score before and six months after arthroplasty did not differ between the groups (P > 0.05). Conclusions Perioperative oral pregabalin and duloxetine similarly reduce pain and the need for analgesic consumption within 48 hours after TKA but do not affect knee mobility status.
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Affiliation(s)
- Farnad Imani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Azadeh Emami
- Pain Research Center, Department of Anesthesiology and Pain Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mahzad Alimian
- Pain Research Center, Department of Anesthesiology and Pain Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Nasim Nikoubakht
- Pain Research Center, Department of Anesthesiology and Pain Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Niloofar Khosravi
- Pain Research Center, Department of Anesthesiology and Pain Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Rajabi
- Department of Anesthesiology, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Arthur Christopher Hertling
- Department of Anesthesiology, Perioperative Care and Pain Medicine, School of Medicine, New York University, New York, USA
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Scardini IL, Sarra G, Braga MM, dos Santos M, Freire LG. The Effect of Number of Visits, Use of Solvent and Gutta-percha Removal Technique on Postoperative Pain following Nonsurgical Endodontic Retreatment; A Systematic Review and Meta-analysis. Iran Endod J 2023; 18:71-84. [PMID: 37152852 PMCID: PMC10155107 DOI: 10.22037/iej.v18i2.39945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/19/2023] [Accepted: 03/16/2023] [Indexed: 05/09/2023]
Abstract
Introduction The nonsurgical endodontic retreatment (NERT) is the first choice of dental ministration when primary/initial endodontic treatment fails. The present study aimed to investigate the presence of postoperative pain (POP) after NERT in permanent asymptomatic teeth as well as possible factors associated with POP. Materials and Methods A comprehensive search of literature was performed in Pubmed/MEDLINE, Embase, Scopus and Web of Science databases, up to January 2023; including randomized clinical trials and prospective studies. The risk of bias was assessed with RoB 2.0 and ROBINS-I tools. Subgroups analyses were conducted to evaluate the differences in the incidence or level of POP between the number of visits, the use/not use of solvent, the removal technique of gutta-percha, and the period of POP analysis. Mean differences and confidence intervals (CI) of 95% were used as measures of effect, and meta-regression was used along with subgroup analysis. The certainty of evidence was assessed using GRADE, and the probability value of <0.05 was considered significant. Results Twenty-four studies were selected, with thirteen included in the meta-analysis. There was a statistical difference between the incidence of POP after 24 h (95% CI, 0.28 to 0.52) and one week (95% CI, 0.02 to 0.13) from the endodontic retreatment (P<0.01). However, there was no statistical difference between different techniques, number of visits and use of solvent (P>0.05) in the same period. In addition, the certainty of evidence was very low. Conclusions Post-operative pain is a common response to NERT, independent of the retreatment technique(s) applied, number of visits and use of solvent(s); with very low certainty of evidence as well as low risk of bias. Moreover, the current analysis showed a (very) serious risk of inconsistency and imprecision. However, POP was significantly reduced within 1 week of the NERT.
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Affiliation(s)
- Iandara Lima Scardini
- Department of Restorative Dentistry, Faculty of Dentistry, University of São Paulo, Sao Paulo, Brazil;
- Corresponding author: Iandara Lima Scardini; Department of Restorative Dentistry, Faculty of Dentistry, University of Sao Paulo, Avenue Professor Lineu Prestes, 2227, Zip Code 05508-000, Sao Paulo, SP, Brazil. E-mail:
| | - Giovanna Sarra
- Department of Restorative Dentistry, Faculty of Dentistry, University of São Paulo, Sao Paulo, Brazil;
| | - Mariana Minatel Braga
- Department of Pediatric Dentistry, Faculty of Dentistry, University of São Paulo, Sao Paulo, Brazil
| | - Marcelo dos Santos
- Department of Restorative Dentistry, Faculty of Dentistry, University of São Paulo, Sao Paulo, Brazil;
| | - Laila Gonzales Freire
- Department of Restorative Dentistry, Faculty of Dentistry, University of São Paulo, Sao Paulo, Brazil;
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Fernandes LA, de Sousa Santos CF, Ditzel Westphalen VP, da Silva Neto UX, Carneiro E. Postoperative Endodontic Pain after Treatment Using XP-endo Finisher: A Randomized Clinical Trial. Iran Endod J 2023; 18:145-151. [PMID: 37431528 PMCID: PMC10329762 DOI: 10.22037/iej.v18i3.33925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/19/2023] [Accepted: 06/07/2023] [Indexed: 07/12/2023]
Abstract
Introduction This randomized clinical trial aimed to determine whether the XP-endo finisher combined with or without foraminal enlargement has any significant effect on the incidence and intensity of postoperative pain in necrotic pulps. Materials and Methods Clinical pain levels were measured after 6, 12, 24, 48, and 72 hours and at 7 postoperative days. All treatments were performed by an endodontist in a single visit. One hundred and twenty patients were included. All patients had a single tooth treated. The patients were divided into four groups: No FE (None Foraminal Enlargement) (n=30), FE (Foraminal Enlargement) (n=30), No FE+XPF (None Foraminal Enlargement+XP-endo Finisher) (n=30) and XPF+FE (XP-endo Finisher and Foraminal Enlargement) (n=30). The canals were irrigated with sodium hypochlorite, shaped using WaveOne Gold Medium file, and then filled by using a matching single cone and AH-Plus sealer. The cavity was filled using glass ionomer cement. Pain intensity was assessed using the visual analog scale. The data were analyzed with the ANOVA and Games-Howell test. The significance level was 5%. Results The XPF+FE group experienced a higher level of pain, being classified on the visual analog scale as moderate for 48 postoperative hours and mild for 7 postoperative days (P<0.05). In the other groups, the pain was mild, only with different time intervals (P>0.05). Conclusions Foraminal enlargement associated with XP-endo Finisher may cause moderate postoperative pain.
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Affiliation(s)
- Leonardo Alexandre Fernandes
- Graduate Program, Dentistry Course, Life Sciences School, Pontifical Catholic University of Paraná, Curitiba, Brazil
| | | | | | - Ulisses Xavier da Silva Neto
- Graduate Program, Dentistry Course, Life Sciences School, Pontifical Catholic University of Paraná, Curitiba, Brazil
| | - Everdan Carneiro
- Graduate Program, Dentistry Course, Life Sciences School, Pontifical Catholic University of Paraná, Curitiba, Brazil
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Sha Z, Zhang P. LncRNA-GAS5 and its Promoter Region Polymorphism Associate with Helper Th17 Polarization and Predict Postoperative Pain and the Prognosis of the Patients with Hepatocellular Carcinoma Undergoing Hepatectomy. Iran J Immunol 2022; 19:349-357. [PMID: 36585876 DOI: 10.22034/iji.2022.92678.2168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND The relationship between genetic polymorphism and postoperative pain and the prognosis of patients with hepatocellular carcinoma (HCC) undergoing hepatectomy is not fully understood. OBJECTIVE To examine whether lncRNA-GAS5 and its promoter region rs145204276 polymorphism can predict postoperative pain and prognosis of the patients with HCC undergoing hepatectomy. METHODS Seventy patients with HCC undergoing hepatectomy were enrolled. The lncRNA-GAS5 levels in CD4+ T cells from peripheral blood mononuclear cells (PBMC-CD4+ T cells) and tumor tissues were measured by qRT-PCR. Genotyping analysis of rs145204276 was performed using the TaqMan platform. PBMC-CD4+ T cells were isolated and the cytokine levels in helper T (Th) cells were determined by flow cytometry. Patients with Ins/Ins genotype carrying the rs145204276 polymorphism were allocated into the Ins group, and others were allocated into the Del group. RESULTS The lncRNA-GAS5 level decreased significantly in PBMC-CD4+ T cells and tumor tissues compared with the healthy controls and corresponding adjacent non-tumor tissues. The patients with Del/Del genotype showed significantly higher lncRNA-GAS5 expression in PBMC-CD4+ T cells, lower postoperative pain scores, and better overall survival. LncRNA-GAS5 expression in PBMC-CD4+ T cells was negatively associated with IL-6, IL-17, and the RORγT/CD3 ratio (an indicator of Th17 polarization). CONCLUSION LncRNA-GAS5 expression and its promoter region rs145204276 polymorphism are prognostic biomarkers that can predict postoperative pain of patients with HCC undergoing hepatectomy.
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Affiliation(s)
- Zhanming Sha
- Department of Anesthesiology, Shandong Provincial Third Hospital, Cheeloo College of Medicine, Jinan, 250031, China
| | - Panpan Zhang
- Department of Anesthesiology, Shandong Provincial Third Hospital, Cheeloo College of Medicine, Jinan, 250031, China
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Rahimzadeh P, Faiz SHR, Salehi S, Imani F, Mueller AL, Sabouri AS. Unilateral Right-Sided Ultrasound-Guided Erector Spinae Plane Block for Post-Laparoscopic Cholecystectomy Analgesia: A Randomized Control Trial. Anesth Pain Med 2022; 12:e132152. [PMID: 36938107 PMCID: PMC10016115 DOI: 10.5812/aapm-132152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 11/26/2022] [Accepted: 11/28/2022] [Indexed: 12/27/2022] Open
Abstract
Background Post-laparoscopic cholecystectomy (LC) pain control is still an issue postoperatively. Objectives We investigated the effectiveness of the unilateral right-side ultrasound-guided erector spinae plane block (ESPB) on post-LC pain intensity and opioid consumption. Methods This is a parallel-arm randomized control trial on 62 adult patients with an American Society of Anesthesiologists (ASA) physical status ≤ 2 who underwent LC. The patients were randomized into 2 groups (the block group [BG] and the control group [CG]; n = 31 per group). BG received a single-shot right-sided T7 ESPB with 20 mL of 0.2% ropivacaine at arrival time in the post-anesthesia care unit (PACU). CG) received no regional anesthesia. Both groups received patient-controlled intravenous fentanyl and rescue meperidine for analgesia. The primary outcome was the pain intensity determined using a Numerical Rating Scale (NRS) in the first 24 hours after surgery. Secondary outcomes included total fentanyl and meperidine consumption within 24 hours. Results Median pain scores were significantly higher in CG at rest and with coughing up to 12 hours after surgery compared with BG. Pain scores were higher in CG with a cough at 24 hours compared with BG (median 1 [interquartile range (IQR) 1, 2] vs. 1 [1, 0]; P = 0.0005). Total fentanyl consumption and meperidine consumption within 24 hours were significantly lower in BG compared with CG (median 60 µg [IQR 60, 90] vs 250 µg [90, 300]; P < 0.0001 and median 20 µg [IQR 10, 20] vs 25 [20, 25]; P = 0.002, respectively). Conclusions A single-shot, right-sided, unilateral ESPB decreases post-LC opioid consumption and pain.
