Role of Oral Curcumin as an Analgesic for Pain Management in Breast Cancer Surgery: A Randomised Control Trial

Introduction: Postoperative pain management is of prime importance to the surgeon, as it significantly influences a patient’s recovery. A multimodal approach to pain management is an essential component of postoperative care. Curcumin, a natural antioxidant and anti-inflammatory compound, also exhibits analgesic properties. However, its use in the postoperative setting has not been extensively studied. Aim: To evaluate the role of oral curcumin as an analgesic in the management of postoperative pain following breast cancer surgery. Materials and Methods: This was a single-blind, randomised controlled trial that was conducted in the Department of Surgical Oncology, Cancer Research Institute, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India and included 60 patients undergoing surgery for breast cancer between October 2023 and April 2024. The study group was administered oral curcumin lozenges twice daily, along with standard analgesics, from Postoperative Day (POD) 1. The control group received a placebo. Postoperative pain was assessed from POD 0 to POD 7 using the 11-point Numeric Pain Scale (NPS) and compared using the independent t-test performed with the Statistical Package for the Social Sciences (SPSS) version 25.0. Results: Sixty patients were enrolled (30 in each group). One patient in the study group was excluded from the final analysis as the study protocol was not followed; therefore, 59 patients were analysed. A statistically significant difference in pain scores between the study and control groups was observed on POD 6 and POD 7 (p-value=0.006). No significant difference was observed between the groups regarding the use of SOS analgesics (p-value=0.322) or drain output (p-value>0.05). No adverse events were reported by any patient in the study group. Conclusion: This study demonstrated that curcumin may be beneficial in postoperative pain management. The use of a nutraceutical such as curcumin, with its favourable safety profile and minimal side-effects, offers a promising option. A longer follow-up period is warranted to fully explore the analgesic potential of curcumin. Additionally, studies employing a doubleblind design and larger sample sizes are recommended to provide further evidence of its effectiveness in postoperative pain management.

#36889 Closing the gaps in postoperative pain management: challenges and future perspectives

A Systematic Review of Race, Sex, and Socioeconomic Status Differences in Postoperative Pain and Pain Management

This systematic review and meta-analysis evaluated the impact of intraoperative epidural steroid-soaked gelatin sponge in lumbar spine surgery for conditions like spinal stenosis and nerve root compression. Surgery often involves removing structures to decompress the nerves. Steroids are used to alleviate inflammation and pain, with gelatin sponges serving as carriers to extend their effect. While epidural steroid injections have been effective, the combined use of gelatin sponges remains controversial. The study systematically searched databases including PubMed, MEDLINE, and Cochrane Central Registry of Controlled Trials databases involving lumbar surgeries using steroid-soaked gelatin sponges. Seven studies with 620 patients were included, focusing on postoperative pain scores, analgesic use, hospital stay, and complications. The quality of the studies was assessed using the Cochrane Risk of Bias 2 tool. Results showed no significant difference in pain scores between the steroid and control groups on postoperative day 1 and at three months. However, there was a trend toward reduced pain in the steroid group. Notably, patients in the steroid group required fewer analgesics, indicating a significant reduction in postoperative pain medication use. Other factors, such as surgery time, blood loss, and hospital stay, showed no statistically significant differences between the groups. The findings suggest that while the use of steroid-soaked gelatin sponges does not significantly change immediate postoperative pain levels, it may contribute to improved pain management. This approach is safe, with minimal risk of complications, and may provide prolonged, localized effects due to the slow release of steroids. Future large-scale randomized trials are needed to further validate these findings. In conclusion, the use of steroid-soaked gelatin sponges in lumbar spine surgery is a feasible option to consider, with potential benefits in postoperative pain management and reduced analgesic consumption.

