Adequate Postoperative Pain Management Research Articles

Comparison between Carprofen and Meloxicam for Post-Neutering Pain Management in Pet Rabbits.

Surgical neutering in pet rabbits is common practice to prevent reproduction and associated health issues. Adequate postoperative pain management is crucial for recovery, yet effective methods in clinical settings remain underexplored. This study compared the analgesic effects of carprofen and meloxicam in pet rabbits undergoing surgical neutering. Fifty rabbits of varied demographics were included, with pain assessed using the Centro Animali Non Convenzionali Rabbit Scale (CANCRS). Rabbits were allocated to receive postoperative 2 mg kg-1 carprofen or 1 mg kg-1 meloxicam by subcutaneous injection. Anesthesia was induced with an intramuscular combination of ketamine (20 mg kg-1), medetomidine (0.4 mg kg-1), and butorphanol (0.2 mg kg-1), and ovariectomy or orchiectomy were performed. The CANCRS scale was used to assess pain by evaluating the rabbit preoperatively, 6 h postoperatively, and at three time points the following day. Times of return to spontaneous feeding and fecal production were also recorded. No statistically significant difference was found between treatment groups based on CANCRS scores and resumption of food intake and fecal output. No clinically detectable adverse effects were noted. While limitations include the use of a single pain assessment scale and the absence of a placebo control group, the results suggest that both carprofen and meloxicam can be viable options in clinical practice. Further research utilizing diverse pain assessment methods is warranted to enhance understanding and optimize pain management strategies for rabbits undergoing surgical procedures.

Analgesia in Patients After Coronary Artery Bypass Grafting

Adequate postoperative pain management remains a challenge. We discuss pathophysiology of pain after cardiac surgery and describe in detail multimodal and regional anesthesia, their advantages and disadvantages.

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

PurposePostoperative pain management has always been a significant challenge for both hospital staff and surgical patients. Determination of pain management outcomes among surgically treated patients may help develop pain management strategies, improve health services that would yield better outcomes, and increase patient satisfaction. This study aimed to assess the outcomes of pain management among postoperative patients. DesignThe study was a descriptive cross-sectional study. MethodsThe research was performed on postoperative patients at two university hospitals in North Cyprus from July to September 2019. The study sample consisted of 90 patients from both hospitals. The Turkish Version of the revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R-TR) was used for data collection. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist was used to report the present study. FindingsThis study showed that the overall mean for pain severity and the worst pain experienced by patients after 24 hours was slightly higher than medium. Examination of interference of the pain with functions demonstrated that patients experienced problems with physical activities and sleeping. The most experienced side effects were nausea and drowsiness, and the most common emotions were anxiety and helplessness during the postsurgery period. The satisfaction rate of the patients with postoperative pain management was relatively high. ConclusionsA holistic approach with evidence-based practices is crucial for adequate postoperative pain management. The recommendations include the development of individual pain outcome strategies to improve overall satisfaction with pain management among postoperative patients.

Management of postoperative pain in the elderly. Literature review

Timely post-operative pain management in elderly patients is critically important. Given their physiological changes and comorbidities, management in this group of patients is different from the rest of the population. Knowledge of potentially inappropriate medications (Beers criteria) is relevant because of the presence of comorbidities in this population. Although acetaminophen continues to be safe, non-steroidal anti-inflammatory agents produce several adverse effects which need to be considered before they are used. On the other hand, opioids continue to be one of the pillars in analgesia, with due consideration of their adverse affects and interactions, and the need for dose adjustments. Adequate postoperative pain management prevents adverse effects and the risk of developing chronic pain.

Erector Spinae Plane Block versus Paravertebral Block after Thoracic Surgery for Lung Cancer: A Propensity Score Study.