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Affiliation(s)
- Poupak Rahimzadeh
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Hamid Reza Faiz
- Minimally Invasive Surgery Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sajede Salehi
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Farnad Imani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ariel L. Mueller
- Department of Anesthesia, Critical Care and Pain Medicine, Massachussetts General Hospital, Harvard Medical School, Boston, Massachussetts, USA
| | - A. Sassan Sabouri
- Department of Anesthesia, Critical Care and Pain Medicine, Massachussetts General Hospital, Harvard Medical School, Boston, Massachussetts, USA
- Corresponding Author: Department of Anesthesia, Critical Care and Pain Medicine, Massachussetts General Hospital, Harvard Medical School, Boston, Massachussetts, USA.
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Funcke S, Schick-Bengardt X, Pinnschmidt HO, Beyer B, Fischer M, Kahl U, Nitzschke R. The impact of spinal anaesthesia on perioperative opioid consumption, postoperative pain and oncological outcome in radical retropubic prostatectomy-a retrospective before-and-after effectiveness study. Perioper Med (Lond) 2022; 11:49. [PMID: 36184629 PMCID: PMC9528149 DOI: 10.1186/s13741-022-00281-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/09/2022] [Indexed: 11/16/2022] Open
Abstract
Background Spinal anaesthesia preceding general anaesthesia has been conducted for open radical retropubic prostatectomy (RRP) to decrease immediate postoperative pain for many years. Nevertheless, the effectiveness of spinal anaesthesia to reduce postoperative opioid requirements remains unknown. The aim of the present study was to determine the effect of spinal anaesthesia preceding general anaesthesia on opioid requirements, postoperative pain and biochemical cancer-free survival. Methods This before-and-after effectiveness study investigated effects of two different anaesthesia techniques in 636 patients with RRP. Three hundred eighteen consecutive patients in the SPA group (spinal anaesthesia preceding general anaesthesia) were compared with 318 patients in the GA group (general anaesthesia alone). The primary endpoint of the study was opioid consumption in the post-anaesthesia care unit. Secondary endpoints were intraoperative opioid consumption, postoperative pain, postoperative recovery time, the length of hospital-stay, persistence of pain 1 year after surgery and cancer-free survival. Differences between the groups were analysed by a two-sided t-test, χ2-test, Fisher’s exact test and Mann–Whitney U test and the influence of possible confounders on opioid consumption with a general linear model. Cancer-free survival was determined by Kaplan–Meier curves and group differences by log-rank tests and multivariable Cox regression analyses. Results The total amount of morphine equivalent administered postoperatively was 7.5 [6.9; 8.1] mg in the SPA group and 6.0 [5.5; 6.5] mg in the GA group (mean [95% CI], p < 0.001). The amount of intraoperative sufentanil was 56.9 [55.1; 58.7] μg in the SPA group and 84.5 [82.5; 86.5] μg in the GA group (mean [95% CI], p < 0.001). There was no difference found in the postoperative pain level, length of hospital-stay and pain level 1 year after surgery. Biochemical cancer-free survival was highly related to TNM stage (p < 0.001, pT3 vs. pT2 hazard ratio 5.4 [95%CI 3.3; 9.2]) but not to the type of anaesthesia (p = 0.29). Conclusions Spinal anaesthesia preceding general anaesthesia for RRP is associated with increased postoperative opioid consumption compared to general anaesthesia alone. Postoperative pain level and the oncological outcome are not affected by the adjunctive use of spinal anaesthesia. Thus, the addition of spinal anaesthesia to general anaesthesia has no advantage in RRP. Trial registration ClinicalTrial.gov, NCT03565705.
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Affiliation(s)
- Sandra Funcke
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Xenia Schick-Bengardt
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Hans O Pinnschmidt
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Burkhard Beyer
- Martini-Klinik, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Marlene Fischer
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Ursula Kahl
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Rainer Nitzschke
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
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22
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Verma J, Verma S, Margasahayam SV. Comparison of pretreatment gabapentin and pregabalin to control postoperative endodontic pain - a double-blind, randomized clinical trial. J Dent Anesth Pain Med 2022; 22:377-385. [PMID: 36246032 PMCID: PMC9536948 DOI: 10.17245/jdapm.2022.22.5.377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/03/2022] [Accepted: 09/18/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Postoperative endodontic pain is an enigma for the dentist. This study aimed to evaluate the analgesic effect of 300 mg gabapentin or 75 mg pregabalin in reducing postoperative endodontic pain compared with a placebo. METHODS Ninety patients who needed root canal treatment with an initial numerical rating scale (NRS) pain score of > 4 (T0) were randomly divided into three groups (n=30). Patients were then administered either 300 mg gabapentin (group A), 75 mg pregabalin (group B), or a placebo (group C) 30 min prior to the start of endodontic treatment. A single operator performed single-visit endodontics, and pain was evaluated immediately after endodontic treatment (T1) and at 4 h (T2), 8 h (T3), 12 h (T4), 24 h (T5), 48 h (T6), and 72 h (T7) using the NRS. Ibuprofen/paracetamol (400 mg/325 mg) was administered as a rescue dose if needed. RESULTS Pregabalin performed significantly better when compared with gabapentin at all time points except at 72 h after treatment (P=0.170). The placebo group showed significantly higher pain scores than the other two groups. The percentage of pain relief was maximum for pregabalin (92.1%), followed by gabapentin (87.6%) and placebo (69.1%) at 72 h after treatment completion. CONCLUSION This study showed that pretreatment with a single dose of pregabalin and gabapentin both had greater analgesic effects than a placebo. They can be effectively used to reduce postoperative endodontic pain.
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Affiliation(s)
- Jayeeta Verma
- Conservative Dentistry and Endodontics, MGM Dental College and Hospital, Navi Mumbai, India
| | - Sidharth Verma
- Anesthesiology, Dr. DY Patil Medical College, Navi Mumbai, India
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Motyl CM, Dohring C, Wang ML, Gosain S, France F, Poli J, Stoner MC, Doyle AJ. Opioid sparing effects of the bupivacaine pleural catheter in surgical decompression of the thoracic outlet. Ann Vasc Surg 2022; 88:283-290. [PMID: 36058460 DOI: 10.1016/j.avsg.2022.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/05/2022] [Accepted: 07/11/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Rib resection in thoracic outlet decompression can result in significant postoperative pain requiring high levels of opioid medications. We evaluated the impact of a bupivacaine infusing pleural catheter on postoperative pain and opioid usage in patients undergoing rib resection for thoracic outlet syndrome. We hypothesized that delivery of local anesthetic via the pleural catheter would improve postoperative pain control compared to standard multimodal analgesia, and that the use of the catheter would decrease opioid use during the index hospitalization and prescriptions for opioid pain medications at discharge. METHODS We conducted a single-center retrospective cohort study of 26 patients who underwent rib resection for thoracic outlet decompression. Primary outcome was opioid consumption during the index hospitalization, measured in morphine milligram equivalents (MME). Secondary outcomes were MME prescribed at discharge and pain scores during the index hospitalization before and after the pleural drain and pleural catheter were removed. RESULTS Patients in the bupivacaine infusion pleural catheter group (n=11) had significantly lower milligram morphine equivalent (MME) usage during the index hospitalization (22.5 [1.9, 65.6] vs. 119.8 [76.5, 167.4]), and significantly lower MME prescribed at discharge (0 [0, 37.5] vs. 225 [183, 315]), compared to standard multimodal analgesia in controls (n=15). Only 3 patients in the bupivacaine pleural catheter group were discharged with any opioid prescriptions (27%), compared to 14 patients in the control group (93%). There was no difference in postoperative pain scores between groups before or after removal of the pleural drain, which was placed in all cases (p=0.31 and p=0.76, respectively). CONCLUSIONS Intraoperative placement of a bupivacaine infusion pleural catheter significantly reduced opioid use during the index hospitalization and opioid prescribing at discharge. Anesthetic infusion pleural catheters should be the treatment modality of choice for postoperative pain management in patients undergoing thoracic outlet decompression.
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Affiliation(s)
- Claire M Motyl
- Division of Vascular Surgery, University of Rochester, Rochester, NY
| | - Christian Dohring
- Division of Vascular Surgery, University of Rochester, Rochester, NY
| | - Maxwell L Wang
- Division of Vascular Surgery, University of Rochester, Rochester, NY
| | - Suparna Gosain
- Department of Anesthesiology, University of Rochester, Rochester, NY
| | - Fallon France
- Department of Anesthesiology, University of Rochester, Rochester, NY
| | - Joseph Poli
- Department of Anesthesiology, University of Rochester, Rochester, NY
| | - Michael C Stoner
- Division of Vascular Surgery, University of Rochester, Rochester, NY
| | - Adam J Doyle
- Division of Vascular Surgery, University of Rochester, Rochester, NY.
