Acute Postoperative Pain In Patients Research Articles

Efficacy of ultrasound-guided stellate ganglion block in relieving acute postoperative pain: a systematic review and meta-analysis.

The efficacy of ultrasound-guided stellate ganglion block (SGB) in alleviating postoperative pain remains unclear. This meta-analysis was performed to determine the efficacy of ultrasound-guided SGB in relieving acute postoperative pain in patients undergoing surgery with general anesthesia. This systematic review and meta-analysis focused on randomized controlled trials comparing SGB with control or placebo. The primary outcome was the pain score at 24 hours after surgery. A random-effects model was used to calculate the mean difference (MD) or risk ratio with a confidence interval (CI) of 95%. Eight studies involving 470 patients were included in the meta-analysis. The results revealed that ultrasound-guided SGB was significantly associated with a lower pain score at 24 hours after surgery (MD = -0.74; 95% CI = -1.39, -0.08; I2 = 86%; low evidence) and at 8 hours after surgery (MD = -0.65; 95% CI = -1.03, -0.28; I2 = 29%; moderate evidence). Ultrasound-guided SGB is effective in alleviating acute postoperative pain. However, considering the limited number of trials performed to date, more large-scale and high-quality randomized controlled trials are required to confirm these findings.

Efficacy of Erector Spinae Plane (ESP) Block for Non-cardiac Thoracic and Upper Abdominal Surgery: A Single Institute Comparative Retrospective Case Series.

Introduction Erector spinae plane (ESP) block was first introduced for the management of thoracic pain but has become increasingly popular for the treatment of abdominal surgical pain. Previous studies have shown the ESP block can be easily adapted to abdominal procedures at the corresponding dermatome level and provide postoperative analgesia. Though the versatility, simplicity, and safety of the ESP block have been demonstrated, there is a gap in the literature regarding its comparison between thoracic and abdominal surgeries. This study aims to evaluate the efficacy of the ESP block in treating acute postoperative pain in patients undergoing thoracic and abdominal surgeries. Methods This retrospective study included 50 patients in the non-cardiac thoracic surgery group (bilateral breast mastectomy with reconstruction) and 50 patients in the abdominal surgery group (robotic or laparoscopic sleeve gastrectomy). Data was obtained via the acute pain service records at a tertiary care center from 2018 to 2022.All patients received bilateral ESP blocks, performed under ultrasound guidance. Various parameters were evaluated including oral morphine equivalents (OMEs) and visual analog scale (VAS) scores during post-anesthesia care unit (PACU), 6, 12, and 24 hours postop. The use of abortive antiemetic medications within 24 hours was also measured to evaluate the incidence of nausea and vomiting. The results were analyzed and compared. No control group is included, as all patients at our institution receive a peripheral nerve block as a part of the institution's enhanced recovery pathway (ERP). Results This retrospective study included 50 patients in the non-cardiac thoracic surgery group (bilateral breast mastectomy with reconstruction) and 50 patients in the abdominal surgery group (robotic or laparoscopic sleeve gastrectomy). Compared to the thoracic group, the abdominal group had a statistically higher VAS score in PACU with mean difference (MD)1.3 VAS, 95% confidence interval (CI) 0.03-2.56, p-value 0.0443, statistically higher OME consumption in the PACU (difference 13.35 OME, 95% CI 4.97-21.73, p-value 0.0003), and requiredsignificantly more antiemetic pharmacotherapy (mean 1.4 antiemeticsadministered, 95% CI 0.84-2.04, p-value <0.0001). Despite the abdominal group having more OME utilization in the PACU, there was no difference in cumulative OME use in the first 24hours (95% CI-9.745-24.10, p-value 0.4021). Conclusion In this study, we demonstrated that ESP blocks are an effective regional anesthesia technique to reduce postoperative pain and opioid consumption. The ESP block can serve as a useful and safe alternative to either thoracic epidural or paravertebral blocktechniques in thoracic and upper abdominal surgeries for perioperative pain management.

Development of a nomogram for predicting acute pain among patients after abdominal surgery: A prospective observational study.