To define the factors that affect patient's self-assessed postoperative pain after photorefractive keratectomy (PRK). Patients who underwent PRK in 2016 were evaluated. Anonymized data collected included patient gender, age, and season at the time of surgery, ablation depth, surgeon status (attending vs. resident), topical tetracaine use, and subjective pain scores at postoperative days (PODs) 1 and 7. Average pain scores and amount of pain medication taken were analyzed for each of the previously mentioned variables. Overall, 231 patients who underwent PRK were analyzed. The mean pain score and SD were 0.78 ± 1.87 on POD 1 and 0.03 ± 0.37 by POD 7. Patients who used topical tetracaine reported significantly higher pain on POD 1 and 7 compared with patients who did not use tetracaine (P < 0.001 and P = 0.038, respectively). No significant differences in pain scores were seen based on surgeon status, ablation depth, gender, and season. Patients who used topical tetracaine took a higher amount of oral pain medication (9.44 ± 6.01) compared with those who did not (7.02 ± 4.71) (P = 0.022). Postoperative pain was significantly elevated in patients who used tetracaine on POD 1 and POD 7. These patients were also more likely to take oral pain medication than those who did not use topical tetracaine. Surgeon status, season, gender, and ablation depth showed no significant differences in subjective pain scores. Oral pain medication should be evaluated to assess efficacy and safety in inhibiting ocular pain after PRK.