The prevention of respiratory complications is a major issue after thoracic surgery for lung cancer, and requires adequate post-operative pain management. The erector spinae plane block (ESPB) may decrease post-operative pain. The objective of this study was to evaluate the impact of ESPB on pain after video or robot-assisted thoracic surgery (VATS or RATS). The main outcome of this retrospective study with a propensity score analysis (PSA) was to compare the post-operative pain at 24 h at rest and at cough between a group that received ESPB and a group that received paravertebral block (PVB). Post-operative morphine consumption at 24 h and complications were also assessed. One hundred and seven patients were included: 54 in the ESPB group and 53 in the PVB group. The post-operative median pain score at rest and cough was lower in the ESPB group compared to the PVB group at 24 h (respectively, at rest 2 [1; 3.5] vs. 2 [0; 4], p = 0.0181, with PSA; ESPB -0.80 [-1.50; -0.10], p = 0.0255, and at cough (4 [3; 6] vs. 5 [4; 6], p = 0.0261, with PSA; ESPB -1.48 [-2.65; -0.31], p = 0.0135). There were no differences between groups concerning post-operative morphine consumption at 24 h and respiratory complications. Our results suggest that ESPB is associated with less post-operative pain at 24 h than PVB after VATS or RATS for lung cancer. Furthermore, ESPB is an acceptable and safe alternative compared to PVB.

Effectiveness of Postoperative Pain Management and Postoperative Emergency Pain Management at Prof.Dr. I.G.N.G. Ngoerah General Hospital

Background: Early postoperative recovery has undergone many developments. Early mobilization, early nutritional intake, and adequate postoperative pain management are the scope of early postoperative recovery. The principle of postoperative pain management starts from preoperative evaluation which includes medical and psychological conditions, medication history, history of chronic pain, drug abuse, and previous postoperative treatment regiments to guide postoperative pain management plans. Method: This research is an analytical observational study, carried out at Sanglah Hospital Denpasar from June 2021 to December 2021. The accessible population of this study was all postoperative patients at the Central Surgical Installation and the Emergency Room at Sanglah Hospital Denpasar who were consulted by the Acute Pain Service (APS) team. Inclusion criteria were all patients who underwent surgical procedures under general and regional anesthesia, ASA physical status 1-3, and age above 18 years. Results: There were 166 patients managed by continuous intravenous postoperative analgesia (73.1%), 43 patients by epidural postoperative analgesia (18.9%), and 18 patient-controlled analgesia/PCA (7.9%). The most widely used intravenous regiment was fentanyl by 85 (37.4%).Conclusion: This study shows incidences number of acute postoperative pain in the elective and emergency department at Sanglah Hospital Denpasar gave good results with a much lower incidence of pain compared to the existing literature.

Resolution of the Federal Joint Committee on the mandatory introduction and implementation of acute pain management concepts-Importance and consequences for ophthalmology

Patient-centered and adequate postoperative pain management is an important part of amodern treatment concept and should also be standard in ophthalmology. Due to the "Regulation on the mandatory introduction and implementation of acute pain management concepts for adequate postoperative pain therapy" prescribed by the Federal Joint Committee of the German statutory healthcare system (G-BA), hospitals and outpatient facilities have been required to have regulations on pain management in place since 9December 2020. It is very likely that the need of pain management in ophthalmic surgery has been systematically underestimated so far and studies on postoperative pain hardly exist. In the opinion of the authors, the decision represents an opportunity to pay more attention to the topic and to develop standards for ophthalmology as well. This article explains the G‑BA decision and the resulting consequences for ophthalmic surgical institutions.

Evaluation of Opioid Prescribing Patterns and Use Following Hysterectomy for Benign Indication: A Prospective Cohort Study.

To evaluate surgeon opioid prescribing patterns for patients undergoing hysterectomy for benign indication, as well as patient use of postoperative medications and satisfaction with postoperative pain management. Patients undergoing hysterectomy for benign indications at Kingston Health Sciences Centre were invited to participate in a telephone survey 2 weeks post-surgery to review their analgesia use and pain management. Patient demographics, medical history, intraoperative surgical details, and postoperative prescriptions were gathered through patient record review. Opioid prescribing and utilization patterns were assessed, as was satisfaction with postoperative pain management. Of 124 eligible patients 110 (89%) completed the telephone survey, a mean 15.9 ± 2.3 days after surgery. The mean age of participants was 51.6 ± 11.9 years. Most surgeries (84.5%) were minimally invasive, and 45.5% of patients were discharged within 24 hours of surgery. An opioid prescription was given to 71.8% of participants, and 52.7% used at least 1 dose of opioid medication after discharge. Most participants described very good or adequate postoperative pain management (88.2%). Satisfaction with postoperative pain control was not associated with receipt of an opioid prescription (P=0.89). A greater proportion of those who used 1 or more doses of opioids versus none indicated poor or inadequate pain management (19.0% vs. 4.1%; P=0.035). Many patients do not use postoperative opioid analgesia following hospital discharge after hysterectomy, without experiencing poor pain management. Surgeons should assess each individual and tailor the analgesia plan as necessary, optimizing non-opioid options.

