Acute Postsurgical Pain Research Articles

Plantar incision with severe muscle injury can be a cause of long-lasting postsurgical pain in the skin

AimsAlthough chronic local inflammation in deeper tissues after skin wound healing might produce chronification of acute postsurgical pain, its mechanisms have not been fully elucidated. We hypothesized that muscle injury and severe inflammation would prolong acute postsurgical pain by its central nervous system mechanisms. Main methodsAfter approval of the Animal Care Committee, experiments were performed in Male Sprague-Dawley rats weighing 250–300 g. Plantar incision and plantar incision combined with cryoinjury of the plantar flexor digitorum brevis muscle were made in the plantar incision group and muscle injury group, respectively. Pain-related behaviors were assessed, and inflammatory cells were isolated from injured muscle and analyzed by flow cytometry. Spinal microglial activation was assessed with Iba-1 staining. Key findingsMechanical hyperalgesia from day 5 to day 8 and spontaneous pain-related behavior from day 3 to day 7 were significantly greater in the muscle injury group than in the plantar incision group (P < 0.05), whereas there was no significant difference between the two groups in thermal hyperalgesia. In the muscle injury group, the number of inflammatory cells on day 4 was significantly larger and spinal Iba-1 expression levels on days 4 and 7 were significantly higher than those in the plantar incision group (P < 0.05). SignificanceSurgical injury in deep tissues accompanying severe muscle inflammation induced prolonged postsurgical pain in the healing wound of the skin not by the persistence of muscle inflammation but by a central mechanism involving microglial activation at the level of the spinal cord.

Prognostic prediction models for chronic postsurgical pain in adults: a systematic review.

Chronic postsurgical pain (CPSP) affects an estimated 10% to 50% of adults depending on the type of surgical procedure. Clinical prediction models can help clinicians target preventive strategies towards patients at high risk for CPSP. Therefore, the objective of this systematic review was to identify and describe existing prediction models for CPSP in adults. A systematic search was performed in MEDLINE, Embase, PsychINFO, and the Cochrane Database of Systematic Reviews in March 2020 for English peer-reviewed studies that used data collected between 2000 and 2020. Studies that developed, validated, or updated a prediction model in adult patients who underwent any surgical procedure were included. Two reviewers independently screened titles, abstracts, and full texts for eligibility; extracted data; and assessed risk of bias using the Prediction model Risk of Bias Assessment Tool. The search identified 2037 records; 28 articles were reviewed in full text. Fifteen studies reporting on 19 prediction models were included; all were at high risk of bias. Model discrimination, measured by the area under receiver operating curves or c-statistic, ranged from 0.690 to 0.816. The most common predictors identified in final prediction models included preoperative pain in the surgical area, preoperative pain in other areas, age, sex or gender, and acute postsurgical pain. Clinical prediction models may support prevention and management of CPSP, but existing models are at high risk of bias that affects their reliability to inform practice and generalizability to wider populations. Adherence to standardized guidelines for clinical prediction model development is necessary to derive a prediction model of value to clinicians.

Predictors of Acute Postsurgical Pain following Gastrointestinal Surgery: A Prospective Cohort Study.

Background Several predictors have been shown to be independently associated with chronic postsurgical pain for gastrointestinal surgery, but few studies have investigated the factors associated with acute postsurgical pain (APSP). The aim of this study was to identify the predictors of APSP intensity and severity through investigating demographic, psychological, and clinical variables. Methods We performed a prospective cohort study of 282 patients undergoing gastrointestinal surgery to analyze the predictors of APSP. Psychological questionnaires were assessed 1 day before surgery. Meanwhile, demographic characteristics and perioperative data were collected. The primary outcomes are APSP intensity assessed by numeric rating scale (NRS) and APSP severity defined as a clinically meaningful pain when NRS ≥4. The predictors for APSP intensity and severity were determined using multiple linear regression and multivariate logistic regression, respectively. Results 112 patients (39.7%) reported a clinically meaningful pain during the first 24 hours postoperatively. Oral morphine milligram equivalent (MME) consumption (β 0.05, 95% CI 0.03–0.07, p < 0.001), preoperative anxiety (β 0.12, 95% CI 0.08–0.15, p < 0.001), and expected postsurgical pain intensity (β 0.12, 95% CI 0.06–0.18, p < 0.001) were positively associated with APSP intensity. Furthermore, MME consumption (OR 1.15, 95% CI 1.10–1.21, p < 0.001), preoperative anxiety (OR 1.33, 95% CI 1.21–1.46, p < 0.001), and expected postsurgical pain intensity (OR 1.36, 95% CI 1.17–1.57, p < 0.001) were independently associated with APSP severity. Conclusion These results suggested that the predictors for APSP intensity following gastrointestinal surgery included analgesic consumption, preoperative anxiety, and expected postsurgical pain, which were also the risk factors for APSP severity.