Over the past 2 years, the COVID-19 pandemic has impacted the entire health-care profession, and spinal surgery had to adjust along with it. Although it may take years to truly assess the overall effect, early trends have clearly pointed toward a patient demand for telemedicine. Additionally, as COVID strained our hospitals and diverted critical resources away from elective surgical procedures, non-time-sensitive cases have been increasingly pushed out to outpatient surgical centers. Decreased inpatient elective surgical capability has also forced more patients to pursue extended nonoperative treatment modalities. Although it remains too early to determine the long-term impact of these shifts, we expect future studies to examine these issues extensively. This annual update on spine surgery includes an examination of peer-reviewed literature for all spinal conditions, in addition to abstracts presented at annual society meetings, over the past year. We chose these articles due to their potential to impact and advance our profession, with a preference toward the highest levels of evidence. Spondylotic Cervical Myelopathy Several interesting studies published recently added to our understanding of optimal surgical treatment for spondylotic cervical myelopathy. In the Cervical Spondylotic Myelopathy Surgical (CSM-S) randomized clinical trial, Ghogawala et al. compared the impact of anterior surgery with that of posterior surgery on patient outcomes1. In a select population in which clinical equipoise existed (exclusion of patients with kyphosis of >5°, ossification of the posterior longitudinal ligament, or segmental kyphotic deformity), 1-year and 2-year Short Form-36 (SF-36) Physical Component Summary (PCS) scores were not different between the 2 groups. The authors did identify a higher complication rate in the anterior surgery group, with dysphagia predominating. The major complication rates did not differ. Interestingly, in the nonrandomized analysis comparing laminoplasty, posterior cervical fusion, and anterior cervical fusion, the patients who underwent laminoplasty fared significantly better in physical function, complication rate, and resource utilization. Posterior cervical fusion is more commonly performed in the United States, and a recent study demonstrated that laminoplasty is likely underutilized despite growing evidence for improved performance metrics2. Current literature has mixed results with regard to determination of the optimal lower instrumented vertebra (LIV) in long posterior cervical fusions. In addressing the question of crossing the cervicothoracic junction, Truumees et al.3 evaluated patient-reported outcomes, radiographic outcomes, and revision rates in fusions stopping at C6/7 or T1/2 in a retrospective analysis of 264 patients with at least a 2-year follow-up. Patient-reported outcome measures improved equally in both groups. Radiographic outcomes were similar between groups, with both groups demonstrating similar improvement in cervical lordosis. The study did not detect a difference in revision rates, but was not powered to do so. Patients who underwent fusions into the thoracic spine did have more blood loss and longer operative time. Similarly, in a retrospective cohort study with a 4-year follow-up, Guppy et al. did not identify a difference in reoperation rates for adjacent segment disease4 or pseudarthrosis5 when cervical fusions were stopped at C7 or T1/T2. In the absence of extenuating factors, stopping at C7 may be a reasonable option given the lower morbidity and complication rate, although further work is needed in this area. Cervical Radiculopathy Numerous studies have been published comparing cervical disc arthroplasty with anterior cervical discectomy and fusion (ACDF). However, many of these studies may have been biased by industry sponsorship and a lack of blinded outcome assessment. The Norwegian Cervical Arthroplasty Trial (NORCAT) was designed as a blinded and randomized clinical trial of 136 patients comparing patient-reported outcomes after ACDF or cervical disc arthroplasty for single-level disease6. The patients and surgeons were blinded, with the treatment arm revealed to the surgeon only after neurologic decompression was completed. Both groups demonstrated a significant improvement in the Neck Disability Index (NDI) at 5 years, without a difference observed between groups. Secondary outcomes, including neck pain, arm pain, and adjacent segment disease, were not different between groups. The reoperation rate was not significantly different between groups, and nearly all reoperations were at the index level. Only 1 patient underwent reoperation for adjacent segment disease at 5 years. This study demonstrates that clinical outcomes are likely independent of implant choice; however, the effect on adjacent segment disease needs to be addressed with longer-term follow-up. The 10-year Investigational Device Exemption (IDE) trial data for the Bryan and Mobi-C cervical disc arthroplasty devices are now available. In a study comparing adverse events between the Bryan cervical disc arthroplasty and ACDF, Loidolt et al. demonstrated a similar rate of adverse events over a 10-year period7. The rate of revision surgery at the index level was not significantly different between the 2 groups. The rate of adjacent level surgery in the ACDF group trended higher (15.8% compared with 9.7%) but did not reach significance at 10 years. Additionally, the 10-year outcomes from the Mobi-C IDE trial were published8. This study was limited by lack of an ACDF control group and had an approximately 73% follow-up rate from the original cohort. At 10 years, the authors identified a rate of revision surgery of 5.1% at the index level and 4.3% at the adjacent level. No serious adverse events were reported between 7 and 10 years. One of the most common symptoms after anterior cervical surgery is dysphagia. In a meta-analysis of 7 randomized controlled trials, Garcia et al. evaluated the dysphagia rate after ACDF with prophylactic administration of local or intravenous corticosteroid9. The study provides moderate-quality evidence that the administration of corticosteroids reduces the dysphagia rate and severity after ACDF. A subgroup of studies on the pseudarthrosis rate did not identify a difference. No infections were reported in this meta-analysis. In a recent, well-designed, randomized, and double-blinded controlled trial, Kim et al.10 corroborated these results: after undergoing multilevel ACDF, patients received retropharyngeal corticosteroid or placebo. Dysphagia was assessed with validated outcomes. The corticosteroid group had significantly better scores at all time points up to 1 month. These results suggest that corticosteroid administration likely reduces dysphagia rates, although the effect on pseudarthrosis remains to be fully elucidated. Lumbar Disc Herniation and Lumbar Degenerative Conditions Lumbar disc herniation remains a common clinical problem11. Several recent studies have examined options for the management of lumbar disc herniation. In a randomized controlled trial, Wilby et al. compared microdiscectomy with transforaminal epidural corticosteroid injection in patients with persistent radicular pain for <1 year secondary to disc herniation12. The authors found that there were no significant differences in pain scores between the epidural injection group and the surgery group, although 18% of the injection group underwent a surgical procedure prior to the completion of the study. The authors also posited that a surgical procedure is less cost-effective than an epidural injection, although this work is ongoing. In a systematic review and meta-analysis, Wei et al. compared open microdiscectomy, microendoscopic discectomy, percutaneous endoscopic discectomy, tubular discectomy, and percutaneous discectomy13. The authors found no significant differences between most approaches, except that percutaneous endoscopic discectomy had the best safety and efficacy, although this review was limited by the heterogeneity of the included studies. Ran et al. compared computed tomography (CT)-navigated percutaneous endoscopic discectomy with open microdiscectomy in 68 patients and found that the percutaneous discectomy group reported less postoperative back pain and the percutaneous approach generated lower serum markers of muscle trauma14. In a systematic review and meta-analysis, Gadjradj et al. found that moderate-quality evidence supports percutaneous transforaminal endoscopic discectomy as an equivalent treatment to open microdiscectomy, but there is a paucity of high-quality evidence comparing the 2 approaches15. Additionally, the topic of annular repair or other implants to reduce reherniation rates has been reexamined in the last 2 years. In a systematic review, Rickers et al. found a trend toward improved outcomes with annular repair. In contradistinction to the prior study, the authors