Postoperative pain experience after proximal femur fracture in dementia

The present study aimed to assess the postoperative pain experience in cognitive deficit patients with special reference to sensory or affective pain quality. Nineteen patients with normal cognition up to cognitive impairments according to the DemTect screening-tool were studied regarding their postoperative pain experience after proximal femur fracture. The numerical rating scale (NRS), the cognitive DemTect questionnaire, the pain sensation questionnaire (SES), and aquantitative sensory test (QST) were used as examination instruments. The mean ± SD age of the patients was 83.8 ± 10.0years. Of the 19patients, 6(31.6%) had normal cognitive abilities. In 4patients (21.1%) there were indications of mild cognitive impairments, and in 9patients (47.4%) the suspicions of the presence of dementia arose. The mean postoperative pain intensity (NRS) was 4.0 (1.6). With comparable analgesic therapy, the reported pain intensities did not differ between the three patient groups with different cognitive impairments and the first three postoperative treatment days. There were no statistically significant differences between the groups for the sensory or affective total scores of the pain sensation scale. The QST parameters deep pain (PPT), superficial mechanical pain after needle stimulation (MPT), and the superficial sensitivity to light touch stimuli (MDT) showed asignificantly increased sensitivity of the operated side. For the sensation of vibration (VDT) no differences between operated and healthy extremities could be proven. The postoperative pain experience does not differ between patients with normal and limited cognition. The quantitative sensory testing showed mechanical hyperalgesia in the operated area. The study points to the importance of adequate postoperative pain management even in those with dementia.

Effect of Wound Infiltration with Bupivacaine after Laparoscopic Cholecystectomy – A Randomized, Controlled Trial

Background and Objective: Adequate post-operative pain management can improve surgical outcome. Patients undergoing surgery can be affected socially, psychologically, economically with undertreated pain. We aimed to evaluate the effect of 0.25% bupivacaine infiltration on postoperative pain, analgesic requirement, satisfaction level, hospital discharge and quality of life after laparoscopic cholecystectomy.
 Methodology: Fifty eight patients undergoing laparoscopic cholecystectomy were enrolled and randomized in two groups – placebo and intervention. Patients were infiltrated with 10 ml 0.25% bupivacaine in intervention and 10 ml 0.9% normal saline in placebo group. Post-operative pain was managed with morphine using Patient Controlled Analgesia (PCA). Pain intensity was assessed on the matrix of visual analogue scale and verbal rating scale up to 12 post-operative hours. This study also assessed its effect on analgesic requirements, hospital stay, patient satisfaction level after 24hours, pain score on discharge, time taken to return to job and quality of life (on 15th and 30th post-operative day).
 Results: It was revealed 0.25% bupivacaine can lower post-operative pain up to six post-operative hour of performing laparoscopic cholecystectomy. Total analgesic requirement was also reduced (p= 0.0003) with decreased side effect like vomiting (p= 0.0002). However, satisfaction and quality of life were not affected by bupivacaine infiltration in this study.
 Conclusion: 0.25% Bupivacaine infiltration offered more effective management of postoperative analgesia with decreased analgesic requirement and less incident of vomiting. But it was not effective after long duration in terms of satisfaction level, hospital discharge, time to return to job or quality of life.