Personalization over Protocolization.

Personalization over Protocolization.

This Month in Anesthesiology

This Month in Anesthesiology

Optimal Regional Anaesthesia – Analgesia for Knee Surgery: Current Trends &amp; Future Perspectives

Major orthopedic surgery is frequently associated with high pain scores. For many procedures, especially those that are known to cause severe postoperative pain, guidelines from many countries recommend the use of RA for postoperative pain control. Although randomized controlled trials have demonstrated clinically significant pain reduction after peripheral nerve blocks and wound infiltration with local anesthesia, these techniques are still underused [1]. Approximately 15% of patients report persistent knee pain despite surgical success following total knee arthroplasty. Acute postsurgical pain, generally regarded as pain within the first 72 hours postoperatively, has been found to be independent risk factor of chronic postsurgical pain [2]. Early mobilization is the cornerstone of enhanced recovery program. Early mobilization (sitting out of bed/walking) can result in a reduced length of stay of 1 to 2 days and should be considered within the first 24 hours after surgery [3]. Early ambulation (on post-operative day 1) is also associated with lower hospitalization costs [4]. What are the different approaches? Periarticular infiltration using the appropriate technique and knowledge of intraarticular knee anatomy may increase pain control and maximize rehabilitation [5]. Femoral block is also associated with lower opioid consumption and a better recovery at 6 weeks than periarticular infiltration [6]. Early postoperative activity measures were proved to be possible indicators of knee function recovery at 6 weeks after surgery. In a metaanalysis , Adductor Canal Block method was superior in terms of equivalent morphine consumption in the first 24 hours and 48 hours, without increasing the risk of complications, when compared to the Peri articular Infiltration method [7]. What’s the best approach? Blocking multiple nerves was preferable to blocking any single nerve, periarticular infiltration, or epidural analgesia. 1- Proximal blocksThe combination of femoral and sciatic nerve block appears to be one of the best approaches [8]. The combination of Femoral, Sciatic, Obturator and Lateral Cutaneous of the thigh nerve blocks has shown that the opioids requirements in the first 48hours were extremely low (20mg to 30mg Oral Morphine Equivalent). Quadruple nerve block could be considered as a reliable option to achieve per and postoperative analgesia for TKA in combination with a multimodal analgesia regimen (intravenous dexamethasone, intravenous ketamine, paracetamol, ketoprofen, etc). 2- Distal blocksCombined Obturator and Femoral triangle block reduces morphine consumption better than LIA after TKA [9]. There is moderate level evidence that iPACK might provide analgesia for posterior pain after total knee arthroplasty when compared with a control group at 12 h, but was not associated with any other meaningful benefits. Based on these results, there is currently limited evidence supporting the use of iPACK as a complement to adductor canal block for analgesia after total knee arthroplasty [10]. Genicular nerve blockade may also be associated with a reduction in opioid consumption at 24 hours in primary total knee arthroplasty patients [11]. 3- Association of LIA and Distal BlocksIn a recent publication, the 24 h resting VAS score was lowest in Adductor Canal Block + Peri Articular Infiltration and 48 h resting and movement VAS score was lowest in continuous ACB also showing the interest of the catheter in this indications [12] . The best choice for optimal analgesia in TKA remains controversial. Combination of different techniques is preferable than using a single nerve injection or a unique approach. Early mobilization should be considered for an optimal enhanced recovery program. Suitable analgesia may reduce the risk of chronic postsurgical pain lasting more than 6 months after surgery.