To develop a nomogram to provide a screening tool for recognising patients at risk of post-operative pain undergoing abdominal operations. Risk prediction models for acute post-operative pain can allow initiating prevention strategies, which are valuable for post-operative pain management and recovery. Despite the increasing number of studies on risk factors, there were inconsistent findings across different studies. In addition, few studies have comprehensively explored predictors of post-operative acute pain and built prediction models. A prospective observational study. A total of 352 patients undergoing abdominal operations from June 2022 to December 2022 participated in this investigation. A nomogram was developed for predicting the probability of acute pain after abdominal surgery according to the results of binary logistic regression. The nomogram's predictive performance was assessed by discrimination and calibration. Internal validation was performed via Bootstrap with 1000 re-samplings. A total of 139 patients experienced acute post-operative pain following abdominal surgery, with an incidence of 39.49%. Age <60, marital status (unmarried, divorced, or widowed), consumption of intraoperative remifentanil >2 mg, indwelling of drainage tubes, poor quality sleep, high pain catastrophizing, low pain self-efficacy, and PCIA not used were predictors of inadequate pain control in patients after abdominal surgery. Using these variables, we developed a nomogram model. All tested indicators showed that the model has reliable discrimination and calibration. This study established an online dynamic predictive model that can offer an individualised risk assessment of acute pain after abdominal surgery. Our model had good differentiation and calibration and was verified internally as a useful tool for risk assessment. The constructed nomogram model could be a practical tool for predicting the risk of experiencing acute post-operative pain in patients undergoing abdominal operations, which would be helpful to realise personalised management and prevention strategies for post-operative pain. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines were adopted in this study. Before the surgery, research group members visited the patients who met the inclusion criteria and explained the purpose and scope of the study to them. After informed consent, they completed the questionnaire. The patients' pain scores (VAS) were regularly assessed and documented by the bedside nurse for the first 3 days following surgery. Other information was obtained from medical records.

The Influence of Pre-operative Pain and Anxiety on Acute Postoperative Pain in Cardiac Surgery Patients Undergoing Enhanced Recovery after Surgery.

Perioperative multimodal analgesia is an important step in enhanced recovery after surgery (ERAS) care. Many factors, such as preoperative chronic pain and anxiety, may provide information about the expected postoperative pain. In this study, we evaluated preoperative pain and anxiety and investigate their effects on acute postoperative pain in patients undergoing elective cardiac surgery. After ethics committee approval, 67 consenting patients undergoing on-pump cardiac surgery under the ERAS program were included in our prospective observational study. Pre- and postoperative pain scores were obtained using a numeric rating scale (NRS) at rest and during movement. Preoperative anxiety was assessed on a 0-10 scale, and data were recorded. The relationships between pre-operative pain/anxiety and postoperative pain were evaluated using correlation analysis. In preoperative pain assessment, the percentage of patients with a pain score above 4 with NRS was 1.5%, regardless of whether they were at rest or mobilize. In postoperative pain assessment, there were 20.9% and 34.3% patients with NRS >4 at rest and mobilization, respectively. 7.5% of patients had preoperative anxiety of grade 5 or higher. While preoperative pain was not correlated with postoperative pain, preoperative anxiety had a moderate positive correlation with postoperative pain (r=0.382, P=0.003). The prevalence of preoperative pain in patients who underwent cardiac surgery is quite low and is not associated with postoperative pain. There is also a significant relationship between the severity of preoperative anxiety and postoperative pain.

Gender differences on preoperative psychologic factors affecting acute postoperative pain in patients with lumbar spinal disorders