also found that percutaneous discectomy performed the worst of all current surgical approaches, although, overall, there were no significant differences between treatments16. Additionally, the risk of bias was high in 15 of the 32 included studies. The debate with regard to the optimal management protocol for lumbar degenerative spondylolisthesis has continued lately. Heemskerk et al.17 compared open transforaminal lumbar interbody fusion (TLIF) and minimally invasive surgery (MIS)-TLIF for patient-reported outcomes, and Droeghaag et al.18 compared open TLIF and MIS-TLIF for cost-effectiveness. Heemskerk et al. found that MIS-TLIF and open TLIF had equivalent outcomes at the 2-year follow-up; Droeghaag et al. found that MIS-TLIF is more cost-effective than open TLIF. These results suggest that MIS-TLIF may be an important tool in the long-term management of lumbar degenerative spondylolisthesis. However, in a meta-analysis of 7 studies, Zhang et al. found that oblique lateral interbody fusion with supplementary posterior fixation yielded better improvements in symptoms compared with MIS-TLIF and was associated with a shorter operative time19. Furthermore, the type of posterior fixation for lumbar fusion remains controversial. In a systematic review and meta-analysis, Chang et al. compared traditional pedicle screws with cortical-based trajectory screws for the treatment of lumbar degenerative spondylolisthesis in patients who underwent interbody fusion20. The authors found that cortical screws were associated with decreased operative time and less blood loss during the surgical procedure, but the overall fusion rates were similar at 1 year. Additionally, Zhu et al. performed a systematic review and meta-analysis comparing MIS-TLIF and endoscopic TLIF, which demonstrated the noninferiority of the endoscopic approach compared with traditional minimally invasive techniques21. The applications of navigation and robotics continue to rapidly expand in the field of spinal surgery. Fu et al.22 and Zhou et al.23 both performed meta-analyses comparing the freehand placement of pedicle screws with robotic-assisted placement. Both studies found significant improvements in pedicle screw accuracy, including reduced violation of the cephalad facet joint and intraoperative radiation dose, with robotic assistance, although revision rates for screw malpositioning were similar in the latter article. Klingler et al. performed a randomized trial of fluoroscopically assisted MIS-TLIF and navigated TLIF and found that the type of navigation used in the study did not significantly reduce radiation exposure to the surgeon, while simultaneously increasing radiation exposure to the patient24. Therefore, the role of navigation and robotics is still being developed. There has also been increasing interest in single-position prone lateral lumbar interbody fusion as an option for patients requiring surgical stabilization for spondylolisthesis. Walker et al. performed a retrospective review of 30 patients with spondylolisthesis undergoing either prone or lateral decubitus lateral interbody fusion with posterior instrumentation25. The authors found that the prone position yielded significantly improved segmental lordosis compared with the traditional position. Additionally, Guiroy et al. performed a systematic review comparing these approaches and found that single-position lateral decubitus trended toward shorter operative time and hospital stay, although only 4 studies were included26. Interestingly, in a separate systematic review and meta-analysis, Mills et al. examined lateral decubitus compared with the prone position without repositioning and found that the single-position lateral decubitus reduced operative time and radiation exposure compared with the prone position, and the improvement in segmental lordosis was higher in the prone group27. However, pedicle screws placed using the lateral decubitus position had a higher rate of complications. Perioperative Pain Management There has been increasing interest in the utilization of local or regional anesthesia for pain control in patients undergoing lumbar spinal surgery. Erector spinae plane blockade continues to gain traction in this regard. In randomized controlled trials, Jin et al.28 examined the efficacy of an erector spinae plane block in patients undergoing lumbar laminoplasty, and Zhu et al.29 and Goel et al.30 examined the efficacy of an erector spinae plane block in patients undergoing single-level lumbar fusion. The authors found that erector spinae plane blockade resulted in significantly reduced postoperative pain scores, reduced opioid consumption, and higher patient satisfaction, suggesting that erector spinae plane blockade should become more routinely utilized in the perioperative period. Liposomal bupivacaine injection is an additional multimodal pain management technique to reduce postoperative pain and opioid consumption. Nguyen et al. performed a systematic review of retrospective cohort studies and randomized controlled trials investigating this technique and found that lower-quality evidence supports its use and moderate-quality studies were equivocal31. The authors maintained that higher-quality studies are needed before the efficacy of this technique can be fully appreciated. Multimodal anesthesia and various enhanced recovery after surgery (ERAS) postoperative pain management protocols have been developed to expedite patient recovery and improve satisfaction after spinal surgery. Recently, there have been several high-quality studies adding to the data on this topic. Soffin et al. published a trial of 56 patients randomized to either the ERAS protocol after lumbar fusion or traditional postoperative pain management, finding decreased opioid consumption and improved patient-reported pain scores in the immediate postoperative period with the ERAS protocol32. However, significant clinical impact was not proven with the ERAS protocol, which was possibly related to the small sample size. In a randomized controlled trial, Kraiwattanapong et al. similarly evaluated multimodal drug infiltration in the postoperative wound bed, demonstrating that this technique reduced postoperative pain scores and opioid consumption33. Sharaf et al. performed a randomized controlled trial comparing postoperative physical therapy with and without neural mobilization in patients who underwent lumbar decompression for stenosis; the authors found that the addition of neural mobilization improved outcomes across all patient-reported outcome measures34. Lastly, Ma et al. performed a prospective randomized trial evaluating the utility of postoperative spinal orthoses after MIS-TLIF35. The authors found that the use of a postoperative orthosis had no significant effect on the Oswestry Disability Index (ODI) or visual analog scale pain score at 6 or 12 months after MIS-TLIF. Additionally, the orthosis had no effect on the fusion rate at the final follow-up. Adult Spinal Deformity Surgical decision-making for patients with adult spinal deformity is complex. In several recent studies, authors have examined the risk-and-benefit calculation that aids our surgical indications, patient optimization, and preoperative counseling. The Prospective Evaluation of Elderly Deformity Surgery (PEEDS)36 study illustrates the potential benefit of spinal deformity surgery: this prospective, multicontinental study evaluated disability (ODI) in patients ≥60 years of age who underwent spinal deformity surgery. The authors demonstrated that, after an initial recovery period, 70% of patients experienced at least 10% improvement from their baseline disability, which was sustained at 2 years. Meanwhile, approximately 25% of patients reported no change from baseline and approximately 5% of patients reported worsening of the disability. Importantly, although there was an overall significant improvement in disability, the mean ODI of 27% at 2 years was still worse than normative values, and was consistent with moderate disability. This article also stratified the shift in ODI based on preoperative ODI deciles, which is a useful counseling tool for shared decision-making. Similar findings were identified in the 5-year outcomes reported by the Scoli-RISK-1 Study Group37. This study was limited by a 5-year follow-up rate of 28%, but identified a significant improvement in patient-reported outcomes, with 62% of patients having a clinically meaningful improvement in the ODI score. Numerous studies have shown the complication profile of deformity surgery. The 5-year results from the Scoli-RISK-1 Study Group demonstrated worse lower-extremity motor scores in 9.3% of patients who were available for follow-up at 5 years38. This rate was improved from 14% at the time of hospital discharge and was unchanged from 2 years postoperatively. In a recent study, Lakomkin et al.39 helped to contextualize the surgical invasiveness of deformity surgery by