Modeling and Analysis of Monitored vs. Self-reported Postsurgical Acute Pain in a Clinical Trial

This work aims to study postsurgical trauma modeling to characterize the physiological process in postoperative pain assessment in an observational trial. The skin impedance data is proposed to be fitted by derived-Cole models, i.e., single and double dispersion models and a distributed model with an inductive term related to sweat glands. These models are motivated by the biological characteristics of the skin, its physiological stratification and the current intra-and extra-cellular pathways. The correlation between the identified parameters with the patient's pain reported using the numerical rating scale (NRS) is analyzed for one patient for all three models. Following the trial, a statistically significant positive linear relationship was observed between the Anspec-Pro index and NRS (r(2) = 0.16, p=0.00), driving the further study of the relationship between the estimated dielectric parameters. The paper focuses to analyze the changes of the coefficients related to the particular clinical data, successfully identified using the non-linear least square procedure. The clinical significance of the results may be related to the individual model parameters for postoperative pain detection, validated on patients. Copyright (C) 2021 The Authors.

Subacute pain trajectories following major musculoskeletal surgery in adolescents: A pilot study

ABSTRACT Background: Adolescents who undergo major surgery experience high rates of disabling acute and chronic postsurgical pain (CPSP). However, little is known about the subacute period when acute to chronic pain transition occurs. Aims: The aims of this study were to examine feasibility of electronic daily monitoring of pain and opioid use in adolescents during the first 30 days at home following major surgery and identify target features of subacute pain curves associated with CPSP at 4 months. Methods: Twenty-five youth (10–18 years) undergoing major musculoskeletal surgery reported daily pain severity, interference, and opioid use on the Brief Pain Inventory each evening for 30 days after hospital discharge to form short time series trajectories. At 4 months, youth reported on pain intensity and health-related quality of life. Characteristics of subacute pain severity and interference curves were compared by 4-month CPSP status. Results: At 4 months, 20.8% of youth met criteria for CPSP. During the 30-day monitoring period, youth who went on to develop CPSP reported high pain severity on 45.9% of days compared to 2.9% of days in youth who recovered (P = 0.005) and high pain interference on 49.4% of days vs. 9.7% in youth who recovered (P = 0.01). Pain variability and rate of change were not significantly associated with CPSP in our pilot sample. Conclusions: We found it feasible to collect daily pain data in youth recovering at home after major surgery. Pilot findings suggest that daily electronic monitoring may identify early recovery problems at home after surgery. Larger studies are needed to validate subacute pain trajectory features to identify risk for CPSP.

Differences in nurses’ perceptions of self-reported pain and the administered morphine dose according to the patient’s facial expression in Korea

PurposeThis study aimed to compare nurses’ perceptions of self-reported pain, the recorded pain score, and pain treatment according to the patient’s facial expression.MethodsIn this descriptive cross-sectional survey, the participants were 472 nurses working at a tertiary hospital in Seoul, Korea. A self-report questionnaire presented nurses with a smiling patient complaining of acute post-surgical pain and a grimacing patient with cancer pain, both of whom reported a pain level of 8 out of 10, and asked nurses to indicate their perception of the pain intensity, the pain score that they would record, and the medication that they would provide for each patient.ResultsThe pain intensity perceived by nurses for the grimacing patient was significantly higher than that for the smiling patient (P<0.001). The recorded pain score was likewise significantly higher for the grimacing patient than for the smiling patient (P<0.001). There was a significant difference in the amount of morphine chosen by the nurses for pain interventions between the smiling and grimacing patients (P=0.040). Higher perceived pain intensity and score were associated with higher administered doses of morphine.ConclusionThese findings suggest that nurses might be affected by patients’ facial expressions when treating pain. A pain management program should be developed that trains nurses to accurately recognize pain hidden in patients’ faces and provides them with the knowledge of how to appropriately assess and manage patients’ pain.

Auricular Acupuncture for Preoperative Anxiety-Protocol of Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Background: Preoperative anxiety causes profound psychological and physiological reactions that may lead to a worse postoperative recovery, higher intensity of acute and persistent postsurgical pain and impaired quality of life in the postoperative period. Previous randomized controlled trials (RCTs) suggest that auricular acupuncture (AA) is safe and effective in the treatment of preoperative anxiety; however there is a lack of systematic evidence on this topic. Therefore, this protocol was developed following the PRISMA guidelines to adequately evaluate the existing literature regarding the value of AA for the reduction in anxiety in patients in a preoperative setting, compared to other forms of acupuncture, pharmacological, or no control interventions and measured with questionnaires regarding anxiety and fear. Methods: The following databases will be searched: MEDLINE (PubMed), EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), ISI Web of Science, and Scopus Database. RCTs will be included if an abstract is available in English. Data collection and analysis will be conducted by two reviewers independently. Quality and risk assessment of included studies will be done using the Cochrane 5.1.0 handbook criteria and meta-analysis of effectiveness and symptom scores will be conducted using the statistical software RevMan V.5.3. Conclusions: This systematic review will evaluate the efficacy and safety of AA for preoperative anxiety. Since all data used in this systematic review and meta-analysis have been published, this review does not require ethical approval. The results may be published in a peer-reviewed journal or be presented in relevant conferences. Registration number: PROSPERO ID CRD42020.