BackgroundPsychosexual factors are one of the preoperative factors influencing acute postoperative pain. Because of gender differences in pain, the preoperative factors that influence acute postoperative pain may also differ between males and females. However, there have been no reports on such factors in patients with spinal disorders that focused on gender differences. Therefore, the purpose of this study was to examine the preoperative factors that influence acute postoperative pain, focusing on gender differences. MethodsThe subjects were 75 males and 60 females admitted for surgery for lumbar spinal disorders. Preoperatively, the following were assessed: low back pain using the Numeric Rating Scale (NRS); anxiety and depression using the Japanese version of the Hospital Anxiety and Depression Scale (HADS); catastrophic thinking using the Pain Catastrophizing Scale (PCS); psychiatric problems using the Brief Scale for Psychiatric Problems in Orthopaedic Patients (BS-POP); and neurological assessments. Acute postoperative pain was also assessed using the NRS within 48 h, postoperatively. Based on these data, we analyzed gender differences in preoperative factors affecting acute postoperative pain in patients with lumbar spinal disorders. ResultsPostoperative NRS and preoperative PCS scores were higher in females compared to males. In the males, the coefficient of determination of the multiple regression equation was 0.088, and PCS (β = 0.323, p = 0.015) was extracted as a significant factor. In the females, the coefficient of determination of the multiple regression equation was 0.075, and BS-POP (β = 0.300, p = 0.019) was extracted as a significant factor. ConclusionPreoperative factors influencing acute postoperative pain for patients with lumbar spinal disorders vary by gender. It was suggested that males should be screened using PCS. In females, on the other hand, PCS alone is not sufficient for evaluation. It was suggested that evaluation using BS-POP should be considered in addition to PCS.

Pain Trajectory after Short-Stay Anorectal Surgery: A Prospective Observational Study

The evolution of pain after anorectal surgery has not been well characterized. The main objective of this study is to evaluate patterns in acute postoperative pain in patients undergoing short-stay anorectal surgery. A total of 217 patients were included in the study, which used group-based trajectory modeling to estimate postoperative pain and then examined the relationships between sociodemographic or surgical factors and pain trajectories. Three distinct postoperative pain trajectories were determined: hemorrhoidectomy (OR, 0.15), higher anxiety (OR, 3.26), and a higher preoperative pain behavior score (OR, 3.15). In multivariate analysis, they were associated with an increased likelihood of being on the high pain trajectory. The pain trajectory group was related to postoperative analgesic use (p < 0.001), with the high-low group needing more nonsteroidal analgesics. The study showed that there were three obvious pain trajectories after anorectal surgery, including an unreported low-moderate-low type. More than 60% of patients maintained moderate to severe pain within 7 days after the operation. These postoperative pain trajectories were predominantly defined by surgery factors and patient factors.

Esketamine combined with pregabalin on acute postoperative pain in patients undergoing resection of spinal neoplasms: study protocol for a randomized controlled trial

BackgroundPerioperative pain management is one of the most challenging issues for patients with spinal neoplasms. Inadequate postoperative analgesia usually leads to severe postsurgical pain, which could cause patients to suffer from many other related complications. Meanwhile, there is no appropriate analgesic strategy for patients with spinal neoplasms.Methods/designThis is a protocol for a randomized double-blind controlled trial to evaluate the effect of esketamine combined with pregabalin on postsurgical pain in spinal surgery. Patients aged 18 to 65 years scheduled for spinal neoplasm resection will be randomly allocated into the combined and control groups in a 1:1 ratio. In the combined group, esketamine will be given during the during the surgery procedure until 48-h postoperative period, and pregabalin will be taken from 2 h before the surgery to 2 weeks postoperatively. The control group will receive normal saline and placebo capsules at the same time points. Both groups received a background analgesic regimen by using patient-controlled intravenous analgesia (containing 100 μg sufentanil and 16 mg ondansetron) until 2 days after surgery. To ensure the accuracy and reliability of this trial, all the researchers and patients will be blinded until the completion of this study. The primary outcome will be the proportion of patients with acute moderate-to-severe postsurgical pain (visual analog scale, VAS ≥ 40, range: 0–100, with 0, no pain; 100, the worst pain) during the 48-h postoperative period. The secondary outcomes will include the maximal VAS scores (when the patients felt the most intense pain over the last 24 h before being interviewed) at 0–2 h, 2–24 h, 24–48 h, and 48–72 h after leaving the operating room and 24 h before discharge; the incidence of acute moderate-to-severe postsurgical pain at each other time point; chronic postsurgical pain assessment; neuropathic pain assessment; and the incidence of drug-related adverse events and other postoperative complications, such as postoperative delirium and postoperative nausea and vomiting (PONV).DiscussionThe aim of this study was to evaluate the effect of esketamine combined with pregabalin on acute postsurgical pain in patients undergoing resection of spinal neoplasms. The safety of this perioperative pain management strategy will also be examined.Trial registrationClinicalTrials.gov NCT05096468. Registered on October 27, 2021