comparing it with other major operations. Using a variation of the validated Postoperative Morbidity Survey score, the authors added length of hospital stay and operative time to develop the novel Surgical Invasiveness and Morbidity Score (SIMS). Using the National Surgical Quality Improvement Program (NSQIP) database and controlling for comorbidities, the authors compared SIMS across major surgical procedures. Adult spinal deformity surgery fared better than coronary artery bypass grafting, abdominal aortic aneurysm repair, and cystectomy, performed similarly to mitral valve replacement, and was, overall, worse than prostatectomy, total shoulder arthroplasty, and hip fracture fixation. This study provides an intuitive counseling tool for patients considering adult spinal deformity surgery. Several studies have shown the importance of patient frailty as a predictor of outcomes and complications. Passias et al.40 demonstrated that frailty was independent of chronological age in predicting positive outcomes in adult spinal deformity surgery. Patients ≥70 years of age who were not frail fared better than elderly patients who were frail or severely frail. Gum et al.41 demonstrated that the cost of quality-adjusted life-year (QALY) was impacted more by patient frailty than by surgical invasiveness. Frail and severely frail patients had significantly and incrementally higher costs per QALY than non-frail patients. Surgical invasiveness did not have a substantial impact on cost per QALY. The authors recommended focusing on patient optimization with respect to modifiable risk factors to improve cost optimization. These studies help to understand the risk and benefit of adult spinal deformity surgery and provide an increased awareness of patient factors that may impact outcomes. Nonoperative Treatments Spine surgery continues to evolve with the rest of the surgical profession, and, as many have proven, high-quality randomized controlled trials are difficult to perform with surgical procedures. In contrast, our interventional pain colleagues may be better positioned to conduct studies within this gold standard of evidence-based medicine. Their ability to do so, coupled with an increase in the nonoperative treatment environment, has created an exponential growth across the United States at a time when our patients were hesitant to seek hospital-based care. A thorough discussion of all available pain management procedures is beyond the scope of this update, but we believe that it is particularly important that all orthopaedic surgeons understand the basics behind these procedures and the early evidence to support their use. We do advise the reader that each of the studies in this section was industry-funded. The minimally invasive lumbar decompression (mild) procedure is approved by the U.S. Food and Drug Administration (FDA) for the treatment of neurogenic claudication and gained approval for reimbursement by the U.S. Centers for Medicare & Medicaid Services (CMS) in 2017. The procedure uses a small portal to remove part of the lamina and ligamentum flavum using radiographic assistance. Most recently, in 2021, Deer et al. published the 6-month results of a randomized controlled trial comparing the mild procedure with conventional medical management and found the mild procedure to have superior results, albeit in very early results42. Multiple interspinous devices are currently available on the market, and we have seen an increased use among our pain management colleagues. These devices have an established role in the management of neurogenic claudication, but their specific indications continue to evolve. Schenck et al. recently reported the results of their 5-year randomized controlled trial of interspinous devices compared with decompressive surgery and found similar results, but with a higher risk of reoperation within the first 2 years following use of interspinous devices43. Intraosseous basivertebral nerve ablation procedure was approved by the FDA in 2016 for the treatment of chronic low back pain in patients with disc degeneration and Modic end plate changes. This procedure has recently demonstrated positive results. Fischgrund et al. performed a double-blinded randomized trial, finding that the ablation of the basivertebral nerve yielded continued improvement in pain and function at a mean of 6.4 years postoperatively in this challenging patient population44. Telemedicine in Spine Surgery With the COVID-19 nearly the entire spine a in surgical procedures and an increase in The of and there has been exponential growth within the most of the literature on the and with articles evaluating the long-term outcomes of so. Several authors validated the performance of the with an on the neurologic Similar to the rest of the the spine to back with Over the past 2 years, we have different and expect to continued growth of this important advance forced by the Although this has been a of the it not the among colleagues in At the time of this all future society are currently to be at the Spine in in the Cervical Spine in in the in in the Lumbar Spine in in the Spine in and the of in in The of a of recently published studies related to the that received a higher of In addition to articles in this update, 6 other articles to spine surgery are to this review after the standard with a each article to help further in an evidence-based in this area. with or without fusion in degenerative lumbar spondylolisthesis. In a noninferiority study, et al. evaluated all patients with lumbar degenerative spondylolisthesis with a of who were randomized to either decompression or decompression and fusion. The of and evidence of a were not into their The outcome was an improvement of the ODI score by At 2 years, an equivalent of patients had a clinically important improvement of the ODI in the group and in the decompression and fusion at 2 years, reoperation rates trended higher in the group at than in the decompression and fusion group at but this difference was not This study was limited by the heterogeneity of the included as the and of degenerative spondylolisthesis were not included in the reoperation rates be useful in understanding the of decompression in the of degenerative spondylolisthesis. this study useful to the debate fusion for degenerative but of the of patients who benefit most from decompression and fusion compared with decompression Current of adjacent segment following lumbar fusion a systematic review and meta-analysis of recent Spine The risk of adjacent segment degeneration at adjacent levels to lumbar fusion remains a clinical surgery has been developed to this et al. performed a systematic review comparing these and the reported rate of adjacent segment The authors found no significant differences in adjacent segment disease or reoperation between groups, although the analysis demonstrated lower of adjacent segment degeneration in the The of included studies was there still is no on surgery decreased adjacent segment a systematic review and meta-analysis comparing Spine In a systematic review and meta-analysis, et al. compared stabilization with fixation for lumbar had improved length of stay, operative and blood loss but worse loss of deformity at final Patient-reported outcomes were not significantly different between groups. The literature remains on which surgical approach is of arthroplasty fusion for patients with cervical a randomized clinical et al. performed a randomized clinical trial comparing single-level ACDF with cervical disc Patients were blinded to and surgeons were blinded to treatment neurologic decompression was completed. The outcome was the and the secondary outcomes were arm and neck pain scores, of reoperation rate, and adjacent segment There were 136 patients with follow-up at 5 years. scores significantly improved in both groups, without a difference observed between groups. No differences were in reoperation rate or adjacent segment This study demonstrated that neck disability scores were not significantly different between groups within 5 years. for adjacent segment disease and reoperation longer-term follow-up. of to surgical after spine surgery: a systematic review and meta-analysis. Pain et al. performed a systematic review and meta-analysis of studies only 6 were randomized controlled and found that the addition of in the wound after spinal as as and a of the 2 yielded significant in surgical corroborated by this systematic review, reduce after spine surgery. in a systematic review and meta-analysis of randomized controlled Spine et al. performed a systematic review and meta-analysis of the available literature comparing the use of orthoses with no in the management of The authors found that, overall, there were no significant differences between the group orthoses and the group with no with regard to pain scores or radiographic and recommended that treatment of not These findings studies on the topic.

