Analgesia For Delivery Research Articles

Analgesic outcomes of tramadol alone and in combination with Butorphanol or Flurbiprofen Axetil after cesarean section: a retrospective study with propensity score matching analysis

BackgroundThe Society for Obstetric Anesthesia and Perinatology recommends a multimodal analgesia regimen for cesarean delivery analgesia. This study aimed to compare the analgesic effects of tramadol alone and combined with butorphanol or flurbiprofen axetil after a cesarean section.MethodsWe performed a retrospective analysis based on the electronic medical records of a teaching hospital in China from January 2018 to January 2020. We collected data on demographic characteristics, anesthesia, analgesia strategy, and pain intensity postoperatively during the first 48 hours. Inadequate postoperative analgesia during this period was defined as an NRS score ≥ 4. We also collected data regarding off-bed activity and intestinal function recovery. Participants were classified into three groups according to analgesia regimens. Groups T, TF, and TB received tramadol, a mixture of tramadol and flurbiprofen axetil, and a combination of tramadol and butorphanol, respectively. Analgesic outcomes were compared using propensity score matching analysis.ResultsData from 2323 cases of caesarean section were included in the analysis, and 521 pairs were matched in each group according to their propensity score. Compared with group T, The inadequate analgesia on pain at rest and pain at movement was lower in group TF (RR: 0.42, 95% CI: 0.36–0.49, P = 0.001 and RR: 0.58, 95% CI: 0.48–0.69, P < 0.001, respectively),and the incidence of inadequate control of pain at movement was higher in group TB (RR: 1.38, 95% CI: 1.22–1.55, P < 0.001).Additionally, the percentage of off-bed activity at 2 days postoperatively was higher in group TB than in groups TF and T (78.7% vs. 68.5 and 78.7% vs. 64.9%, respectively, P < 0.001). The incidence of intestinal function recovery 2 days after cesarean delivery in group TB was higher than that in group TF (73.3% vs. 66.2%, P = 0.013).ConclusionsCombining tramadol and flurbiprofen axetil could enhance the analgesic effect and be safely used for analgesia after a cesarean section. However, combining tramadol and butorphanol may produce an antagonistic effect.

Management of Cancer-Related Pain With Intrathecal Drug Delivery: A Systematic Review and MetaAnalysis of Clinical Studies

Pain is a prevalent and under-treated symptom in patients with cancer. Intrathecal (IT) therapy is a targeted delivery of analgesics to the IT space. We report a systematic review and meta-analysis of the efficacy of IT therapy for the relief of cancer pain, systemic opioid use, and infection rates.

Randomized Clinical Trial Comparing Quadratus Lumborum Block and Intrathecal Morphine for Postcesarean Analgesia.

To compare the efficacy of quadratus lumborum (QL) block and intrathecal morphine (M) for postcesarean delivery analgesia. Thirty-one pregnant women with ≥ 37 weeks of gestation submitted to elective cesarean section were included in the study. They were randomly allocated to either the QL group (12.5 mg 0.5% bupivacaine for spinal anesthesia and 0.3 ml/kg 0.2% bupivacaine for QL block) or the M group (12.5 mg bupivacaine 0.5% and 100 mcg of morphine in spinal anesthesia). The visual analog scale of pain, consumption of morphine and tramadol for pain relief in 48 hours, and side effects were recorded. Median pain score and/or pain variation were higher in the morphine group than in the QL group (p = 0.02). There was no significant difference in the consumption of morphine or tramadol between groups over time. Side effects such as pruritus, nausea, and vomiting were observed only in the morphine group. Quadratus lumborum block and intrathecal morphine are effective for analgesia after cesarean section. Patients undergoing QL block had lower postoperative pain scores without the undesirable side effects of opioids such as nausea, vomiting, and pruritus.

Low dose bupivacaine spinal anesthesia for emergency cesarean section in a patient with uncorrected tetralogy of fallot, presenting with placenta previa

Background: Pregnant women with congenital heart disease tetralogy of fallot who undergo cesarean section have their own challenges for the anesthesiologist, not to mention if they have pregnancy complications such as placenta previa. The choice of the safest anesthetic technique is still debated today. The anesthetic technique must be able to maintain systemic vascular resistance, avoid increasing pulmonary vascular resistance, and be aware of the threat of blood loss due to placenta previa. Case Report: 29 years old pregnant woman, weighing 46 kg and height 155 cm, G1P0A0, Gravida 27-28 weeks, single alive fetus, fetal distress, comes with complaints of shortness of breath, vaginal bleeding due to placenta previa with tetralogy of fallot planned emergency cesarean section. The patient presented with functional class NYHA II-III. We used low-dose spinal anesthesia with 5 mg bupivacaine 0.5% and 25 ug fentanyl as an adjuvant. Colloading was done with gelofusin colloid fluid to replace the amount of bleeding. Hemodynamics prior to anesthesia were BP 120/80, Heart Rate 80 x/minure, SpO2 72% with a non-rebreathing mask 10 litre/minute. There was no severe hypotension during surgery, and was hemodynamically stable with limited use of vasopressors. After the cesarean section was completed, the patient was transferred to the ICU and treated for 2 days, and was only discharged after 5 days of treatment without additional complications. Conclusion: The use of low-dose spinal anesthesia in combination with adjuvant fentanyl results in a relatively safe anesthetic technique with minimal hemodynamic changes and adequate analgesia for cesarean delivery.