Predictors of acute postoperative pain in patients with breast cancer

To date, modern medicine does not have reliable tools for objectifying and measuring pain. In order to avoid the development of chronic pain, we must effectively treat intraoperative and postoperative acute pain. In this prospective study, we wanted to estimate whether and to what extent algometer and PSQ (Pain Sensitivity Questionnaire) and CSQ (Coping Strategies Questionnaire) predict the intensity and strength of postoperative pain. Accordingly, we wanted to adjust the analgesia protocol. The study was conducted from February to April 2019, at the University Hospital for Tumors in Zagreb, and included 100 patients who were admitted to the hospital for breast cancer surgery. Preoperatively all patients completed PSQ and CSQ questionnaires and pain sensitivity was measured with the algometer. The same analgesic protocol was applied to all patients. The pain was measured postoperatively by NRS (numeric rating scale) 2, 6, 12, 18, 24, 48 and 72 hours after the operation. According to the obtained results, the patients were grouped into the group of slightly sensitive, medium sensitive, or very sensitive. Correlation between PSQ and NRS was statistically significant in the group of very sensitive patients. Research has shown that algometer can identify very sensitive patients and enables planning the analgesic protocol prior the operation. We can conclude that the analgesic protocol applied during the study was successful in preventing postoperative pain.

More Opioids Associated with Persistent Postoperative Opioid Use in Crohn’s Disease

INTRODUCTION: Up to 70% of patients with Crohn’s Disease (CD) experience debilitating abdominal pain during flares and often live with chronic abdominal pain. Furthermore, ~70% will require at least 1 operation during their disease course, with 50% of patients requiring multiple operations. Between 13% and 50% of adults with inflammatory bowel disease (IBD) chronically use opioids to manage pain. Surgery poses challenges for management of both chronic abdominal pain and acute postoperative pain in patients with IBD. Despite being a high-risk group, there are limited studies investigating prescribing patterns and the clinical impact of postoperative opioid use in CD. METHODS: The study population consisted of 357 patients with CD who underwent disease-related major abdominal operation between January 2014 and December 2018. Persistent opioid use was defined as either: 1) visit to outpatient pain service within 1 year; or 2) continued opioid use within 1 year after operation. RESULTS: Of the patients studied, 56 (15.7%) patients had persistent postoperative opioid use and 301 (84.3%) patients did not. Patients with persistent opioid use were prescribed significantly (p < 0.0001) higher total morphine milligram equivalents (240.0 MME) on hospital discharge postoperatively compared with patients who did not have persistent use (225.0 MME). There was no significant difference in history of previous major abdominal operation, length of stay, laparoscopic vs open approach, or procedure between patients who did and did not have persistent use (Table). CONCLUSION: Patients with CD who are prescribed more opioids after disease-related major abdominal operation are more likely to have persistent opioid use within 1 year postoperatively. Table. - Patient Population Characteristics Characteristic Persistent use (n = 56) No persistent use (n = 301) p Value Sex, f, (%) 27 (48.2%) 126 (41.9%) 0.38 Age (years), median (range) 39 (30, 50.5) 34 (27, 47) 0.06 BMI (kg/m2), median (range) 21.8 (19.4, 25.0) 21.2 (18.6, 24.9) 0.42 Alcohol/Smoker/Drug Use, n (%) 8 (14.3%) 38 (12.6%) 0.67 Public Insurance, n (%) 4 (7.1%) 24 (8.0%) 1.00 History of 1+ prior abdominal surgeries, n (%) 14 (25.0%) 72 (24.0%) 0.87 Length of Stay (days), median (range) 6 (5, 9) 6 (4, 8) 0.20 Laparoscopic (vs Open) Approach, n (%) 50 (89.3%) 274 (91.0%) 0.62 Total MME Prescribed, median (range) 240.0 (225.0, 570.0) 225.0 (157.5, 240.0) <.0001

Effect of Sufentanil Combined with Gabapentin on Acute Postoperative Pain in Patients Undergoing Intraspinal Tumor Resection: Study Protocol for a Randomized Controlled Trial.