Perioperative Pain Control in Bariatric Surgeries, a Systematic Review

Abstract Introduction Research on adequate postoperative pain management is a current trend in post-anesthetic and surgical areas. Patient satisfaction is a parameter of medical quality. High pain scores increase the incidence of post-operative morbidity and lead to delayed recovery, prolonged hospital stay and increased healthcare costs.1 Bariatric Surgeries are surgeries performed for morbid obese patient to reduce patient’s weight through several methods and because morbid obese patients are at higher risk of complications after surgery2, Pain control during bariatric surgery is a major challenge3. Opioids play an important role in anesthesia practice; however, related complications like; sedation, airway obstruction, and respiratory depression are of concern in morbid obese patients .Therefore, opioids should be used sparingly. And newly safe methods better to be used for better perioperative pain control in bariatric surgeries. Objective To cover the gab of knowledge regarding the evidence of the safest and most efficient method to control perioperative pain in bariatric surgeries by reviewing the literature about this evidence through comparative systematic review study. Methodology Systematic review study discussed the results of 30 studies found in the literature related to perioperative pain control in bariatric surgeries according to the inclusion and exclusion criteria . Results and Discussion 30 different studies were discussed about the different methods of anesthesia in bariatric surgeries 6 of them about Transverses abdominis plane. ‘TAP’ block, 5 about Local anesthesia, 4 about Dexmedetomidine, 3 about spinal morphine, 3 about multi modal analgesia, 2 about preoperative medication, 2 about patient controlled analgesia ‘PCA', 1 about continuous infusion catheter, 1 about ibuprofen, 1 about Pulmonary recruitment maneuver, 1 about Sugammadex and 1 about non opioid anesthesia). Results are recorded about the efficacy of each method through the outcome measures. Conclusion It's found that the most effective method is multi modal analgesia represented in preoperative ultra sound guided TAP block, intraoperative port- sites and intraperitoneal infiltration with local anesthesia then recovery by sugammadex followed by postoperative IVI acetaminophen and PCA. Using preoperative clonidine, ketamine, pregabalin, epidural analgesia and pulmonary recruitment maneuver at the end of the surgery are also with low complication. Continuous infusion catheter, IV Ibuprofen, combined Dexmedetomidine and Acetaminophene, preoperative port-site infiltration and post operative intraperitoneal local anesthetic have no evidence based efficacy right now and it needs further studies.

Postoperative Pain Management in Pediatric Patients Undergoing Cardiac Surgery: Where Are We Heading?

Adequate postoperative pain management is crucial in pediatric patients undergoing cardiac surgery because pain can lead to devastating short- and long-term consequences. This review discusses the limitations of current postoperative pain assessment and management in children after cardiac surgery, the obstacles to providing optimal treatment, and concepts to consider that may overcome these barriers. MEDLINE and PubMed. Effective pain management in infants and young children undergoing cardiac surgery continues to evolve with innovative methods of both assessment and therapy using newer drugs or novel routes of administration. Artificial intelligence- and machine learning-based pain assessment and patient-tailored management in both pain measurement and prevention are already being integrated into the routine of current practice.

Acute postoperative pain exacerbates neuroinflammation and related delirium-like cognitive dysfunction in rats.

The acute neuroinflammatory response to surgery may play a key pathogenic role in postoperative delirium (POD). Here, we investigated the contribution of acute postoperative pain to neuroinflammation and related delirium-like behaviors after surgery in adult and aged rats. Animals were assigned into four groups: control, abdominal surgery, surgery with analgesia using local ropivacaine, and surgery with analgesia using systemic morphine. Pain was assessed by the Rat Grimace Scale (RGS). Trace and context memory retention was evaluated following trace fear conditioning during the first 2 days after surgery. Pro-inflammatory cytokines in medial prefrontal cortex and hippocampus were measured by enzyme-linked immunosorbent assay. In both age groups, the RGS increased significantly from baseline until 6h after surgery. The postoperative analgesia with either local or systemic regimens comparably alleviated the RGS increase in adult and aged animals. The two analgesic regimens attenuated the surgery-induced trace and context memory deficits, as well as cytokines overproduction in both medial prefrontal cortex and hippocampus. No age-related differences were found in the neuro-cognitive effectiveness of postoperative analgesia. Our experimental findings provide proof-of-concept for adequate postoperative pain management as one of the main preventive strategies of POD.