To examine parents' knowledge about and attitudes towards pain management, use of pain relief strategies and satisfaction with their children's postoperative pain management, as well as the relationships among these variables. Children's postoperative pain is inadequately managed worldwide. Despite increasing emphasis on parental involvement in children's postoperative pain management, few studies have examined parents' management of their child's postoperative pain in Singapore. A descriptive correlational study. A convenience sample of 60 parents having 6- to 14-year-old children undergoing inpatient elective surgery in a public hospital in Singapore was recruited. Data were collected one day after each child's surgery using the Pain Management Knowledge and Attitudes questionnaire and the Parents' Use of Pain Relief Strategies questionnaire. Descriptive statistics, Mann-Whitney U tests, Kruskal-Wallis tests and Spearman's rank correlation coefficient were used for data analyses. Parents displayed moderate levels of knowledge, attitudes and use of pain relief methods in relation to their children's postoperative pain and pain management. They were generally satisfied with the management of their child's postoperative pain. There was significant difference in Parents' Use of Pain Relief Strategies scores between parents with and without previous experience of caring for their hospitalised child. Statistically significant positive correlations were found between parents' knowledge and attitude, knowledge and satisfaction, attitude and satisfaction, knowledge and pain relief strategies, as well as attitude and pain relief strategies. This study indicates the need to provide parents with more information regarding their children's postoperative pain management. Future studies are needed to develop educational interventions for parents to improve their knowledge and attitudes, which will eventually improve their use of pain relief strategies for their children. Health professionals need to provide more information to equip parents with knowledge and skills regarding paediatric postoperative pain management.