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SaberMoghaddam M, Sheybani S, Bakhtiari E, Shakiba M. The Effect of Preoperative Sublingual Melatonin on Postoperative Pain Severity in Patients Undergoing Colorectal Surgery: A Triple-Blinded Randomized Trial. Med J Islam Repub Iran 2022; 36:90. [PMID: 36128304 PMCID: PMC9448508 DOI: 10.47176/mjiri.36.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 08/10/2022] [Indexed: 11/07/2022] Open
Abstract
Background: Postoperative pain has detrimental physiologic and psychologic effects on patients' outcomes, such as increased postoperative morbidity, delayed recovery, and reduced patient satisfaction. This study aimed to determine the effect of preoperative sublingual melatonin on pain severity after colorectal surgery. Methods: We performed a randomized, placebo-controlled, triple-blinded study to test the efficacy of 6 mg of sublingual melatonin or placebo 1 hour preoperative on pain severity and sedation of 60 patients after colorectal surgeries. Pain and sedation were assessed by numerical verbal response (NVR) and the Ramsey sedation score, respectively, at the baseline, 1, 2, 6, 12, and 24 hours after surgery. The repeated measures analysis of variance was used to assess group × time interaction, and the Bonferroni adjustment was used for between-group comparisons. Results: A total of 60 patients with a mean ± SD age of 49.35 years were equally randomized to the study groups. There was no significant difference between groups with respect to the baseline characteristics. The mean score of pain severity of patients in the melatonin group was significantly lower compared with the placebo group at 2, 6, 12, and 24 hours after surgery. The total mean pain score for the first 12 hours (mean difference [MD] [SE], 0.41 [0.12]; 95% CI, 0.17-0.65; [P = 0.012]) and the mean score of pain in 24 hours after surgery were significantly lower in the melatonin group in comparison with the placebo group (MD [SE], 0.44 [0.13]; 95% CI, 0.19-0.69; [P = 0.001]). Compared with the placebo group, the percent of patients who were cooperative, aware, and calm was significantly higher in the melatonin group at the baseline (43.3% vs 53.3%) and at 1 (36.7% vs 60%) and 2 hours (33.3% vs 80%). Conclusion: The use of 6 mg preoperative melatonin sublingual tablet in patients with colorectal surgeries could reduce the severity of postoperative pain, patients' restlessness and anxiety, and increase patients' cooperation and calmness. Therefore, it seems that sublingual melatonin is an effective drug in controlling postoperative pain.
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Affiliation(s)
- Mohsen SaberMoghaddam
- Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shima Sheybani
- Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Elahe Bakhtiari
- Department of Pharmacology, Faculty of Pharmacology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Shakiba
- Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran,Corresponding author: Dr Maryam Shakiba,
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McGrail K, Chapple AG, Stone G, Sutton EF, Chappell NR. Systematic Review and Meta-Analysis of Perioperative Administration of Acetazolamide for Management of Postoperative Pain after Laparoscopy. JSLS 2022; 26:JSLS.2022.00032. [PMID: 36071992 PMCID: PMC9385114 DOI: 10.4293/jsls.2022.00032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objective To perform a systematic review and meta-analysis to evaluate the efficacy of perioperative acetazolamide (ACTZ) administration with laparoscopy for reducing postoperative referred pain. Methods The following databases were searched from inception to March 1, 2020: Cochrane, PubMed, PubMed Central, Ovid, and Embase. Electronic search used: Acetazolamide AND (laparoscopy OR laparoscopic OR Celioscopy OR Celioscopies OR Peritoneoscopy OR Peritoneoscopies). No limits or filters were used. We included only studies of patients who underwent abdominal laparoscopy (LSC), had a pain assessment at approximately 24 hours postoperatively, and included a treatment with ACTZ group and a no-treatment or minimal-treatment comparison group. Results Five studies met inclusion criteria, with a combined total of 253 participants, 116 in the ACTZ group and 137 in the control group. A Bayesian hierarchical model was assumed for the study specific treatment effects. Posterior sampling was conducted via Markov Chain Monte Carlo methods, and posterior inference carried out on the hierarchical treatment effect. ACTZ significantly decreased average pain scores compared to control group by -0.726 points (95% confidence interval -1.175-0.264). The posterior probability that ACTZ decreases mean pain scores by ≥ 0.5 was 0.846. Conclusion Current available evidence demonstrates that perioperative ACTZ may provide a modest improvement in postoperative referred pain following LSC.
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Affiliation(s)
- Kaitlin McGrail
- Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, Baton Rouge, Louisiana
| | - Andrew G Chapple
- Department of Biostatics, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Gabrielle Stone
- Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, Baton Rouge, Louisiana
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Ilfeld BM, Finneran Iv JJ, Dalstrom D, Wallace AM, Abdullah B, Said ET. Percutaneous auricular nerve stimulation (neuromodulation) for the treatment of pain following outpatient surgery: a proof-of-concept case series. Reg Anesth Pain Med 2022; 47:rapm-2022-103777. [PMID: 35715011 PMCID: PMC9340022 DOI: 10.1136/rapm-2022-103777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/10/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Following outpatient surgery, it is often difficult to provide adequate analgesia while concurrently minimizing opioid requirements. Ultrasound-guided percutaneous peripheral nerve stimulation has been proposed as an analgesic, but requires physician-level skills, advanced equipment, up to an hour to administer, and is frequently cost prohibitive. In contrast, percutaneous auricular neuromodulation may be placed by nursing staff in a few minutes without additional equipment, theoretically provides analgesia for nearly any anatomic location, lacks systemic side effects, and has no significant risks. We now present a case report to demonstrate proof of concept for the off-label use of an auricular neuromodulation device-originally developed to treat symptoms associated with opioid withdrawal-to instead provide analgesia following outpatient surgery. CASE PRESENTATION Following moderately painful ambulatory orthopedic and breast surgery, seven patients had an auricular neuromodulation device (NSS-2 Bridge, Masimo, Irvine, California, USA) affixed within the recovery room in approximately 5 min and discharged home. Average resting and dynamic pain scores measured on the 0-10 Numeric Rating Scale were a median of 1 over the first 2 days, subsequently falling to 0. Five patients avoided opioid use entirely, while the remaining two each consumed 5 mg of oxycodone during the first 1-2 postoperative days. After 5 days, the devices were removed at home and discarded. CONCLUSIONS These cases demonstrate that ambulatory percutaneous auricular neuromodulation is feasible and may be an effective analgesic and decreasing or even negating opioid requirements following outpatient surgery. Considering the lack of systemic side effects, serious adverse events, and misuse/dependence/diversion potential, further study with a randomized, controlled trial appears warranted.
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Affiliation(s)
- Brian M Ilfeld
- Department of Anesthesiology, University of California San Diego, La Jolla, California, USA
| | - John J Finneran Iv
- Department of Anesthesiology, University of California San Diego, La Jolla, California, USA
| | - David Dalstrom
- Department of Orthopedic Surgery, University of California San Diego, La Jolla, California, USA
| | - Anne M Wallace
- Department of Surgery, University of California San Diego, La Jolla, California, USA
| | - Baharin Abdullah
- Department of Anesthesiology, University of California San Diego, La Jolla, California, USA
| | - Engy T Said
- Department of Anesthesiology, University of California San Diego, La Jolla, California, USA
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Aygun H, Kiziloglu I, Ozturk NK, Ocal H, Inal A, Kutlucan L, Gonullu E, Tulgar S. Use of ultrasound guided single shot costotransverse block (intertransverse process) in breast cancer surgery: a prospective, randomized, assessor blinded, controlled clinical trial. BMC Anesthesiol 2022; 22:110. [PMID: 35436844 PMCID: PMC9014597 DOI: 10.1186/s12871-022-01651-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 04/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ultrasound guided costotransverse block (CTB) is a relatively new "peri-paravertebral" block that has been described recently. It has been previously reported that CTB, administered with a single high-volume injection, provides effective analgesia in breast conserving surgery. In this study we evaluated the effect of CTB when used in breast cancer surgery. METHODS Seventy patients due to undergo breast cancer surgery were included in this blinded, prospective, randomized, efficiency study. Patients were randomized into two equal groups (CTB group and control group) using the closed envelope technique. All patients underwent general anesthesia. In addition to standard analgesia methods, patients in group CTB also received CTB block while the remaining (control group) did not. Numeric rating (pain) scores and opioid consumption was compared between the two groups. RESULTS Opioid consumption in all time frames and pain scores at 1st and 3rd hours only were found to be significantly lower in Group CTB when compared to the control group. CONCLUSIONS Ultrasound guided CTB improves analgesia quality in breast cancer surgery. TRIAL REGISTRATION Clinicaltrials Registration ID: NCT04197206 , Registration Date: 13/12/2019.
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Affiliation(s)
- Hakan Aygun
- Department of Anesthesiology, Bakircay UniversityFaculty of Medicine Cigli Training and Research Hospital, Izmir, Turkey.
| | - Ilker Kiziloglu
- Department of General Surgery, Bakircay UniversityFaculty of Medicine Cigli Training and Research Hospital, Izmir, Turkey
| | - Nilgun Kavrut Ozturk
- Department of Anesthesiology, University of Health Science Faculty of MedicineAntalya Training and Research Hospital, Antalya, Turkey
| | - Haydar Ocal
- Department of General/Oncological Surgery, Bakircay University Faculty of MedicineCigli Training and Research Hospital, Izmir, Turkey
| | - Abdullah Inal
- Department of General Surgery, Bakircay UniversityFaculty of Medicine Cigli Training and Research Hospital, Izmir, Turkey
| | - Leyla Kutlucan
- Department of Anesthesiology, Bakircay UniversityFaculty of Medicine Cigli Training and Research Hospital, Izmir, Turkey
| | - Edip Gonullu
- Department of Anesthesiology/Algology, Bakircay UniversityFaculty of MedicineCigli Training and Research Hospital, Izmir, Turkey
| | - Serkan Tulgar
- Department of Anesthesiology, Samsun University Faculty of Medicine, Samsun Training and Research Hospital, Samsun, Turkey
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Karageorgos V, Brofidi K, Stefanidou N, Papaioannou A, Daskalakis I, Sperelakis I, Balalis K. Femoral 3-in-1 Nerve Block for Total Knee Replacement, an Analgesic Approach Not to Be Neglected. Single Center Experience and Literature Review. Acta Med Acad 2022; 51:14-20. [PMID: 35695398 PMCID: PMC9982856 DOI: 10.5644/ama2006-124.365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/20/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES Total Knee Replacement Surgery (TKR) is one of the most common elective orthopedic operations. Postoperative pain after total knee replacement, remains a challenge. In this retrospective observational study, we evaluated the effectiveness of 3-in-1 nerve block in patients after total knee arthroplasty compared to standard opioid treatment, and we state the reasons why this approach should still be considered. METHODS To evaluate the effectiveness of the 3-in-1 nerve block, we assessed the acute pain service archive and compared the values of the visual analog scale, by separating patients into two groups according to the analgesic regimen they received as per local protocols. In group A, patients received 0.25% bupivacaine through a 3 in 1 block catheter and additional meperidine IM if needed, while in group B they received meperidine every six hours. RESULTS Our analysis showed the statistically significant better effectiveness of 3-in-1 nerve block with bupivacaine administration in postoperative TKR pain control compared to repeated administration of meperidine. CONCLUSION The results of our study suggest that 3-in-1 nerve block with bupivacaine is an option that must always be considered in order to alleviate post-operative pain after TKR.