Post-adenotonsillectomy analgesia in children: The place of non-steroidal anti-inflammatory drugs

Background: Adenotonsillectomy and tonsillectomy are common surgeries carried out in children under 15 years of age with associated significant pains; therefore, adequate post-operative pain management is mandatory to ensure full recovery. Non-steroidal anti-inflammatory drugs (NSAIDs), being cheap and readily available, could be used to achieve this. Objective: The objective was to determine the effectiveness of post-operative analgesia in these children using NSAIDs – diclofenac sodium/ibuprofen. Methods: All children admitted for adenotonsillectomy/tonsillectomy in the Ear, Nose and Throat surgery department from April 2016 to March 2017 were recruited. All the patients had diclofenac suppository at 1.5 mg/kg immediate post-operative period and then 12 hourly for 48 h and subsequently ibuprofen oral suspension at 5 mg/kg/dose 8 hourly for 5 days. Swallowing and the time of commencement of oral intake were used as indices to ascertain effective or adequate analgesia. The time of commencement of oral intake both for liquids and solids including the duration of hospital stay was documented and analysed using SPSS software version 20.0. The results were presented using simple statistical tables. Results: A total of 78 children were recruited, of which only 75 underwent the full study. The age ranged from 11 months to 14.5 years with 47 males and 28 females. The age group of 2.6–4.5 years was the most commonly seen, which constituted 43.59%, whereas 46.67% of these patients commenced oral intake in 0–6 h post-operation. There was no post-operative bleeding recorded. There was a mortality of 3.85%. Conclusion: NSAIDs at regular intervals offer effective analgesia after adenotonsillectomy and appear to be safe in children.

A prospective randomized study to analyze the efficacy of balanced pre-emptive analgesia in spine surgery

Background ContextSurgical procedures involving the spine are known to cause moderate to severe postoperative pain. Inadequate management of acute pain in the postoperative period results in higher morbidity, and consequently may lead to chronic pain caused by central sensitization. The role of pre-emptive analgesia (PA) and intraoperative analgesia in management of postoperative pain has gained precedence over recent years. Pathophysiology of postoperative pain in spine surgery is unique, as it is a combination of nociceptive, inflammatory, and neuronal stimuli. Blockage of all three stimuli in the perioperative period by pre-emptively administrating a combination of paracetamol (P), ketorolac (K), and pregabalin (PR) might help in adequate management and alleviation of acute postoperative pain. PurposeTo evaluate the analgesic effect of a combination of P, K, and PR as pre-emptive multimodal analgesia, aimed to block or reduce acute postoperative pain after spine surgery. Study DesignA prospective, randomized, controlled, and double-blinded clinical trial. Patient SampleAfter Institutional Review Board approval, 100 consecutive patients requiring single- or double level spinal fusion procedures were randomized into two groups—PA and control (C). MethodsThe PA group received P, K, and PR 4 hours before surgery, as PA. Both groups underwent identical anesthetic and postoperative pain management protocol. Outcome MeasuresDemographic and surgical data, 4 hourly postoperative pain levels—Numeric Pain Rating scale (NRS), Ambulatory NRS scores; level of consciousness—Ramsay sedation scale, total amount of opioids consumed (TOC) through patient-controlled analgesia; functional levels—Oswestry Disability Index (ODI), surgical satisfaction index-North American Spine Society (NASS) satisfaction scale, duration of hospital stay, and all complications were recorded and analyzed. A research grant of 6,032 USD was obtained from AO Spine toward this work. There is no conflict to disclose. ResultsBoth the groups had identical demographic backgrounds and surgical profiles. The average NRS score within the first 48-hour period in the PA group (2.7±0.79) was significantly less than the C group (3.4±0.98) and the differences were more in the first 12 hours following surgery. Similarly, Ambulatory NRS scores were significantly low in the PA group during the first and second postoperative days. The PA group individuals were found to be more physically motivated, as 95.7% were able to ambulate 50 m on the first postoperative day compared with 30% in the C group. The PA group had significantly low TOC (3.02±2.29 mg) in comparison to the C group (4.94±3.08 mg). The duration of hospital stay was 4.17±1.02 and 4.84±1.62 days in the PA and C groups (p=.017), respectively. No major complications occurred in either groups and were found to be similar in percentage between both the groups, except for nausea and vomiting which were more in C group. Dry mouth was the most common side effect noted irrespective of the groups. All patients had significant improvement in ODI with better results in PA group at first month follow up. The PA group (97.90%) was extremely satisfied compared with C group (72%, p=.002) according to NASS scale. ConclusionsPostoperative pain management in spine surgery is maximized if perioperative painful stimuli can be inhibited, which requires adequate blood levels of analgesic, anti-inflammatory, and neuropathic drugs intraoperatively. The employed strategy of preoperative administration of balanced analgesia with a combination of P, K, and PR, each having different mechanisms of action, resulted in lesser pain intensity, allowed better ambulation tolerance, improved functional outcomes and has also reduced the requirement of opioids and duration of hospital stay with no additional complications. Thus, this balanced analgesia administered preoperatively would address the complicated postsurgical pain.