PurposePatients undergoing intraspinal tumor resection usually experience severe postoperative pain. Inadequate postoperative analgesia usually leads to severe postsurgical pain, which could cause patients to suffer from many other related complications. Recently, an increasing number of studies have found that gabapentin can relieve hyperalgesia, postoperative pain, and postoperative inflammation. However, there have been no reports on the use of gabapentin combined with sufentanil preoperatively for acute pain following intraspinal tumor resection.Study Design and MethodsThis is a protocol for a randomized, placebo-controlled, and double-blinded trial. One-hundred and sixty-eight participants with chronic pain related to the intraspinal tumor will be randomized into the gabapentin and placebo groups in a 1:1 ratio. In the gabapentin group, patients will be given 300 mg gabapentin orally 36 h, 24 h, and 12 h before surgery; the placebo group will receive a placebo orally at the same time points preoperatively. To estimate the efficacy and safety endpoints, all the researchers and patients will be blinded until the completion of this study. The primary outcome will be the consumption of sufentanil within 48 h postoperatively. The secondary outcomes include the visual analog scale pain score and Von Frey mechanical pain threshold 36 h and 24 h before and 24 h and 48 h after surgery, the incidence of postoperative nausea, vomiting, and drowsiness, the length of hospital stay and medical expenses.DiscussionThis trial is to evaluate the efficacy and safety of gabapentin combined with sufentanil for postoperative analgesia in patients who complain of pain before intraspinal tumor resection. The findings will provide a new strategy for multimode perioperative analgesia management in these patients.

Transcutaneous electrical nerve stimulation reduces acute pain, and the use of analgesics after ankle fracture surgery

Objective: To evaluate the applicability of transcutaneous electrical nerve stimulation (TENS) as a complementary treatment method to non-opioid analgesics for acute postoperative pain in patients undergoing surgical treatment due to ankle fractures. Methods: A prospective, randomized, analytical, cross-sectional study performed after ankle fracture surgery. Two groups were randomized as follows: group 1 (Intervention) received TENS and non-opioid analgesic (dipyrone), and group 2 (Control) received non-opioid analgesic (dipyrone). Results: This study demonstrated that TENS in patients undergoing surgical treatment of ankle fractures reduces the use of rescue opioids significantly to control postoperative pain. Conclusion: TENS devices may be another safe option to control postoperative pain and reduce the use of opioids, avoiding adverse effects from this class of analgesic. Level of Evidence II; Therapeutic Studies; Prospective Comparative Study.

Treatment of acute postoperative pain in patients undergoing open abdominal aortic repair (current state of the problem)

The epidemiology of acute postoperative pain and complications associated with inadequately controlled acute postoperative pain syndrome were considered. The paper presents treatments for acute postoperative pain, the clinical value of multimodal analgesia in enhanced recovery, and reduction of mortality in patients undergoing open abdominal aortic repair. The problem associated with the limitations of the methods in postoperative pain management after open surgical abdominal aortic repair is also considered. The paper also presents alternative methods of multimodal analgesia in patients undergoing other abdominal surgery. The choice of the optimal method in postoperative pain management under the enhanced recovery protocol after open surgical abdominal aortic repair is now significantly limited, as a comparative analysis of alternative methods of analgesia and epidural analgesia in vascular surgery was not conducted. Multicenter studies on multimodal analgesia in postoperative pain management under the enhanced recovery protocol after open surgical abdominal aortic repair are therefore required when deviating from the standard protocol.

Propofol total intravenous anaesthesia versus inhalational anaesthesia for acute postoperative pain in patients with morphine patient-controlled analgesia: a large-scale retrospective study with covariate adjustment