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Affiliation(s)
| | - Kalliopi Brofidi
- Department of ENT Surgery, University Hospital of Heraklion, Greece
| | - Nefeli Stefanidou
- Department of Anaesthesiology, University Hospital of Heraklion, Greece
| | | | - Ioannis Daskalakis
- Department of Orthopedic Surgery, University Hospital of Heraklion, Greece
| | - Ioannis Sperelakis
- Department of Orthopedic Surgery, University Hospital of Heraklion, Greece
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Tokuç B, Coşkunses FM. Comparison of the effects of articaine and bupivacaine in impacted mandibular third molar tooth surgery: a randomized, controlled trial. J Dent Anesth Pain Med 2021; 21:575-582. [PMID: 34909475 PMCID: PMC8637915 DOI: 10.17245/jdapm.2021.21.6.575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/05/2021] [Accepted: 11/09/2021] [Indexed: 11/15/2022] Open
Abstract
Background The aim of this randomized, triple-blind trial was to determine the anesthetic, analgesic, and hemodynamic effects of articaine and bupivacaine in the extraction of impacted mandibular third molar teeth. Methods Twenty-six patients who underwent removal of bilaterally symmetric mandibular third molars were randomly assigned to articaine and bupivacaine groups in a split-mouth design. The onset of anesthetic action, intraoperative comfort, total amount of solution used, duration of postoperative anesthesia and analgesia, rescue analgesic use, postoperative pain, intraoperative bleeding, and hemodynamic parameters were evaluated. Results In the articaine group, the onset of anesthetic activity was faster, intraoperative comfort was greater, and effective anesthesia required less local anesthetic solution. The bupivacaine group showed a significantly longer duration of postoperative anesthesia and analgesia, in addition to lower visual analog scale values at 6 and 48 hours postoperatively. There were no significant differences between the two solutions regarding rescue analgesic medication use, intraoperative bleeding, or hemodynamics. Conclusion Articaine showed greater clinical efficacy than bupivacaine in intraoperative anesthesia, achieving faster onset of anesthetic action and greater patient comfort while also requiring less reinforcement during surgery. However, bupivacaine was superior in terms of postoperative anesthesia, reducing postoperative pain due to its residual anesthetic and analgesic effects. Both anesthetic solutions led to similar hemodynamics at low doses in mandibular third molar surgery.
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Affiliation(s)
- Berkay Tokuç
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Kocaeli University, Kocaeli, Turkey
| | - Fatih Mehmet Coşkunses
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Kocaeli University, Kocaeli, Turkey
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Kumar G, Sangwan P, Tewari S. Effect of premedication on postoperative pain after root canal therapy in patients with irreversible pulpitis: a systematic review and meta-analysis. J Dent Anesth Pain Med 2021; 21:397-411. [PMID: 34703890 PMCID: PMC8520836 DOI: 10.17245/jdapm.2021.21.5.397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/21/2021] [Accepted: 07/28/2021] [Indexed: 01/14/2023] Open
Abstract
This systematic review aimed to assess the effect of premedication on postoperative pain after root canal treatment in vital teeth. Five electronic databases were searched for randomized clinical trials, and two independent reviewers selected eligible studies, extracted data, and assessed the quality of studies using the Cochrane Risk of Bias tool. Meta-analysis was conducted using the random-effects model, and the pooled effect estimate of the standardized mean difference (SMD) between premedication and placebo was calculated. Subgroup analysis was conducted based on the class and route of the drug. Studies with a high risk of bias were excluded from the sensitivity analysis. Ten trials satisfied the inclusion criteria, of which eight were included in the meta-analysis. Premedication was more effective in reducing postoperative pain than placebo at 6 hours (SMD = −1.00; 95% confidence interval [CI] = −1.33 to −0.66), 12 hours (SMD = −0.80; 95% CI = −1.05 to −0.56), and 24 hours (SMD = −0.72; 95% CI = −1.02 to −0.43). The results of the sensitivity analysis confirmed the findings of the primary analysis. Based on these results, it can be concluded that premedication is effective in reducing postoperative pain in teeth with irreversible pulpitis. However, additional quality studies are required for further validation.
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Affiliation(s)
- Gaurav Kumar
- Post Graduate Institute of Dental Sciences Rohtak, Haryana, India
| | - Pankaj Sangwan
- Post Graduate Institute of Dental Sciences Rohtak, Haryana, India
| | - Sanjay Tewari
- Post Graduate Institute of Dental Sciences Rohtak, Haryana, India
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Zhang C, Li Z, Yu K, Wang Y. A Postoperative Phenomenon of Percutaneous Endoscopic Lumbar Discectomy: Rebound Pain. Orthop Surg 2021; 13:2196-2205. [PMID: 34643334 PMCID: PMC8654651 DOI: 10.1111/os.13088] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/11/2021] [Accepted: 05/10/2021] [Indexed: 11/26/2022] Open
Abstract
Objective After percutaneous endoscopic lumbar discectomy (PELD), most patients with lumbar disc herniation (LDH) experience relief from the typical symptoms of low back and leg pain. However, for a small number of patients, these symptoms are relieved immediately after surgery but aggravated soon after, and then relieved after short‐term full rest or conservative treatment. The aim of the study was to demonstrate this short‐term recurrent phenomenon, termed rebound pain. Methods A retrospective study was conducted on 144 patients who underwent single‐segment PELD from May 2017 to June 2020. Postoperative patients were divided into a rebound pain group and a non‐rebound pain group. For the former group, general information, symptom characteristics and visual analogue score (VAS) changes in rebound pain were summarized. For both groups, postoperative efficacy was evaluated by recent VAS of low back and leg pain in the remission stage, the Oswestry disability index (ODI) and the modified MacNab criteria at the last follow‐up. Logistic regression analysis was used to identify predictors for rebound pain. Results The VAS and ODI exhibited significant improvements at the last follow‐up of average 15.4 months (P < 0.001). The successful outcomes according to the modified MacNab criteria reached 94.4%. A total of 15 patients (10.4%) experienced rebound pain. The typical feature was pain that usually began within 1 month after surgery and lasted for less than 1 month. The symptoms were mainly leg pain with or without low back pain. The range of pain was equal to or less than that before surgery. The symptoms were relieved after conservative treatment. In logistic regression model, postoperative return‐to‐work time > 45 days was found as a protective factor for rebound pain (p = 0.031). Conclusion Although rebound pain with multiple characteristics and a short duration had no significant effect on long‐term postoperative efficacy, its high incidence often caused unnecessary concern in both patients and doctors. As a result, careful differentiation of rebound pain from other postoperative complications is needed.
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Affiliation(s)
- Chang Zhang
- Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Ziquan Li
- Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Keyi Yu
- Department of Orthopaedic, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yipeng Wang
- Department of Orthopaedic, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Mena GE, Zorrilla-Vaca A, Vaporciyan A, Mehran R, Lasala JD, Williams W, Patel C, Woodward T, Kruse B, Joshi G, Rice D. Intraoperative Dexmedetomidine and Ketamine Infusions in an Enhanced Recovery After Thoracic Surgery Program: A Propensity Score Matched Analysis. J Cardiothorac Vasc Anesth 2021; 36:1064-1072. [PMID: 34690059 DOI: 10.1053/j.jvca.2021.09.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/15/2021] [Accepted: 09/22/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To assess the impact of intraoperative dexmedetomidine and ketamine on postoperative pain and opioid consumption within an ERAS program in thoracic pulmonary oncologic surgery. DESIGN Retrospective, propensity-score matched analysis SETTING: Enhanced Recovery After Surgery (ERAS) program. PARTICIPANTS Patients undergoing thoracic pulmonary oncologic surgery between March 2016 and April 2020. INTERVENTIONS Continuous infusion of dexmedetomidine and ketamine. MEASUREMENTS & MAIN RESULTS The authors initially analyzed data of 1,630 patients undergoing thoracic pulmonary oncologic surgery within their ERAS program. In total, 117 matched pairs were included in this analysis. Patients in the intraoperative dexmedetomidine + ketamine group were more likely to be opioid-free (76.6% vs 60.9%, P<0.01). Raw analysis showed lower pain scores at PACU admission (2.8±2.0 vs 3.4±2.0, P=0.03) and less opioid consumption at PACU admission (5 MED [0-10] vs 7.5 MED [0-15], P=0.03) in the dexmedetomidine + ketamine group; however, these differences were not present after adjusting for multiplicity. There were no significant differences in the length of PACU stay (1.9 hours [1.5-2.8] vs 2.0 hours [1.4-2.9], P=0.48) or hospital stay (three days [two-five] vs three days [two-five], P=0.08). Both groups had similar rates of pulmonary complications (5.9% vs 9.4%, P=0.326), ileus (0.9% vs 0.9%, P=1.00), and 30-day readmission (2.6% vs 4.3%, P=0.722). CONCLUSIONS There were no differences in postoperative pain scores and opioid consumption throughout their hospital stay between patients receiving concomitant dexmedetomidine and ketamine infusions versus patients who did not receive these infusions during thoracic surgery.