Effectiveness of Transcutaneous Electrical Nerve Stimulation on Pain and Disability Among Patients with Hip Arthroplasty: A Randomized Control Study

Background: Pain after surgery is highly inevitable, and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) has been reported with side effects. Objectives: This study evaluated the effectiveness of transcutaneous electrical nerve stimulation (TENS) on pain intensity and disability of patients who underwent hip arthroplasty. Methods: A purposive sampling technique was used to recruit 56 subjects that underwent hip arthroplasty. They were randomly allocated to the TENS group (TG) and control group (CG) equally. The subjects in the TG group were treated with conventional TENS twice a day for three weeks, but the CG group was treated with normal drugs only. Pain intensity and hip disability were measured in both groups with the Visual Analogue scale (VAS) and Oxford hip score before the treatment and after the intervention, respectively. Results: The results showed that there was a significant reduction between the pre-treatment and post-treatment pain intensity (t = 3.83, P = 0.003) and hip disability (t = -4.45, P &lt; 0.001) in the TG group. A significant reduction was also observed in pain intensity (t = 3.16, P = 0.01) and hip disability (t = -6.71, P = 0.000) between the pre-treatment and post-treatment periods in the CG group. There was a significant reduction in post-treatment pain intensity (t = 10, P = 0.000) and hip disability (t = -3.51, P = 0.006) when the TG group was compared with the CG group. Conclusions: TENS was effective in the management of acute post-surgical pain and disability of patients with hip arthroplasty.

Postoperative Pain Management in Pediatric Spinal Fusion Surgery for Idiopathic Scoliosis.

This article reviews and summarizes current evidence and knowledge gaps regarding postoperative analgesia after pediatric posterior spine fusion for adolescent idiopathic scoliosis, a common procedure that results in severe acute postoperative pain. Inadequate analgesia may delay recovery, cause patient dissatisfaction, and increase chronic pain risk. Despite significant adverse effects, opioids are the analgesic mainstay after scoliosis surgery. However, growing emphasis on opioid minimization and enhanced recovery has increased adoption of multimodal analgesia (MMA) regimens. While opioid adverse effects remain a concern, MMA protocols must also consider risks and benefits of adjunct medications. We discuss use of opioids via different administration routes and elaborate on the effect of MMA components on opioid/pain and recovery outcomes including upcoming regional analgesia. We also discuss risk for prolonged opioid use after surgery and chronic post-surgical pain risk in this population. Evidence supports use of neuraxial opioids at safe doses, low-dose ketorolac, and methadone for postoperative analgesia. There may be a role for low-dose ketamine in those who are opioid-tolerant or have chronic pain, but the evidence for preoperative gabapentinoids and intravenous lidocaine is currently insufficient. There is a need for further studies to evaluate pediatric-specific optimal MMA dosing regimens after scoliosis surgery. Questions remain regarding how best to prevent acute opioid tolerance, opioid-induced hyperalgesia, and chronic postsurgical pain. We anticipate that this timely update will enable clinicians to develop efficient pain regimens and provide impetus for future research to optimize recovery outcomes after spine fusion.

NGF-Induced Nav1.7 Upregulation Contributes to Chronic Post-surgical Pain by Activating SGK1-Dependent Nedd4-2 Phosphorylation.