Review Objective: The aim of this review is to critically analyse and synthesise the best available evidence on the impact of music listening on postoperative pain Inclusion Criteria: Types of Participants: Adults (18 years or older) who have undergone any elective major or minor surgery irrespective of the severity of underlying condition. Types of Interventions: Any type of recorded music (patient preferred or investigator chosen) of any duration, that is delivered immediately after surgery to the 3rd postoperative day, through any medium (audio or video CD/ tape player, music pillows, e.t.c.), in addition to usual care. Types of Outcome Measures: Primary outcome Postoperative pain measured before and after the intervention by any validated pain assessment tool (such as the Visual Analogue Scale, Verbal Rating Scale, McGill Pain Questionnaire). Secondary outcomes Analgesic consumption measured by patient‐controlled analgesia (PCA) pumps or patient records, and expressed as morphine equivalents (intramuscular/ subcutaneous/ intravenous). Number of adverse events reported in the individual papers included in the review.

Liposomal bupivacaine efficacy for postoperative pain following posterior vaginal surgery: a randomized, double-blind, placebo-controlled trial

BackgroundQuality of life is decreased in patients with hallux valgus deformity, mainly because of pain. Significant improvement is usually achieved by surgery. However, postoperative pain can be moderate to severe for 2–3 days. The aim of the present study was to evaluate the use of transdermal fentanyl for postoperative pain management after forefoot surgery.MethodsSixty patients undergoing hallux valgus or hallux rigidus surgery were allocated to receive a patch delivering either fentanyl 12 μg/hour or placebo for postoperative pain. The consumption of rescue opioid oxycodone, the primary outcome measure, was evaluated daily until the fourth postoperative day. Total consumption of oxycodone during the study period was also assessed. Pain scores and possible adverse effects were evaluated every 6 hours during the first 24 hours and on the fourth postoperative day.ResultsThe use of rescue opioid was low in both groups, the median (range) consumption of oxycodone being 10 (0–50) mg on the day of surgery (no difference between the groups, P=0.31) and 0 (0–35) mg thereafter. The total combined consumption was 10 (0–105) mg in the fentanyl group and 20 (0–70) mg in the placebo group (P=0.23). There were no statistically significant differences in pain scores or adverse effects between the groups.ConclusionAs a part of multimodal analgesia with ibuprofen and acetaminophen, a patch delivering fentanyl 12 μg/hour did not significantly decrease the consumption of rescue opioid or pain scores after forefoot surgery.