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Affiliation(s)
- Gabriel E Mena
- Department of Anesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Andres Zorrilla-Vaca
- Department of Anesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX; Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX; Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, MA.
| | - Ara Vaporciyan
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Reza Mehran
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Javier D Lasala
- Department of Anesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Wendell Williams
- Department of Anesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Carla Patel
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | - TaCharra Woodward
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Brittany Kruse
- Department of Anesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Girish Joshi
- Department of Anesthesiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - David Rice
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
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Norozi V, Ghazi A, Amani F, Bakhshpoori P. Effectiveness of Sublingual Buprenorphine and Fentanyl Pump in Controlling Pain After Open Cholecystectomy. Anesth Pain Med 2021; 11:e113909. [PMID: 34540635 PMCID: PMC8438705 DOI: 10.5812/aapm.113909] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/16/2021] [Accepted: 05/20/2021] [Indexed: 12/17/2022] Open
Abstract
Background The proper management of postoperative pain improves patients’ quality of life, accelerates early postoperative recovery, shortens hospitalization period, and reduces medical costs. This study aimed to compare the effectiveness of intravenous fentanyl pump and sublingual buprenorphine tablet in controlling pain after open cholecystectomy. Objectives Evaluating the effectiveness of sublingual buprenorphine in reducing postoperative pain and complications after open cholecystectomy. Methods This study was a double-blind, randomized clinical trial. The study population encompassed those candidates undergoing open cholecystectomy, patients with ASA class I and II, individuals undergoing no other concomitant surgery, and patients in the age range of 20 - 50 years. The first group received sublingual buprenorphine 6, 12, and 18 hours after the first administration. The second group received fentanyl as patient-controlled analgesia (PCA) for 24 hours. Then nausea, vomiting, sedation, and Visual Analog Scale (VAS) scores were evaluated at the beginning, 2, 6, 12, 18, and 24 hours after surgery. The collected data were analyzed using SPSS software version 20. Results The mean age of the patients in the buprenorphine and fentanyl groups were 44.8 ± 5.5 and 42.8 ± 7.1 years, respectively. In this study, 22.5% of the patients in the buprenorphine group and 35.5% of the patients in the fentanyl group were male. During 6 and 24 hours after surgery, the pain level regarding the VAS scores was significantly lower in the buprenorphine group than in the fentanyl group; however, analgesic consumption was higher in the fentanyl group. In the early hours after surgery (2 and 6 hours), nausea and vomiting were lower in the buprenorphine group than in the fentanyl group even though the difference was not significant. Conclusions This study suggests buprenorphine as an effective drug for patients to reduce postoperative pain because of its limited complications, inexpensiveness, and more convenient administration method.
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Affiliation(s)
- Vadood Norozi
- Ardabil University of Medical Sciences, Fatemi Hospital, Ardabil, Iran
| | - Ahmad Ghazi
- Ardabil University of Medical Sciences, Emam Reza Hospital, Ardabil, Iran
- Corresponding Author: Ardabil University of Medical Sciences, Emam Reza Hospital, Ardabil, Iran.
| | - Firouz Amani
- Ardabil University of Medical Sciences, Ardabil, Iran
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Speed TJ, Jung Mun C, Smith MT, Khanuja HS, Sterling RS, Letzen JE, Haythornthwaite JA, Edwards RR, Campbell CM. Temporal Association of Pain Catastrophizing and Pain Severity Across the Perioperative Period: A Cross-Lagged Panel Analysis After Total Knee Arthroplasty. Pain Med 2021; 22:1727-1734. [PMID: 33532859 PMCID: PMC8502458 DOI: 10.1093/pm/pnab035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Although numerous studies show that preoperative pain catastrophizing is a risk factor for pain after total knee arthroplasty (TKA), little is known about the temporal course of the association between perioperative pain catastrophizing and pain severity. The present study investigated temporal changes and their dynamic associations between pain catastrophizing and pain severity before and after TKA. DESIGN A secondary data analysis of a larger observational parent study featuring prospective repeated measurement over 12 months. SETTING Dual-site academic hospital. SUBJECTS A total of 245 individuals who underwent TKA. METHODS Participants completed pain catastrophizing and pain severity questionnaires at baseline, 6 weeks, and 3, 6, and 12 months after TKA. Cross-lagged panel analysis was conducted with structural equation modeling including age, sex, race, baseline anxiety, and depressive symptoms as covariates. RESULTS Reduction in pain catastrophizing from baseline to 6 weeks after TKA was associated with lower pain severity at 3 months after TKA (standardized β = 0.14; SE = 0.07, P = 0.046), while reduction in pain severity at 6 weeks after TKA was not associated with pain catastrophizing at 3 months after TKA (P = 0.905). In the chronic postsurgical period (>3 months), pain catastrophizing at 6 months after TKA predicted pain severity at 12 months after TKA (β = 0.23, P = 0.009) with controlling for auto-correlation and covariates, but not vice versa. CONCLUSIONS We provide evidence that changes in pain catastrophizing from baseline to 6 weeks after TKA are associated with subsequent pain severity. Future studies are warranted to determine whether targeting pain catastrophizing during the perioperative period may improve clinical outcomes for individuals undergoing TKA.
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Affiliation(s)
- Traci J Speed
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Chung Jung Mun
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael T Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Harpal S Khanuja
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert S Sterling
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Janelle E Letzen
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jennifer A Haythornthwaite
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Claudia M Campbell
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Farahmand Rad R, Imani F, Emami A, Salehi R, Ghavamy AR, Shariat AN. Postoperative Pain Management: Efficacy of Caudal Tramadol in Pediatric Lower Abdominal Surgery: A Randomized Clinical Study. Anesth Pain Med 2021; 11:e119346. [PMID: 34692449 PMCID: PMC8520683 DOI: 10.5812/aapm.119346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 09/12/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND One of the methods of pain control after pediatric surgical procedures is regional techniques, including caudal block, despite their limitations. OBJECTIVES In this study, the pain score and complications of caudal tramadol were evaluated in pediatrics following lower abdominal surgery. METHODS In this study, 46 children aged 3 to 10 years were allocated into two equal groups (R and TR) for performing caudal analgesia after lower abdominal surgery. The injectate contained 0.2% ropivacaine 1 mL/kg in the R group (control group) and tramadol (2 mg/kg) and ropivacaine in the TR group. The pain score, duration of pain relief, amount of paracetamol consumption, hemodynamic alterations, and possible complications at specific times (1, 2, and 6 hours) were evaluated in both groups. RESULTS No considerable difference was observed in the pain score between the groups in the first and second hours (P > 0.05). However, in the sixth hour, the TR group had a significantly lower pain score than the R group (P < 0.05). Compared to the R group, the TR group had a longer period of analgesia and lower consumption of analgesic drugs (P < 0.05). Heart rate and blood pressure differences were not significant between the two groups (P > 0.05). Similarly, the duration of operation and recovery time were not remarkably different between the two groups (P > 0.05). Complications had no apparent differences between these two groups, as well (P > 0.05). CONCLUSIONS In this study, the addition of tramadol to caudal ropivacaine in pediatric lower abdominal surgery promoted pain relief without complications.
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Affiliation(s)
- Reza Farahmand Rad
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Farnad Imani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Azadeh Emami
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Salehi
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Reza Ghavamy
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Nima Shariat
- Icahn School of Medicine of Mount Sinai, Mount Sinai Morningside Hospital Center, New York, USA
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Ökmen K, Gürbüz H, Özkan H. Unilateral rhomboid intercostal and subserratus plane block application for analgesia after laparoscopic cholecystectomy surgery :a quasi-experimental study. Korean J Anesthesiol 2021; 75:79-85. [PMID: 34283910 PMCID: PMC8831438 DOI: 10.4097/kja.21229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 07/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background Interfascial plane block applications can be used for postoperative pain after laparoscopic surgery. We aimed to investigate the effect of ultrasound-guided unilateral rhomboid intercostal and subserratus plane (RISS) block after laparoscopic cholecystectomy operations on the amount of analgesic use. Methods 50 patients underwent laparoscopic cholecystectomy were included in the quasi-experimental study. Patients meeting the criteria were analyzed in two groups as experimental group (RISS block with 20 ml %0.25 bupivacaine+intravenous patient-controlled analgesia (IV-PCA) tramadol ; n = 25) and group Control (IV-PCA tramadol; n = 25).The primary outcome was the total amount of tramadol used over 24 hours.Secondary outcomes included the side effects, additional analgesic use and postoperative pain (during rest and activity) was at the 2nd, 6th, 12th, and 24th hours using the NRS scores . Results Postoperative tramadol consumption at the 24 hours was significantly lower in the Group RISS than the Group Control (p<0.001). The resting NRS scores at the 2nd and 6th hours were statistically significantly low in the Grup RISS. The NRS scores during movement in Grup RISS were significantly low at the postoperative 2nd, 6th, and 12th hours.There was no statistically significant difference in the rate of side effects and additional analgesic use between the groups (p>0.05). Conclusions In conclusion, unilateral RISS block is an effective method for pain management after laparoscopic cholecystectomy and can be used as a part of multimodal analgesia.
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Affiliation(s)
- Korgün Ökmen
- Department of Anesthesiology and Reanimation , Bursa Yuksek Ihtisas Training and Research Hospital, University of Health Sciences , Bursa/TURKEY
| | - Hande Gürbüz
- Department of Anesthesiology and Reanimation , Bursa Yuksek Ihtisas Training and Research Hospital, University of Health Sciences , Bursa/TURKEY
| | - Hakan Özkan
- Department of Anesthesiology and Reanimation , Bursa Yuksek Ihtisas Training and Research Hospital, University of Health Sciences , Bursa/TURKEY
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Edinoff AN, Houk GM, Patil S, Bangalore Siddaiah H, Kaye AJ, Iyengar PS, Cornett EM, Imani F, Mahmoudi K, Kaye AM, Urman RD, Kaye AD. Adjuvant Drugs for Peripheral Nerve Blocks: The Role of Alpha-2 Agonists, Dexamethasone, Midazolam, and Non-steroidal Anti-inflammatory Drugs. Anesth Pain Med 2021; 11:e117197. [PMID: 34540647 PMCID: PMC8438706 DOI: 10.5812/aapm.117197] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 06/22/2021] [Indexed: 12/15/2022] Open
Abstract
Adjuvant drugs for peripheral nerve blocks are a promising solution to acute postoperative pain and the transition to chronic pain treatment. Peripheral nerve blocks (PNB) are used in the brachial plexus, lumbar plexus, femoral nerve, sciatic nerve, and many other anatomic locations for site-specific pain relief. However, the duration of action of a PNB is limited without an adjuvant drug. The use of non-opioid adjuvant drugs for single-shot peripheral nerve blocks (sPNB), such as alpha-2 agonists, dexamethasone, midazolam, and non-steroidal anti-inflammatory drugs, can extend the duration of local anesthetics and reduce the dose-dependent adverse effects of local anesthetics. Tramadol is a weak opioid that acts as a central analgesic. It can block voltage-dependent sodium and potassium channels, cause serotonin release, and inhibit norepinephrine reuptake and can also be used as an adjuvant in PNBs. However, tramadol's effectiveness and safety as an adjuvant to local anesthetic for PNB are inconsistent. The effects of the adjuvants on neurotoxicity must be further evaluated with further studies to delineate the safety in their use in PNB. Further research needs to be done. However, the use of adjuvants in PNB can be a way to help control postoperative pain.