Innovation in Patient Care

This poster will provide evidence that supports a novel approach to managing postoperative pain in the pediatric laparoscopic appendectomy patient, specifically reducing with potential for eliminating the use of opioids for this patient population. BACKGROUND Opioid therapy has long represented the foundation of pain management postoperatively. However, as a significant and concerning increase in prescription-opioid-associated morbidity and mortality has emerged, there is an urgent need to balance adequate postoperative pain management with evidence-based prescription processes and to incorporate the use of multimodal pain management plans to both reduce opioid side effects and decrease the amount of unused opioid prescriptions that are available for diversion. Laparoscopic appendectomy for nonperforated appendicitis is among the most common operation in the pediatric population. There is an opportunity to decrease and even eliminate the use of opioids for this patient population using other modalities of pain control. This study further builds on previous work started in 2013 where we found that patients were taking far less opioids for pain than had been prescribed. This resulted in standardizing the amount of opioids prescribed in this patient population to five doses. PURPOSE The purpose of the study will be to describe pain control in the pediatric postoperative nonperforated appendectomy population after discharge from the hospital. Our hope is that we can show adequate pain control in this patient population, specifically using nonopioid modalities for pain control including acetaminophen and ibuprofen. DESIGN/IMPLEMENTATION This is a prospective cohort study. The standard clinical practice regarding the prescription of postoperative medications for pain management will be followed. Patients and their families are instructed to alternate acetaminophen and nonsteroidal anti-inflammatory drugs (Motrin) as necessary after discharge from the hospital. Parents are also offered a prescription for an opioid to fill in the event that their child had breakthrough pain (pain not relieved with acetaminophen or NSAIDs [Motrin]) and instructed to fill the opioid prescription only if they think their child needs an opioid for pain relief. Parents are instructed to keep track on their child's pain medication history on a sheet given to them detailing how many doses of acetaminophen, Motrin, or opioid doses they gave to their child. The medical record will be reviewed retrospectively to determine whether the child received an intraoperative peripheral block. The patients will be approached by the team (surgeon or nurse practitioner) when discharge prescriptions are explained. The study will be described, and the subjects/families will ask if they would participate in this study. If the subject/family consents to participate, they will receive a follow-up telephone call from a member of the team on Postoperative Day 3. In the event that the family cannot be reached on Postoperative Day 3, a follow-up call will be made on Day 4. No other contact will occur after this time. They will be contacted at the best number supplied by the family. The team member will ask about their child's pain experience and about the use of opioid and nonnarcotic pain relievers (acetaminophen and NSAIDs; see Table 1, data collection sheet). Patient education sheets will be provided per usual practice. EVALUATION/OUTCOME Descriptive and correlational statistics will be used for the analysis of this study. This analysis will be used to interpret the appropriateness and efficacy of utilizing this modality of treatment for pain control in this patient population with the outcome of eliminating the use of opioids for pain control.

Specifičnosti terapije akutnog postoperativnog bola u zemljama u razvoju

Developing countries account to more than 80% of the world population. In the last two decades, the term 'developing countries' is used to group the countries that have not yet reached level of sophisticated industrialization like Western Europe and North America. In developing countries, acute postoperative pain management has special considerations. Barriers to implementing adequate acute postoperative pain management refer to health service organization, drug availability, inadequate education of pain management providers, as well as inadequate education of patients themselves and prejudices they may have regarding their postoperative pain and consequences if is inadequately treated. Health care workers in developing world are making effort to improve postoperative pain management. Serbia has been included in PAIN OUT European network initiative, with the aim to construct the bundle of simply applied measures and the effects of their implementation on postoperative pain treatment. So far, most of these measures refer to health service improvement, increasing availability of opioid analgetics, local anaesthetics and non-steroid anti-inflammatory drugs as well as education of the medical staff, patients and families.