At present, chronic post-surgical pain (CPSP) is difficult to prevent and cure clinically because of our lack of understanding of its mechanisms. Surgical injury induces the upregulation of voltage-gated sodium channel Nav1.7 in dorsal root ganglion (DRG) neurons, suggesting that Nav1.7 is involved in the development of CPSP. However, the mechanism leading to persistent dysregulation of Nav1.7 is largely unknown. Given that nerve growth factor (NGF) induces a long-term increase in the neuronal hyperexcitability after injury, we hypothesized that NGF might cause the long-term dysregulation of Nav1.7. In this study, we aimed to investigate whether Nav1.7 regulation by NGF is involved in CPSP and thus contributes to the specific mechanisms involved in the development of CPSP. Using conditional nociceptor-specific Nav1.7 knockout mice, we confirmed the involvement of Nav1.7 in NGF-induced pain and identified its role in the maintenance of pain behavior during long-term observations (up to 14days). Using western blot analyses and immunostaining, we showed that NGF could trigger the upregulation of Nav1.7 expression and thus support the development of CPSP in rats. Using pharmacological approaches, we showed that the increase of Nav1.7 might be partly regulated by an NGF/TrkA-SGK1-Nedd4-2-mediated pathway. Furthermore, reversing the upregulation of Nav1.7 in DRG could alleviate spinal sensitization. Our results suggest that the maintained upregulation of Nav1.7 triggered by NGF contributes to the development of CPSP. Attenuating the dysregulation of Nav1.7 in peripheral nociceptors may be a strategy to prevent the transition from acute post-surgical pain to CPSP.

Perioperative Pregabalin for Preventive Analgesia in Breast Cancer Surgery: A Meta-analysis of Randomized Controlled Trials.

Pregabalin is a drug for neuropathic pain. Antipronociceptive properties of pregabalin have led to its recent use as an adjuvant to the multimodal postoperative pain regimen. This meta-analysis was conducted to evaluate the efficacy of perioperative pregabalin on acute and chronic postsurgical pain (CPSP) after breast cancer surgery. A meta-analysis including 8 randomized controlled trials searched from MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials was conducted. Subgroup analysis was performed according to doses and timecourse of pregabalin administration. Review Manager 5.3 was selected to conduct the meta-analysis. Preoperative pregabalin in breast cancer surgery alleviated acute postoperative pain at rest 24 hours after surgery by 0.31 points on an 0 to 10 Numerical Rating Scale (95% confidence interval [CI] -0.57 to -0.05). Morphine consumption showed a decrease in postoperative use by 1.09 mg (95% CI: -1.61 to -0.57). The incidence of CPSP 3 months after surgery was reduced to 46% (95% CI: 0.25-0.85). Postoperative nausea and vomiting, dizziness, and sedation showed no overall significant reductions. However, a decrease in the incidence of postoperative nausea and vomiting and an increase in the incidence of dizziness were noted when patients received 300 mg of pregabalin before surgery. This study demonstrated that pregabalin showed more efficacy on chronic pain than acute pain after a breast cancer surgery. Further study based on doses and treatment course of pregabalin should be conducted to establish stronger evidence of treatment effects.

Keeping Children Safe at Home Through Safe Disposal of Unused Opioids

Introduction Opioids, play a vital role in the treatment of acute post-surgical pain. While steps have been taken to address the opioid epidemic such as reducing prescription qualities, limited data on this approach is available. Previous studies suggest that despite the reduction in prescriptions, many opioids written for acute post-operative pain remain unused. The objective of this project was two-fold, to educate patients and families on the dangers of opioids, especially related to improper storage or lack of disposal and to provide a mechanism by which families …

Characteristics of Postoperative Pain After VATS and Pain-Related Factors: The Experience in National Cancer Center of China.

PurposeNo final conclusion has yet been reached on characteristics of postoperative pain and pain-related factors after video-assisted thoracoscopic surgery (VATS). This study was designed to explore features of acute severe pain and chronic post-surgical pain (CPSP), and the pain-related factors of VATS.Patients and MethodsData of patients who underwent VATS for lung cancer in Cancer Hospital, Chinese Academy of Medical Sciences between March 2017 and January 2019 were reviewed in this retrospective study. A numerical rating scale (NRS) was used for evaluating the intensity of postoperative pain including no pain (NRS=0), mild pain (NRS=1–3), moderate pain (NRS=4–6), and severe pain (NRS=7–10). Pain intensity was assessed daily within a week after operation, and also evaluated at 3 months postoperatively.ResultsOne hundred and five (3.4%) of the 3072 patients enrolled experienced severe pain (NRS=7–10) on the 1st day after operation, and 17 (0.6%) on the 2nd day. Smoking history, three-port VATS, prolonged operation time, and without patient-controlled analgesia (PCA) were correlated to increased incidence of severe pain. Among all patients, 237 (7.7%) cases generated CPSP, and VATS type, operation time, duration of drainage, and severe pain on the 1st day were four independent risk factors related to CPSP.ConclusionPatients seemed to experience a lower incidence of acute severe pain and CPSP after VATS than traditional open surgery. Acute severe pain was correlated with smoking history, VATS type, operation time, and PCA; VATS type, operation time, duration of drainage, and severe pain on the 1st day postoperatively were four independent risk factors of CPSP.