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Affiliation(s)
- Amber N. Edinoff
- Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine, Shreveport, LA, USA
| | - Garrett M. Houk
- School of Medicine, Louisiana State University Shreveport, Shreveport, LA, USA
| | - Shilpa Patil
- Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, USA
| | | | - Aaron J. Kaye
- Medical University of South Carolina, Department of Anesthesiology and Perioperative Medicine, Charleston, SC, USA
| | | | - Elyse M. Cornett
- Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, USA
| | - Farnad Imani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Kamran Mahmoudi
- Pain Research Center, Department of Anesthesiology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Adam M. Kaye
- Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA, USA
| | - Richard D. Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Alan D. Kaye
- Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, USA
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Yang A, Nadav D, Legler A, Chen GH, Hingula L, Puttanniah V, Gulati A. An Interventional Pain Algorithm for the Treatment of Postmastectomy Pain Syndrome: A Single-Center Retrospective Review. Pain Med 2021; 22:677-686. [PMID: 33155049 DOI: 10.1093/pm/pnaa343] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Breast cancer is the most common female malignancy worldwide. Breast surgery and adjuvant oncological therapies are often required to increase survival. Treatment-related pain may persist and evolve into postmastectomy pain syndrome (PMPS) in a significant subset of breast cancer survivors. In this retrospective investigation, we will present our experience in applying an interventional algorithmic approach to treat PMPS. DESIGN A retrospective study. SETTING An academic cancer hospital. SUBJECTS Adult females with PMPS diagnosis. METHODS We reviewed 169 records with the diagnosis of PMPS from 2015 to 2019 within our health system. Pre- and post-injection pain scores, relief duration, and medication usage changes were collected. The decision to perform each procedure was based on the anatomic location of the painful area with the corresponding peripheral sensory innervation. Decision-making flow diagrams were created to present our experience in managing PMPS beyond peripheral nerve blocks. RESULTS Ultrasound-guided peripheral nerve block results (n=350) were analyzed. The mean baseline pain score was 7, compared with the post-treatment mean score of 3 (95% confidence interval: 3.58 to 3.98, P = 0.0001). Among the responders, the mean pain relief duration was 45 days, with a median of 84 days. Opioid medication consumption was reduced by 11% (t = 0.72, P = 0.47). CONCLUSIONS Ultrasound-guided nerve blocks of this area could be performed safely and effectively after breast surgeries. We also present our proposed algorithm to provide a stepwise application for selecting the appropriate therapies in the management of more complex PMPS.
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Affiliation(s)
- Ajax Yang
- Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Anesthesiology and Pain Medicine, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA.,The Spine and Pain Institute of New York, New York, USA
| | - Danielle Nadav
- Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Anesthesiology and Pain Medicine, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
| | - Aron Legler
- Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Grant H Chen
- Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Lee Hingula
- Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Vinay Puttanniah
- Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Amitabh Gulati
- Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Ilfeld BM, Gelfand H, Dhanjal S, Hackworth R, Plunkett A, Turan A, Vijjeswarapu AM, Cohen SP, Eisenach JC, Griffith S, Hanling S, Mascha EJ, Sessler DI. Ultrasound-Guided Percutaneous Peripheral Nerve Stimulation: A Pragmatic Effectiveness Trial of a Nonpharmacologic Alternative for the Treatment of Postoperative Pain. Pain Med 2021; 21:S53-S61. [PMID: 33313729 DOI: 10.1093/pm/pnaa332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Percutaneous peripheral nerve stimulation (PNS) is an analgesic modality involving the insertion of a lead through an introducer needle followed by the delivery of electric current after needle withdrawal. This modality has been used extensively to treat chronic pain, but only small series have been published involving postoperative pain. The ultimate objective of this study is to determine the postoperative effects of percutaneous PNS following moderately to severely painful ambulatory surgery within a real-world clinical practice setting. The primary hypothesis is that surgical pain and opioid consumption during the initial 7 days after surgery will be reduced by percutaneous PNS compared with usual and customary analgesia (dual primary outcome measures). DESIGN A multicenter pragmatic effectiveness trial. We are randomizing participants having painful orthopedic surgical procedures of the upper and lower extremity to receive 14 days of either 1) electrical stimulation or 2) sham in a double-masked fashion. End points are being assessed at various time points over 12 postoperative months. SUMMARY The postoperative experience will be much improved if percutaneous PNS provides potent analgesia while concurrently decreasing opioid requirements following painful surgery. Because this modality can be administered for up to 60 days at home, it may provide postoperative analgesia that outlasts surgical pain yet has relatively few risks and, unlike opioids, has no systemic side effects or potential for abuse, addiction, and overdose. Percutaneous PNS has the potential to revolutionize postoperative analgesia as it has been practiced for the past century. This study will inform key stakeholders regarding an evidence-based nonpharmacologic approach to the management of postoperative pain.
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Affiliation(s)
- Brian M Ilfeld
- Department of Anesthesiology, University of California, San Diego, San Diego, California
| | - Harold Gelfand
- Department of Anesthesiology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Sandeep Dhanjal
- Department of Anesthesiology, Brooke Army Medical Center, Fort Sam Houston, San Antonio, Texas
| | - Robert Hackworth
- Department of Anesthesiology, Naval Medical Center San Diego, San Diego, California
| | - Anthony Plunkett
- Department of Anesthesiology, Womack Army Medical Center, Fort Bragg, Fayetteville, North Carolina
| | - Alparslan Turan
- Department of General Anesthesiology and Outcomes Research, Cleveland Clinic, Cleveland, Ohio
| | - Alice M Vijjeswarapu
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Steven P Cohen
- Department of Anesthesiology, Johns Hopkins University, Baltimore, Maryland
| | - James C Eisenach
- Department of Anesthesiology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Scott Griffith
- Department of Anesthesiology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Steven Hanling
- Department of Physical Medicine and Rehabilitation, Columbia Veterans Affairs Health Care System, Columbia, South Carolina
| | - Edward J Mascha
- Department of Anesthesiology and Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Daniel I Sessler
- Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA
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Imani F, Farahmand Rad R, Salehi R, Alimian M, Mirbolook Jalali Z, Mansouri A, Nader ND. Evaluation of Adding Dexmedetomidine to Ropivacaine in Pediatric Caudal Epidural Block: A Randomized, Double-blinded Clinical Trial. Anesth Pain Med 2021; 11:e112880. [PMID: 34221950 PMCID: PMC8241816 DOI: 10.5812/aapm.112880] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 02/14/2021] [Accepted: 02/14/2021] [Indexed: 02/07/2023] Open
Abstract
Background Caudal block is one of the methods of pain management performed following lower abdominal surgery, though having its own limitations. Objectives In the present study, the effects and side effects of adding dexmedetomidine to ropivacaine in the caudal epidural block were investigated in children after lower abdominal surgery. Methods In this randomized, double-blinded clinical trial, 46 children aged three to six years were divided into two groups to perform a caudal block following lower abdominal surgery under general anesthesia. The injectable solution contained ropivacaine in the R group (1 mL/kg ropivacaine 0.2%), as the control group, and dexmedetomidine (2 µg/kg) and ropivacaine 0.2% (1 mL/kg) in the DR group. The pain score (modified CHEOPS score), duration of analgesia, amount of analgesia consumed (i.v. paracetamol), hemodynamic changes, and possible adverse effects were assessed at one, two, and six hours in both groups. Results The pain score at one and two hours showed no significant difference between the two study groups (P > 0.05). In the DR group, however, the pain score at the sixth hour was significantly lower, and the duration of analgesia was longer (P = 0.001). The amount of analgesic consumption was also lower in the DR group (P = 0.001). However, there was no significant difference in systolic blood pressure and heart rate (P < 0.05), in the case of diastolic blood pressure, a significant difference (P < 0.05) was seen (DR group lower than the R group). There was no statistically significant difference between the study groups in the duration of surgery, recovery time, and side effects (P < 0.05). Conclusions In the present study, the addition of dexmedetomidine to ropivacaine in the caudal epidural blockade improved postoperative analgesia without significant adverse effects in pediatric patients.
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Affiliation(s)
- Farnad Imani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Farahmand Rad
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
- Corresponding Author: Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Reza Salehi
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mahzad Alimian
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Mirbolook Jalali
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Mansouri
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
- Corresponding Author: Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Nader D. Nader
- Department of Anesthesiology, University at Buffalo, Buffalo, USA
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Kumar G, Jaremko KM, Kou A, Howard SK, Harrison TK, Mariano ER. Quality of Patient Education Materials on Safe Opioid Management in the Acute Perioperative Period: What Do Patients Find Online? Pain Med 2021; 21:171-175. [PMID: 30657963 DOI: 10.1093/pm/pny296] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Guidelines on postoperative pain management recommend inclusion of patient and caregiver education on opioid safety. Patient education materials (PEMs) should be written at or below a sixth grade reading level. We designed this study to compare the readability of online PEMs related to postoperative opioid management produced by institutions with and without a regional anesthesiology and acute pain medicine (RAAPM) fellowship. METHODS With institutional review board exemption, we constructed our cohort of PEMs by searching RAAPM fellowship websites from North American academic medical centers and identified additional websites using structured Internet searches. Readability metrics were calculated from PEMs using the TextStat 0.4.1 textual analysis package for Python 2.7. The primary outcome was the Flesch-Kincaid Grade Level (FKGL), a score based on words per sentence and syllables per word. We also compared fellowship-based and nonfellowship PEMs on the presence or absence of specific content-related items. RESULTS PEMs from 15 fellowship and 23 nonfellowship institutions were included. The mean (SD) FKGL for PEMs was grade 7.84 (1.98) compared with the recommended sixth grade level (P < 0.001) and was not different between groups. Less than half of online PEMs contained explicit discussion of opioid tapering or cessation. Disposal and overdose risk were addressed more often by nonfellowship PEMs. CONCLUSIONS Available online PEMs related to opioid management are beyond the recommended reading level, but readability metrics for online PEMs do not differ between fellowship and nonfellowship groups. More than two-thirds of RAAPM fellowship programs in North America are lacking readable online PEMs on safe postoperative opioid management.