Local analgesic effect of pethidine infiltrated intrafascially after total abdominal hysterectomy: A randomized, double-blind study

Objective: Surgical-site infiltration with local anesthetics is a key component of multimodal analgesia regimen for adequate postoperative pain management. This randomized, double-blind study was designed to evaluate the local analgesic efficacy of pethidine in patients undergoing total abdominal hysterectomy (TAH) through a Pfannenstiel incision. Materials and Methods: Patients were randomized into two groups. The first group received wound infiltration (WI) with 0.5 mg/kg pethidine, diluted in 15 ml normal saline, and injected in the fascial layer at the end of surgery, combined with a simultaneous intramuscular (IM) injection of 2.5 ml normal saline (WI group). The second group received WI with 15 ml normal saline combined with an IM injection of 0.5 mg/kg pethidine and diluted in 2.5 ml normal saline (IM group). All patients received general anesthesia following a standardized anesthetic protocol. Study end points were 24-h total morphine consumption and pain scores based on a visual analog scale (VAS) at rest and on coughing at 1, 3, 6, and 24 postoperative h, as well as sedation scores observed using a 0–10 numeric rating scale. Adverse effects from morphine uptake, such as nausea, vomiting, and the need for rescue antiemetics, were recorded as well. Results: Postoperative VAS assessments showed no statistically significant advantage between WI and IM method, while the total (24h) consumption of morphine was lower in the IM, compared to the WI group (27.2%). The latter demonstrated a consistently higher median sedation score at all assessed time points after the operation (P < 0.05); however, it was significantly different only at the 6 h time point. Conclusions: Local WI with pethidine after TAH did not reduce the total morphine consumption for the first 24 h postoperatively. Morphine consumption was lower in the IM group, compared to the WI group. Further studies are needed to assess the effectiveness of pethidine as a local anesthetic agent.

Assessments of health professionals knowledge towards post-operative pain management in Asella Teaching and Referral Hospital, South East Ethiopia

Pain is defined as any an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Adequate postoperative pain management can reduce the patients‟ length of hospitalization and decrease postoperative complications. However, post-operative pain has not been satisfactorily relieved. Thus, the aim of this work is to assess professionals’ knowledge on post-operative pain management. Institutional based cross sectional study design was conducted. All health professionals who have worked in operation room, surgical ward, recovery room, and post anesthesia care unit were included. Data was entered into Epi info version 7 and transported to SPSS version 21 for analysis. Tables and narratives were used to determine descriptive statistics. A total of 52 participants were included in the study of which 59.6% were male. 69% of the respondents were found to be between the age of 20 and 23 years. Almost all patients in this study (94.23%) do not use pain assessment tools and 78.85% of the respondents do not know about multimodal analgesia. Approximately, one third of the respondents 32.69% mentioned that the drug is administered when the patient complain of pain. These showed that there is a knowledge gap on postoperative pain managements. Therefore, it was strongly recommended to improve professionals’ knowledge on postoperative pain management. Key words: Pain, postoperative pain management, Asella Teaching Referral Hospital.

Predictors, prevention, and management of postoperative pain associated with nonsurgical root canal treatment: A systematic review.

Postoperative pain after root canal treatment can be reduced by applying recent advances in endodontic techniques and equipment. This systematic review includes current knowledge about pain after nonsurgical root canal treatment, including predictors, related factors, effects of recent advances, and management. A literature search was performed using the PubMed, ScienceDirect, and Cochrane Library databases for articles published between 1990 and 2016. Search keywords included postoperative pain, nonsurgical treatment, single visit, recent advances in endodontics, and management of postoperative pain with endodontic treatment. Only original research studies were included; editorials, reviews, brief notes, conference proceedings, and letters to the editor were excluded. The initial search yielded 4941 articles, which were assessed and filtered using the selection criteria. Sixty-five studies met the inclusion criteria and were included in the review. The findings showed that pain after nonsurgical root canal treatment occurred in 3–69.3% of patients. Microorganisms were identified as the primary contributors to postoperative pain, and there was no significant difference in postoperative pain between single- and multiple-visit treatments. Postoperative pain after root canal treatment ranges from mild to moderate and occurs even after optimally performed procedures. Furthermore, adequate management of postoperative pain is often considered an indicator of clinical excellence. Application of recently developed endodontic techniques and devices will reduce postoperative pain. Furthermore, a flexible, severity-based drug administration plan can be used to control and manage pain after root canal treatment. Application of the current research findings will reduce pain following root canal treatment and improve patient outcomes.