BackgroundTo compare the postoperative analgesic effect of propofol total intravenous anaesthesia (TIVA) versus inhalational anaesthesia (GAS) in patients using morphine patient-controlled analgesia (PCA).MethodsA retrospective cohort study was performed in a single tertiary university hospital. Adult patients who used PCA morphine after general anaesthesia across 15 types of surgeries were included. Patients who received propofol TIVA were compared to those who had inhalational anaesthesia. Primary outcomes assessed were postoperative numerical rating scale (NRS) pain scores and postoperative opioid consumption.ResultsData from 4202 patients were analysed. The overall adjusted NRS pain scores were significantly lower in patients who received propofol TIVA at rest (GEE: β estimate of the mean on a 0 to 10 scale = -0.56, 95% CI = (-0.74 to -0.38), p < 0.001; GAS as reference group) and with movement (β estimate = -0.89, 95% CI = (-1.1 to -0.69), p < 0.001) from postoperative days (POD) 1–3. Propofol TIVA was associated with lower overall adjusted postoperative morphine consumption (β estimate = -3.45, 95% CI = (-4.46 to -2.44), p < 0.001). Patients with propofol TIVA had lower adjusted NRS pain scores with movement for hepatobiliary/pancreatic (p < 0.001), upper gastrointestinal (p < 0.001) and urological surgeries (p = 0.005); and less adjusted postoperative morphine consumption for hepatobiliary/pancreatic (p < 0.001), upper gastrointestinal (p = 0.006) and urological surgeries (p = 0.002). There were no differences for other types of surgeries.ConclusionPropofol TIVA was associated with statistically significant, but small reduction in pain scores and opioid consumption in patients using PCA morphine. Subgroup analysis suggests clinically meaningful analgesia possibly for hepatobiliary/pancreatic and upper gastrointestinal surgeries.Trial registrationThis study is registered at ClinicalTrials.gov (NCT03875872).

Acute postoperative pain and opioid consumption after laparoscopic cholecystectomy is associated with body mass index: a retrospective observational single-center study

Aim: The aim of this study was to determine the relationship between postoperative pain scores and opioid analgesic consumption according to BMI levels in patients undergoing laparoscopic cholecystectomy.&#x0D; Material and Method: In this retrospective observational study, we scanned the medical data of 154 patients aged from 18-55 years who underwent laparoscopic cholecystectomy. Patients were divided into two groups based on the BMI cut-off value (Group Non-obese, BMI 30 kg/m2, n=35). Postoperative visual analog scale (VAS) pain scores, total tramadol consumption, and intraoperative fentanyl bolus requirements were compared between the groups at five-time points (T0: in the recovery room, T1: 1st hour in the ward, T2: 6th hour, T3: 12th hour, and T4: 24th hour).&#x0D; Results: Postoperative VAS pain scores were significantly higher in the Group Obese at T1-2 time points (p=0.009). The number of patients with a VAS score of &gt;3 at the T-0 time point was significantly higher in the Group Obese (p=0.014). Total tramadol consumption was significantly higher in the Group Obese (40.0±46.6 mg) than in the Group Non-obese (16.10±34.0 mg) (p=0.003). There was a weak positive correlation between BMI and postoperative pain scores (T0, T-1, T-2) of the patients, and a moderate positive correlation (r=0.307) between total tramadol consumption.&#x0D; Conclusions: According to the results of this study, BMI is associated with acute postoperative pain in patients undergoing cholecystectomy, and obese patients require more opioid analgesia postoperatively. However, postoperative analgesia requirements should be determined according to BMI levels in patients undergoing cholecystectomy.

Intravenous patient-controlled analgesia plus psychoeducational intervention for acute postoperative pain in patients with pulmonary nodules after thoracoscopic surgery: a retrospective cohort study

BackgroundThe association of psychological factors with postoperative pain has been well documented. The incorporation of psychoeducational intervention into a standard analgesia protocol seems to be an attractive approach for the management of acute postoperative pain. Our study aimed to evaluate the impact of psychoeducational intervention on acute postoperative pain in pulmonary nodule (PN) patients treated with thoracoscopic surgery.MethodsIn this study, 76 PN patients treated with thoracoscopic surgery and intravenous patient-controlled analgesia (IV-PCA) plus psychoeducational evaluation and intervention were selected as the psychoeducational intervention group (PG). Another 76 PN patients receiving IV-PCA without psychoeducational intervention after thoracoscopic surgery, treated as the control group (CG), were identified from the hospital database and matched pairwise with PG patients according to age, sex, preoperative body mass index (BMI), opioid medications used for IV-PCA and the educational attainment of patients.ResultsThe most common psychological disorders were anxiety and interpersonal sensitivity, which were recorded from 82.9% (63/76) and 63.2% (48/76) of PG patients. The numerical rating scale (NRS) pain scores of the PG patients were significantly lower than those of the CG patients at 2 and 24 h after surgery (P < 0.001). Total opioid consumption for acute postoperative pain in the PG was 52.1 mg of morphine equivalent, which was significantly lower than that (67.8 mg) in the CG (P = 0.038). PG patients had a significantly lower incidence of rescue analgesia than CG patients (28.9% vs. 44.7%, P = 0.044). Nausea/vomiting was the most common side effect of opioid medications, recorded for 3 (3.9%) PG patients and 10 (13.2%) CG patients (P = 0.042). In addition, no significant difference was observed between PG and CG patients in terms of grade 2 or higher postoperative complications (10.5% vs. 17.1%, P = 0.240).ConclusionsPsychoeducational intervention for PN patients treated with thoracoscopic surgery resulted in reduced acute postoperative pain, less opioid consumption and fewer opioid-related side effects.