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Affiliation(s)
- Gunjan Kumar
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California.,Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Kellie M Jaremko
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alex Kou
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California.,Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Steven K Howard
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California.,Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - T Kyle Harrison
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California.,Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Edward R Mariano
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California.,Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
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da Silveira MT, Batista SM, Mamede Veloso SR, de Oliveira NG, de Vasconcelos Carvalho M, de Melo Monteiro GQ. Effect of Reciprocating and Rotary Systems on Postoperative Pain: A Systematic Review and Meta-Analysis. Iran Endod J 2021; 16:1-16. [PMID: 36704409 PMCID: PMC9709880 DOI: 10.22037/iej.v16i1.27944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 11/05/2020] [Accepted: 11/22/2020] [Indexed: 01/28/2023]
Abstract
Introduction Our study aimed to compare the incidence and intensity of postoperative pain after endodontic instrumentation with reciprocating and rotary systems. Methods and Materials An electronic literature search was performed with MEDLINE via PubMed, Scopus, and Web of Science databases from January 2008 to June 2020. Two high-impact endodontic journals were also hand searched. The selection criteria were: 1) Population; patients requiring endodontic treatment (primary or secondary), 2) Intervention and Comparison; endodontic instrumentation with reciprocating versus rotary systems, and 3) Outcome; postoperative pain. We extrapolated all included research data and reported them as dichotomized ordinal variables to evaluate the incidence of pain and continuous variables to assess pain intensity. Standardized mean difference (SMD) was calculated with Inverse Variance method for pain intensity; the incidence of postoperative pain was calculated using relative risk (RR) with the Mantel-Haenszel method. Random-effects model and 95% confidence interval (CI) were used for all meta-analyses. The I2 statistic was used to evaluate the statistical heterogeneity among studies (P<0.05). Results Twenty-one articles were selected and 17 of them were included in the meta-analysis for the evaluation of postoperative pain in the first 24 h. The meta-analysis was performed in two steps: a) all studies were included; b) subsequently studies with preoperative pain were excluded. A significant difference was observed in the intensity of postoperative pain; with rotary system having more favorable in both steps [a) SMD: 0.27; 95% CI: 0.13 to 0.41; P=0.0002; b) SMD: 0.37; 95% CI: 0.15 to 0.58; P=0.0010]. There was no significant difference in the incidence of pain, and the incidence of mild, moderate and severe pain (P>0.05). Conclusion The meta-analysis results revealed that rotary system were the instrument of choice as they had lower intensity of postoperative pain. Further controlled studies are advocated to provide clarification for intensity/incidence of postoperative pain in endodontic treatment with mechanized instruments.
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Affiliation(s)
| | | | | | | | - Marianne de Vasconcelos Carvalho
- Dental School, Universidade de Pernambuco/FOP-UPE, Brazil,Corresponding author: Marianne de Vasconcelos Carvalho, Av. General Newton Cavalcanti, 1650; Tabatinga, Camaragibe-PE, Brazil; Zip code: 54.756-220. Tel: +55 81 3184-7659, E-mail:
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Chen J, Tong Y, Cheng Y, Xue Z, Liu M. Establishment and Empirical Evaluation of a Quality Indicator System for Postoperative Pain Management. Pain Med 2020; 21:3270-3282. [PMID: 33040153 DOI: 10.1093/pm/pnaa221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES This study aimed to establish a quality indicator system for postoperative pain management and test its reliability, validity, and discrimination in China. METHODS We established a quality indicator system using the Delphi method. Further, we designed and administered a survey questionnaire in the orthopedic departments of nine hospitals, located in the Zhejiang and Jiangsu Provinces, through purposive and convenience sampling methods to examine the reliability, validity, and discrimination of the quality indicator system. RESULTS We established a quality indicator system to assess structure, process, and outcome measures of postoperative pain management using three first-level, eight subordinate second-level, and 32 subordinate third-level quality indicators. The scale-level content validity indexes of the three sections of the questionnaire, assessing structure, process, and outcomes measures, were 0.99, 0.98, and 0.98, respectively. We identified two common factors from the third section that demonstrated a cumulative variance contribution rate of 80.38% and a Cronbach's α coefficient of 0.95. The total scores and scores of the structure, process, and outcome quality indicators demonstrated statistically significant differences (P < 0.05) between the wards (N = 4) that participated in the "Painless Orthopedics Ward" quality improvement program and those (N = 5) that did not. CONCLUSIONS This quality indicator system highlights the need for multidisciplinary cooperation and process characteristics of postoperative pain management, along with interdepartmental quality comparisons. And it demonstrates acceptable reliability, validity, and discrimination; thus it may be completely or partially employed in Chinese hospitals.
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Affiliation(s)
- Jiajia Chen
- Medical College, Hangzhou Normal University, Hangzhou, China.,Department of Anesthesiology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Yingge Tong
- Medical College, Hangzhou Normal University, Hangzhou, China
| | - Yan Cheng
- Zhejiang Provincial People's Hospital, Hangzhou, China
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Hilleman DE, Malesker MA, Aurit SJ, Morrow L. Evidence for the Efficacy of an Opioid-Sparing Effect of Intravenous Acetaminophen in the Surgery Patient: A Systematic Review. Pain Med 2020; 21:3301-3313. [PMID: 32869091 DOI: 10.1093/pm/pnaa256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Intravenous (IV) acetaminophen is used in multimodal analgesia to reduce the amount and duration of opioid use in the postoperative setting. METHODS A systematic review of published randomized controlled trials was conducted to define the opioid-sparing effect of IV acetaminophen in different types of surgeries. Eligible studies included prospective, randomized, double-blind trials of IV acetaminophen compared with either a placebo- or active-treatment group in adult (age ≥18 years) patients undergoing surgery. Trials had to be published in English in a peer-reviewed journal. RESULTS A total of 44 treatment cohorts included in 37 studies were included in the systematic analysis. Compared with active- or placebo-control treatments, IV acetaminophen produced a statistically significant opioid-sparing effect in 14 of 44 cohorts (32%). An opioid-sparing effect was more common in placebo-controlled comparisons. Of the 28 placebo treatment comparisons, IV acetaminophen produced an opioid-sparing effect in 13 (46%). IV acetaminophen produced an opioid-sparing effect in only 6% (one out of 16) of the active-control groups. Among the 16 active-control groups, opioid consumption was significantly greater with IV acetaminophen than the active comparator in seven cohorts and not significantly different than the active comparator in eight cohorts. CONCLUSIONS The results of this systematic analysis demonstrate that IV acetaminophen is not effective in reducing opioid consumption compared with other adjuvant analgesic agents in the postoperative patient. In patients where other adjuvant analgesic agents are contraindicated, IV acetaminophen may be an option.
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Affiliation(s)
- Daniel E Hilleman
- Department of Pharmacy Practice, Creighton University School of Pharmacy and Health Professions, Omaha, Nebraska
| | - Mark A Malesker
- Department of Pharmacy Practice, Creighton University School of Pharmacy and Health Professions, Omaha, Nebraska
| | - Sarah J Aurit
- Department of Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Lee Morrow
- Department of Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
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Sugragan C, Sirintawat N, Kiattavornchareon S, Khoo LK, Kc K, Wongsirichat N. Do corticosteroids reduce postoperative pain following third molar intervention? J Dent Anesth Pain Med 2020; 20:281-291. [PMID: 33195806 PMCID: PMC7644360 DOI: 10.17245/jdapm.2020.20.5.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/05/2020] [Accepted: 08/10/2020] [Indexed: 12/03/2022] Open
Abstract
Background Corticosteroids have been widely used by oral surgeons for reducing swelling caused by wisdom teeth surgery. However, they have not been proven to decrease pain. This study was aimed at analyzing previous studies pertaining to corticosteroids and pain reduction following wisdom teeth surgery. Methods The Science Direct, PubMed, and MEDLINE databases were searched for relevant journals according to a systematic search strategy (Patient Intervention Comparison Outcome Study). Randomized controlled trials published in English from 1998 to 2017 were extracted. Results Twenty-seven articles were included, with a total of 36 comparative cases. Methylprednisolone and dexamethasone were the most commonly used corticosteroids. Intramuscular injections of corticosteroids were optimal for pain reduction, regardless of the time of administration. Conclusions Corticosteroids can be used as an adjuvant for pain reduction following wisdom teeth surgery. Methylprednisolone and dexamethasone delivered via the intramuscular route is the best method for effective pain reduction. The ideal time for administration of corticosteroids is the preoperative period.
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Affiliation(s)
- Chollathit Sugragan
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Nattapong Sirintawat
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | | | - Lee Kian Khoo
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Kumar Kc
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Natthamet Wongsirichat
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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Yeo J, Sia AT, Sultana R, Sng BL, Tan EC. Analysis of SCN9A Gene Variants for Acute and Chronic Postoperative Pain and Morphine Consumption After Total Hysterectomy. Pain Med 2020; 21:2642-2649. [PMID: 32403129 DOI: 10.1093/pm/pnaa109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Single nucleotide polymorphisms (SNPs) of the voltage-gated sodium channel alpha subunit gene (SCN9A) have been associated with pain in various settings. The aim of this study was to investigate the association of the SNPs to evaluate the influence of common gene variants on chronic postoperative pain (CPSP) and other related pain variables in a cohort of patients who underwent a scheduled hysterectomy. METHODS DNA samples from a cohort of 1,075 patients who underwent a scheduled total hysterectomy in our hospital were genotyped for three common SCN9A SNPs using TaqMan assays. Multivariate logistic regression models were used to quantify the association between independent covariates such as pain threshold, pain endurance, pain scores, morphine use, and the presence of chronic pain. RESULTS Frequencies of the minor alleles were different between the different ethnic groups. There was a statistically significant association of rs16851799 with morphine consumption and self-reported postoperative pain for the 1,038 subjects genotyped, with the TT genotype reporting higher pain and using more morphine. For the subpopulation of 446 subjects with chronic pain data, there was a similar association with self-reported postoperative pain and tolerance of pressure pain. Univariate analysis also showed a statistically significant association of rs16851799 with CPSP, whereas multivariable analysis revealed a similar association of rs4387806 with this outcome. There were three haplotypes with different relative frequencies for the CPSP and non-CPSP groups. CONCLUSIONS Our results showed that SCN9A polymorphisms could play a role in acute pain perception and the susceptibility to chronic pain.