This study aimed to evaluate an animation-based caregiver-patient interaction model for postoperative pain and anxiety management in preschool children with congenital heart disease (CHD). This randomized controlled trial included 70 preschoolers undergoing CHD surgery under general anesthesia, who were enrolled in the Cardiac Critical Care Unit at Beijing Children's Hospital (June-October 2024). Participants were stratified into intervention (n=35) and control (n=35) groups. The control group received standard postoperative care, while the intervention group additionally received a structured animation-based program involving preoperative personalized animation selection, post-extubation viewing (≤30 min/session, 3-6 times/day) with nurse-guided interaction, and parental involvement. Pain (WongBaker FACES scale) and anxiety (mYPAS) were assessed at 1 h/6 h postextubation, 24 h/48 h postsurgery, during OR transport, and 24 h postsurgery.Pain was assessed at four time points: 1 h/6 h post-extubation and 24 h/48 h post-surgery. At 1 h post-extubation, there was no significant difference in pain scores between the intervention and control groups (median 9 vs 8, p= 0.462). Pain scores were significantly lower in the intervention group than in controls at 6 h post-extubation (median 6 vs 9), 24 h post-operative (3 vs 6), and 48 h post-operative (2 vs 4); all p < 0.001. Anxiety scores (m-YPAS) were also significantly lower in the intervention group, both on transport to the OR (median 76 vs 80) and at 24 h after surgery (60 vs 80), p < 0.001. Friedman tests demonstrated significant within-group changes over time in anxiety levels (intervention p < 0.001), confirming that the intervention group experienced substantially reduced anxiety at these two key perioperative time points. The interactive animation model significantly reduces postoperative pain and perioperative anxiety in preschool patients with CHD, offering a safe non-pharmacological adjuvant for pain management.

Lumbar fusion is one of the most commonly used surgical procedures to improve the pain and instability of the spinal vertebrae. After surgery, patients experience varying degrees of pain. The aim of this study was to determine the effect of tizanidine for the management of postoperative pain after lumbar spinal fusion surgery. This randomized clinical trial study was performed on 50 patients who were selected for spinal fusion surgery. Patients were randomly divided into two groups of 25 patients. Patients in the tizanidine and placebo groups received 4 mg oral tizanidine and placebo one hour before surgery and 24 hours after that. Severity of pain, presence of nausea, vomiting, pruritus, headache, vertigo, xerostomia, somnolence, bradycardia and excess opiate in the two groups were evaluated and recorded prior to exit from recovery and 2, 4, 6, 12, 24 and 48 hours after surgery. Data were analyzed by SPSS software version 24. There was a significant difference in pain score in tizanidine group at 24 and 48 hours after surgery compared with placebo (P &lt;0.005). In the control group, the use of morphine sulfate was more than the tizanidine group. There was no significant difference in the incidence of side effects in the two groups (P&gt; 0.05). Low dose tizanidine in postoperative pain management is effective without significant side effects. Due to its simpler administration, it is recommended to use for postoperative pain control after lumbar fusion surgery.

Nurses’ experiences of barriers and strategies to the management of Patients’ postoperative pain in hospitals in Northern Ghana

1.1. Background: Postoperative pain remains one of the greatest burdens for patients following surgery. Nurses play a vital role in postoperative pain assessment and management following surgery. Therefore, nurses should have adequate knowledge about to carry out such responsibilities. 1.2. Methods: A descriptive cross-sectional study was conducted to assess the nurse’s knowledge regarding postoperative pain assessment and management among 50 respondents in NCMH, Nepal. Non –probability convenience sampling technique was used to select subject of the study. A self-prepared structured interview questionnaire was used to collect needed data. Ethical consideration was maintained to reduce biasness. Statistical Package of Social Science (SPSS) 21 was applied for data analysis. 1.3. Results: The study showed that majority of participants, twenty-six (52%) of respondents were the aged group of 20-24 year. It reported that 17.6% of the participants had low level of knowledge regarding postoperative pain management while 17.6% had medium level of knowledge, 64.7% had high level of knowledge. It was seen that knowledge regarding pain assessment was significantly higher than knowledge regarding management of pain (P=0.04). 1.4. Conclusion: However, majority of participants had high level of knowledge regarding postoperative pain management, nurse’s professional development, training, or in service education should be arranged to enhance knowledge of nurse regarding postoperative pain management

Childrenʼs experiences of their postoperative pain management: a qualitative systematic review