Intraoperative Intercostal Nerve Block for Postoperative Pain Control in Pre-Pectoral versus Subpectoral Direct-to-Implant Breast Reconstruction: A Retrospective Study.

Background and Objectives: Patients undergoing mastectomy and implant-based breast reconstruction have significant acute postsurgical pain. The purpose of this study was to examine the efficacy of intercostal nerve blocks (ICNBs) for reducing pain after direct-to-implant (DTI) breast reconstruction. Materials and Methods: Between January 2019 and March 2020, patients who underwent immediate DTI breast reconstruction were included in this study. The patients were divided into the ICNB or control group. In the ICNB group, 4 cc of 0.2% ropivacaine was injected intraoperatively to the second, third, fourth, and fifth intercostal spaces just before implant insertion. The daily average and maximum visual analogue scale (VAS) scores were recorded by the patient from operative day to postoperative day (POD) seven. Pain scores were compared between the ICNB and control groups and analyzed according to the insertion plane of implants. Results: A total of 67 patients with a mean age of 47.9 years were included; 31 patients received ICNBs and 36 patients did not receive ICNBs. There were no complications related to ICNBs reported. The ICNB group showed a significantly lower median with an average VAS score on the operative day (4 versus 6, p = 0.047), lower maximum VAS scores on the operative day (5 versus 7.5, p = 0.030), and POD 1 (4 versus 6, p = 0.030) as compared with the control group. Among patients who underwent subpectoral reconstruction, the ICNB group showed a significantly lower median with an average VAS score on the operative day (4 versus 7, p = 0.005), lower maximum VAS scores on the operative day (4.5 versus 8, p = 0.004), and POD 1 (4 versus 6, p = 0.009), whereas no significant differences were observed among those who underwent pre-pectoral reconstruction. Conclusions: Intraoperative ICNBs can effectively reduce immediate postoperative pain in subpectoral DTI breast reconstruction; however, it may not be effective in pre-pectoral DTI reconstruction.

Psychosocial Predictors of Acute and Chronic Pain in Adolescents Undergoing Major Musculoskeletal Surgery

Acute and chronic pain delay recovery and impair outcomes after major pediatric surgery. Understanding unique risk factors for acute and chronic pain is critical to developing effective treatments for youth at risk. We aimed to identify adolescent and family psychosocial predictors of acute and chronic postsurgical pain after major surgery in adolescents. Participants included 119 youth age 10 to 18 years (Mage = 14.9; 78.2% white) undergoing major musculoskeletal surgery and their parents. Participants completed presurgery baseline questionnaires, with youth reporting on baseline pain, anxiety, depression, insomnia and sleep quality, and parents reporting on parental catastrophizing and family functioning. At baseline, 2-week, and 4-month postsurgery, youth completed 7 days of daily pain diaries and reported on health-related quality of life. Sequential logistic regression models examined presurgery predictors of acute and chronic postsurgical pain, defined as significant pain with impairment in health-related quality of life. Acute pain was experienced by 27.2% of youth at 2 weeks, while 19.8% of youth met criteria for chronic pain at 4 months. Baseline pain predicted acute pain (odds ratio [OR] = 1.96; 95% confidence interval [CI] = 1.32–2.90), while depressive symptoms (OR = 1.22; 95%CI = 1.01–1.47), and sleep quality (OR = 0.26; 95%CI = 0.08–0.83) predicted chronic pain. Tailored interventions need to be developed and incorporated into perioperative care to address risk factors for acute and chronic pain. PerspectiveLongitudinal results demonstrate adolescents’ presurgery pain severity predicts acute postsurgical pain, while depressive symptoms and poor sleep quality predict chronic postsurgical pain. Tailored interventions should address separate risk factors for acute and chronic pain after adolescent surgery.