Postoperative Pain After Mohs Micrographic Surgery is Well Tolerated Regardless of Psychological and Pain-Related Comorbidities.

Preoperative patient screening has been evaluated in many surgical specialties as a way to improve the overall patient experience. Current data are limited regarding patient screening for dermatologic procedures. The goal of preoperative screening is to identify patients at risk for poor outcomes and tailor the treatment plan to ensure a greater overall patient experience. To investigate the association between psychological comorbidities and acute postoperative pain in patients treated with Mohs micrographic surgery (MMS). Subjects were recruited from a single center, single provider, uniformed service MMS practice, and asked to complete preoperative and postoperative questionnaires for scheduled MMS. Outcome variables included anticipated pain, actual pain after MMS, duration of pain, and medications used for pain. Mohs micrographic surgery was well tolerated. There were no significant differences in anticipated or reported pain, or in medication use between cohorts. Significant differences in pain were noted with closure technique with complex surgical repairs generating the greatest pain across groups. Mohs micrographic surgery is well tolerated by patients, both with and without psychological comorbidities. Our results show no statistically significant differences, suggesting a limited role for preoperative screening as a tool to guide pain management after MMS.

Analgesic Efficacy of Nefopam as an Adjuvant in Patient-Controlled Analgesia for Acute Postoperative Pain After Laparoscopic Colorectal Cancer Surgery.

Despite rapid advancements in laparoscopic surgical techniques and perioperative management, postoperative pain remains a significant clinical issue. We examined the analgesic efficacy of nefopam as an adjuvant in patient-controlled analgesia (PCA) for acute postoperative pain in patients undergoing laparoscopic colorectal cancer surgery. We retrospectively analyzed the medical records of 120 patients who did or did not receive 80 mg of nefopam as an adjuvant in fentanyl PCA; they were allocated to the nefopam (n = 60) or non-nefopam group (n = 60). The demographic, clinical, and anesthetic data, with data on pain severity and opioid administration at the postoperative anesthesia care unit (PACU) on postoperative days (PODs) 1, 3, and 5, were compared between the groups. The pain score and opioid administration did not differ at the PACU or on PODs 1, 3, or 5. The day of PCA discontinuation, time to pass flatus, length of the hospital stay, and incidence of nausea/vomiting, dizziness, and headache also did not differ between the groups. Fentanyl PCA with 80 mg of nefopam as an adjuvant did not have a superior analgesic effect after laparoscopic colorectal cancer surgery.

Psychological Characteristics, Female Sex, and Opioid Use Predict Acute Postoperative Pain in Patients Surgically Treated for Thumb Base Osteoarthritis: A Cohort Study.