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Affiliation(s)
| | - Alex T Sia
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore
| | - Rehana Sultana
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Ban Leong Sng
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore
| | - Ene-Choo Tan
- Research Laboratory, KK Women's and Children's Hospital and Paediatrics Academic Clinical Programme, SingHealth Duke-NUS Medical School, Singapore
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Knaak C, Spies C, Schneider A, Jara M, Vorderwülbecke G, Kuhlmann AD, von Haefen C, Lachmann G, Schulte E. Epidural Anesthesia in Liver Surgery-A Propensity Score-Matched Analysis. Pain Med 2020; 21:2650-2660. [PMID: 32651587 DOI: 10.1093/pm/pnaa130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To assess the effects of epidural anesthesia (EA) on patients who underwent liver resection. DESIGN Secondary analysis of a prospective randomized controlled trial. SETTING This single-center study was conducted at an academic medical center. METHODS A subset of 110 1:1 propensity score-matched patients who underwent liver resection with and without EA were analyzed. Outcome measures were pain intensity ≥5 on a numeric rating scale (NRS) at rest and during movement on postoperative days 1-5, analyzed with logistic mixed-effects models, and postoperative complications according to the Clavien-Dindo classification, length of hospital stay (LOS), and one-year survival. One-year survival in the matched cohorts was compared using a frailty model. RESULTS EA patients were less likely to experience NRS ≥5 at rest (odds ratio = 0.06, 95% confidence interval [CI] = 0.01 to 0.28, P < 0.001). These findings were independent of age, sex, Charlson comorbidity index, baseline NRS, and surgical approach (open vs laparoscopic). The number and severity of postoperative complications and LOS were comparable between groups (P = 0.258, P > 0.999, and P = 0.467, respectively). Reduced mortality rates were seen in the EA group one year after surgery (9.1% vs 30.9%, hazard ratio = 0.32, 95% CI = 0.11 to 0.90, P = 0.031). No EA-related adverse events occurred. Earlier recovery of bowel function was seen in EA patients. CONCLUSIONS Patients with EA had better postoperative pain control and required fewer systemic opioids. Postoperative complications and LOS did not differ, although one-year survival was significantly improved in patients with EA. EA applied in liver surgery was effective and safe.
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Affiliation(s)
- Cornelia Knaak
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Claudia Spies
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Alice Schneider
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Maximilian Jara
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Gerald Vorderwülbecke
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Anna Dorothea Kuhlmann
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Clarissa von Haefen
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Gunnar Lachmann
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Erika Schulte
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Carter JA, Black LK, Sharma D, Bhagnani T, Jahr JS. Efficacy of non-opioid analgesics to control postoperative pain: a network meta-analysis. BMC Anesthesiol 2020; 20:272. [PMID: 33109098 PMCID: PMC7592505 DOI: 10.1186/s12871-020-01147-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/03/2020] [Indexed: 12/19/2022] Open
Abstract
Background The aim of this network meta-analysis (NMA) was to evaluate the safety and efficacy of intravenous (IV) Meloxicam 30 mg (MIV), an investigational non-steroidal anti-inflammatory drug (NSAID), and certain other IV non-opioid analgesics for moderate-severe acute postoperative pain. Methods We searched PubMed and CENTRAL for Randomized Controlled Trials (RCT) (years 2000–2019, adult human subjects) of IV non-opioid analgesics (IV NSAIDs or IV Acetaminophen) used to treat acute pain after abdominal, hysterectomy, bunionectomy or orthopedic procedures. A Bayesian NMA was conducted in R to rank treatments based on the standardized mean differences in sum of pain intensity difference from baseline up to 24 h postoperatively (sum of pain intensity difference: SPID 24). The probability and the cumulative probability of rank for each treatment were calculated, and the surface under the cumulative ranking curve (SUCRA) was applied to distinguish treatments on the basis of their outcomes such that higher SUCRA values indicate better outcomes. The study protocol was prospectively registered with by PROSPERO (CRD42019117360). Results Out of 2313 screened studies, 27 studies with 36 comparative observations were included, producing a treatment network that included the four non-opioid IV pain medications of interest (MIV, ketorolac, acetaminophen, and ibuprofen). MIV was associated with the largest SPID 24 for all procedure categories and comparators. The SUCRA ranking table indicated that MIV had the highest probability for the most effective treatment for abdominal (89.5%), bunionectomy (100%), and hysterectomy (99.8%). MIV was associated with significantly less MME utilization versus all comparators for abdominal procedures, hysterectomy, and versus acetaminophen in orthopedic procedures. Elsewhere MME utilization outcomes for MIV were largely equivalent or nominally better than other comparators. Odds of ORADEs were significantly higher for all comparators vs MIV for orthopedic (gastrointestinal) and hysterectomy (respiratory). Conclusions MIV 30 mg may provide better pain reduction with similar or better safety compared to other approved IV non-opioid analgesics. Caution is warranted in interpreting these results as all comparisons involving MIV were indirect.
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Affiliation(s)
- John A Carter
- Blue Point LLC, 711 Warrenville Road, Wheaton, IL, 60189, USA.
| | | | | | | | - Jonathan S Jahr
- Department of Anesthesiology and Perioperative Medicine, UCLA, Los Angeles, CA, USA
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Yoon JY, Park JH, Lee KJ, Kim HS, Rhee SM, Oh JH. The effect of postoperatively applied far-infrared radiation on pain and tendon-to-bone healing after arthroscopic rotator cuff repair: a clinical prospective randomized comparative study. Korean J Pain 2020; 33:344-351. [PMID: 32989199 PMCID: PMC7532301 DOI: 10.3344/kjp.2020.33.4.344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/09/2020] [Accepted: 07/04/2020] [Indexed: 11/25/2022] Open
Abstract
Background The effects of far-infrared radiation (FIR) on the treatment of rotator cuff diseases remains unknown. We evaluated the safety and efficacy of FIR after arthroscopic rotator cuff repair with regard to postoperative pain and healing. Methods This prospective randomized comparative study included 38 patients who underwent arthroscopic rotator cuff repair due to a medium-sized tear. Patients were randomly divided into the FIR or control group (n = 19 per group). In the FIR group, FIR with an FIR radiator started 1 week postoperatively for 30 minutes per session twice daily. It lasted until abduction brace weaning at 5 weeks postoperatively. We assessed pain using a pain visual analogue scale (pVAS) and measured the range of motion (ROM) of the shoulder at 5 weeks, and 3 and 6 months, postoperatively. The anatomical outcome was evaluated using magnetic resonance imaging at 6 months postoperatively. Results At 5 weeks postoperatively, the average pVAS score was lower in the FIR group than in the control group (1.5 ± 0.8 vs. 2.7 ± 1.7; P = 0.019). At 3 months postoperatively, the average forward flexion was higher in the FIR group (151.6° ± 15.3° vs. 132.9° ± 27.8°; P = 0.045), but there was no significant difference at 6 months postoperatively. There was no significant difference in healing failure between the groups (P = 0.999). Conclusions FIR after arthroscopic rotator cuff repair could be an effective and safe procedure to reduce postoperative pain, thereby facilitating rehabilitation and better ROM in the early postoperative period.
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Affiliation(s)
- Ji Young Yoon
- Department of Orthopaedic Surgery, National Police Hospital, Seoul, Korea
| | - Joo Hyun Park
- Department of Orthopaedic Surgery, Bundang Jesaeng Genenral Hospital, Seongnam, Korea
| | - Kwang Jin Lee
- Department of Orthopaedic Surgery, Sun's Hospital, Seoul, Korea
| | - Hyong Suk Kim
- Department of Orthopaedic Surgery, Incheon Sarang Hospital, Incheon, Korea
| | - Sung-Min Rhee
- Department of Orthopeadic Surgery, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Joo Han Oh
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Amiri HR, Ohadian Moghadam S, Momeni SA, Amini M. Preemptive Analgesia with a Second Dose of Pregabalin, Acetaminophen, Naproxen, and Dextromethorphan: A Comparative Clinical Trial in Major Surgeries. Anesth Pain Med 2020; 10:e100718. [PMID: 34150558 PMCID: PMC8207851 DOI: 10.5812/aapm.100718] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 08/03/2020] [Accepted: 08/08/2020] [Indexed: 01/14/2023] Open
Abstract
Background Postoperative pain management can improve patients’ quality of life and decrease hospitalization rates. Preemptive analgesia may provide an effective approach for both pain control and opioid consumption decrease. A common approach for pain management after surgery is to relieve the pain that has already occurred. Objectives The aim of this clinical trial was to compare the preemptive analgesic effect of single-dose versus two-dose administration of pregabalin, acetaminophen, naproxen, and dextromethorphan (PAND) combination. Methods This study involved 60 patients who had undergone one surgery (including nephrectomy, cystectomy, prostatectomy, colectomy, Whipple, and RPLND). They were randomly divided into two groups: The first group received a single dose of PAND, while the other group received a second dose within 6 hours after discharge from recovery. Pain intensity was assessed by the Universal Pain Assessment Tool (UPAT) in both groups 2, 4, 6, 8, 12, 24, and 48 hours postoperatively. The postoperative morphine dose in both groups was also recorded. Data were analyzed using SPSS version 25. Results Mean pain scores were significantly different between the two groups at 2, 12, 24, and 48 hours after surgery (P < 0.05). There was a statistically significant difference between the two groups in terms of opioid consumption (P < 0.001). The total opioid consumption in the second group (with the second administration of PAND) was lower than the first group. Conclusions Preemptive analgesia with a second dose of PAND is an effective method for reducing pain and morphine consumption after surgery.
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Affiliation(s)
- Hamid Reza Amiri
- Uro-Oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Seyed Ali Momeni
- Uro-Oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Majid Amini
- Department of Anesthesiology and Critical Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding Author: Department of Anesthesiology and Critical Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
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