The effect of transversus abdominis plane block on the chronic pain after colorectal surgery: a retrospective cohort study

BackgroundChronic postsurgical pain (CPSP) is common and would reduce the quality of life of patients. Transversus abdominal plane (TAP) block has been widely used in lower abdominal surgery and many researches demonstrated that it could improve acute postsurgical pain. We aim to determine whether TAP block could improve chronic postoperative pain at 3 months and 6 months after colorectal surgery.MethodsA total of 307 patients received selective colorectal surgery under general anesthesia between January, 2015 and January, 2019 in a single university hospital were included: 128 patients received TAP block combined with patient-controlled intravenous analgesia (PCIA) for postsurgical analgesia (group TP) and 179 only administrated with PCIA (group P). Main outcome was the NRS score of pain at 3 months after colorectal surgery. The data was analyzed by two-way repeated measures anova and the chi-square test.ResultsThe NRS score at rest and during movement was decreased significantly at 24 h after surgery (rest NRS 1.07 ± 1.34 vs 1.65 ± 1.67, movement NRS 3.00 ± 1.45 vs 3.65 ± 1.89; all P = 0.003) in group TP than those of group P. There was no significant difference of NRS score at 48 h after surgery (P > 0.05). At 3 months after surgery, the NRS score during movement was also lower in group TP than that in group P (0.59 ± 1.23 vs 0.92 ± 1.65, P = 0.045). There was no significant difference of NRS score at 6 months after surgery (P > 0.05).The prevalence of CPSP was 19.5% (25/128) in group TP and 20.7% (37/179) in group P at 3 months after surgery. 13.2% (17/128) of patients suffered from CPSP in group TP and 13.9% (25/179) in group P at 6 months after surgery. Both at 3 months and 6 months after surgery, there was no statistical difference of the prevalence of CPSP between the two groups (all P > 0.05) .ConclusionsTAP block reduced NRS during movement at 3 months after surgery but did not reduce the incidence of CPSP at 3 months and 6 months after selective colorectal surgery.

Indication-Specific Opioid Prescribing for US Patients With Medicaid or Private Insurance, 2017

Although opioids can be effective medications in certain situations, they are associated with harms, including opioid use disorder and overdose. Studies have revealed unexplained prescribing variation and prescribing mismatched with patient-reported pain for many indications. To summarize opioid prescribing frequency, dosages, and durations, stratified across numerous painful medical indications. Retrospective cross-sectional analysis of 2017 US administrative claims data among outpatient clinical settings, including postsurgical discharge. Participants had any of 41 different indications associated with nonsurgical acute or chronic pain or postsurgical pain or pain associated with sickle cell disease or active cancer and were enrolled in either private insurance (including Medicare Advantage) in the OptumLabs Data Warehouse data set (n = 18 016 259) or Medicaid in the IBM MarketScan Multi-State Medicaid Database (n = 11 453 392). OptumLabs data were analyzed from October 2018 to March 2019; MarketScan data were analyzed from January to April 2019. Nonsurgical acute or chronic pain or postsurgical pain; pain related to sickle cell disease or active cancer. Indication-specific opioid prescribing rates; days' supply per prescription; daily opioid dosage in morphine milligram equivalents; and for chronic pain indications, the number of opioid prescriptions. During the study period, of 18 016 259 eligible patients with private insurance, the mean (95% CI) age was 42.7 (42.7-42.7) years, and 50.3% were female; of 11 453 392 eligible Medicaid enrollees, the mean (95% CI) age was 20.4 (20.4-20.4) years, and 56.1% were female. A pain-related indication under study occurred in at least 1 visit among 6 380 694 patients with private insurance (35.4%) and 3 169 831 Medicaid enrollees (27.7%); 2 270 596 (35.6% of 6 380 694) privately insured patients and 1 126 508 (35.5% of 3 169 831) Medicaid enrollees had 1 or more opioid prescriptions. Nonsurgical acute pain opioid prescribing rates were lowest for acute migraines (privately insured, 4.6% of visits; Medicaid, 6.6%) and highest for rib fractures (privately insured, 44.8% of visits; Medicaid, 56.3%), with variable days' supply but similar daily dosage across most indications. Opioid prescribing for a given chronic pain indication varied depending on a patient's opioid use history. Days' supply for postoperative prescriptions was longest for combined spinal decompression and fusion (privately insured, 9.5 days [95% CI, 9.4-9.7 days]) or spinal fusion (Medicaid, 9.1 days [95% CI, 8.9-9.2 days]) and was shortest for vaginal delivery (privately insured, 4.1 days [95% CI, 4.1-4.1 days] vs Medicaid, 4.2 days [95% CI, 4.2-4.2 days]). Indication-specific opioid prescribing rates were not always aligned with existing guidelines. Potential inconsistencies between prescribing practice and clinical recommendations, such as for acute and chronic back pain, highlight opportunities to enhance pain management and patient safety.