It is unclear which factors predict acute postoperative pain in patients surgically treated for thumb base osteoarthritis. The authors investigated the influence of type of surgery, preoperative sociodemographics, preoperative patient-reported outcome measures, psychological characteristics, and postoperative opioid use on acute postoperative pain 24 hours postoperatively following surgery for thumb carpometacarpal osteoarthritis. In addition, preoperative and acute postoperative pain were compared. In this prospective cohort study, 215 patients surgically treated for thumb carpometacarpal osteoarthritis were included. Data were collected in 16 clinics for hand surgery and therapy in The Netherlands. Hierarchical regression was used to identify whether type of surgery, preoperative sociodemographics, preoperative patient-reported outcome measures, psychological characteristics (including treatment credibility and expectations, illness perception, pain catastrophizing, anxiety, and depression), and postoperative opioid use predicted acute postoperative pain 24 hours postoperatively, measured using the Numeric Pain Rating Scale (range, 0 to 10). Female sex, opioid use, higher preoperative satisfaction with hand, and higher self-reported consequences and coherence predicted greater postoperative pain, with 31 percent explained variance in the final model including psychological factors. Mean postoperative Numeric Pain Rating Scale score was lower (5.1 ± 2.4) than preoperative pain, measured using visual analogue scales (during the past week, 6.7 ± 1.7; physical load, 7.5 ± 1.7) and the Michigan Hand Outcomes Questionnaire (6.4 ± 1.4; p < 0.001). Psychological factors, female sex, and opioid use enhance the prediction of acute postoperative pain beyond surgery type, preoperative sociodemographics, and patient-reported outcome measures. Female sex and opioid use were the strongest predictors, even after controlling for psychological factors. Future studies may investigate sex-based approaches and patient education for reducing acute postoperative pain. Risk, II.

“It's Like Learning by the Seat of Your Pants”: Surgeons Lack Formal Training in Opioid Prescribing

To determine the training surgical residents and faculty receive on opioid prescribing, and to identify opportunities for curricula development to fill training gaps. We conducted qualitative semi-structured interviews and surveys. After applying an overarching organizational framework, we used an iterative, team-based process to develop relevant inductive codes. We then performed thematic analyses to identify and catalogue critical domains related to surgeons' education about opioid prescribing. Tertiary care academic medical center. Maximum variation purposive sampling was used to recruit general surgery residents and surgical faculty members. We interviewed 21 attending surgeons and 20 surgical residents. Surgeons reported minimal formal training on pain management and prescribing opioids. A minority of individuals described receiving opioid training in the form of continuing medical education, intern boot camp sessions, and medical school classes. Participants compensated for the lack of formal training during residency by informally learning from senior residents, consulting pain specialists, and seeking external learning resources. Increased surgical experience was correlated with increased comfort with pain management. A majority of surgeons desired formal training. The most commonly requested educational resources were opioid prescribing guidelines for common operations and recommendations for treating chronic pain patients. Residents requested that training occur early in residency to maximize the benefits received. Based on these findings, we developed a conceptual framework to explain how surgeons learn to prescribe opioids and to highlight opportunities for improvement. Although surgeons routinely prescribe opioids and desire education on opioids, a majority of them do not receive any training. Instituting formal educational programs is critical for improving opioid prescribing practices among surgeons.These programs should include standard prescribing guidelines and address management of acute postoperative pain in patients with chronic pain.

Continuous Wound Infiltration With Ropivacaine After Mastectomy: A Randomized Controlled Trial

BackgroundTo evaluate the efficacy of continuous wound infiltration with ropivacaine to reduce acute postoperative pain in patients undergoing mastectomy for carcinoma of the breast. Materials and methodsA randomized, double-blind, placebo-controlled trial was conducted. One hundred fifty patients were randomly assigned to receive continuous ropivacaine (0.2%) (group A, n = 74) or saline solution (0.9%) (group B, n = 76) at 10 mL/h for 48 h through a multilumen catheter placed during the surgical procedure. Postoperative morphine consumption and visual analog scale (VAS) pain scores were recorded. A quality of life score (Quality of life questionnaire Core 30) and a VAS score were obtained at 1, 3, and 6 mo after surgery. ResultsThe difference in mean morphine consumption between the two groups was close to significance during the first 48 h postsurgery (P = 0.056; 10.8 ± 16.5 versus 4.8 ± 10.4 mg). At day 1, patients in the ropivacaine-infusion group had lower morphine consumption than the control group (P = 0.0026). The link between local ropivacaine infiltration and a decrease in mean postoperative VAS scores reached significance for the first 24 h postsurgery (P = 0.039). No significant difference was found between the two arms for VAS pain scores (P = 0.36) or for quality of life (overall QLQ-C30 score, P = 0.09) at 1, 3, or 6 mo. ConclusionsContinuous wound infiltration with ropivacaine is efficacious in reducing postoperative pain. Quality of life and chronic pain at 1, 3, and 6 mo were not improved by ropivacaine wound infiltration.