A systematic review of subcutaneous versus intramuscular or intravenous routes of opioid administration on pain outcomes in cancer and post-surgical clinical populations - challenging current assumptions in palliative care practice.

The objective of this review is to investigate the use of the subcutaneous route of administration of analgesics, common practice within palliative medicine. Systematic review using consensus approach, direct comparison of subcutaneous route with intravenous and intramuscular routes. The limited available evidence demonstrates non-inferiority of the subcutaneous route in both cancer patients and those post-surgery. Pain management is comparable to other routes. Route-related side effects are rare and systemic side effects are comparable. Pain management is a critical role of palliative medicine. The subcutaneous route of administration offers a viable option for the delivery of parenteral analgesia within all settings, including the community. This review supports current practice, demonstrating equivalence with more invasive routes of administration.

A Narrative Review of the Uses of Ultrasound in the Evaluation, Analgesia, and Treatment of Distal Forearm Fractures

BackgroundDistal forearm fractures are a commonly encountered injury in the emergency department (ED), accounting for 500,000 to 1.5 million visits and 17% of ED fractures. The evaluation and management of these fractures frequently employs x-ray studies, conscious sedation, closed reduction, and splinting. Point-of-care ultrasound (POCUS) can offer significant benefit in the diagnosis and management of these common injuries. Objective of the ReviewTo review the clinical utility of POCUS in the diagnosis of distal forearm fractures, as well as to demonstrate the performance of ultrasound-guided analgesia delivery and ultrasound-guided reduction technique. DiscussionThe initial evaluation of forearm injuries frequently includes x-ray studies. However, multiple studies have shown ultrasound to be sensitive and specific for distal radius fractures, with the added value of detecting soft tissue injuries missed by conventional radiography. POCUS may also facilitate analgesia through the use of ultrasound-guided hematoma blocks, which removes the need for conscious sedation prior to manipulation. Finally, POCUS can be used after manipulation to assess cortical realignment of the bone fragments and spare the patient multiple reduction attempts and repeat radiographs. ConclusionDistal forearm fractures are common, and the emergency physician should be adept with the evaluation and management of these injuries. POCUS can be a reliable modality in the detection of these fractures and can be used to facilitate analgesia and augment success of reduction attempts. These techniques may decrease length of stay, improve patient pain, and decrease reduction attempts.

The Use of Dissemination and Implementation to Improve Multimodal Analgesia in Head and Neck Surgery.

To optimize the delivery of multimodal analgesia to patients undergoing major head and neck oncologic surgeries. Pilot study included patients enrolled to receive either scheduled acetaminophen and as-needed opioids (control group) or scheduled acetaminophen, gabapentin, ketorolac, and as-needed opioids (experimental group). RCT, a hybrid type 1 effectiveness-implementation pragmatic trial, was designed to test the effectiveness of the intervention. Arm A received scheduled acetaminophen and as-needed opioids. Arm B received scheduled gabapentin, ketorolac, a regional nerve block at the free tissue donor site, scheduled acetaminophen and as-needed opioids. Pilot: Thirty-one patients undergoing major head and neck surgery were enrolled. Mean MMEs administered in control group (n=15) was 251.60 mg (SD=224.57 mg); mean MMEs in Experimental group (n=16) was 195.78 mg (SD=131.08 mg), p=0.401. LOS was 8.0 days in control versus 7.0 days in experimental group (p=0.054). RCT: Interim analysis for safety and futility was planned during trial's design after 30 patients (n=14 Arm A, and n=16 Arm B). Mean MMEs administered were 135.1 mg in Arm A, (SD=86.0 mg) versus mean MME of 51.3 mg in Arm B (SD=43.3 mg, (p < 0.05)). Given clear superiority results, the trial was prematurely terminated. Functional pain scores, LOS, and complications were similar between the arms (p > 0.05). Variability of mean MME was compared before and after implementation of the management protocols: SD in RCT#1 was 181.46 mg versus 124.6 mg in RCT#2. Multimodal analgesia significantly reduced the need for opioids in patients undergoing major head and neck surgery. 1, Randomized Clinical Trial Laryngoscope, 133:S1-S11, 2023.

Trend in neuraxial morphine use and postoperative analgesia after cesarean delivery in Japan from 2005 to 2020

The increasing rate of cesarean deliveries warrants obstetric anesthesiologists to deliver high-quality post-cesarean delivery analgesia. The aim of this study was to evaluate the temporal trends in the use of neuraxial morphine for cesarean deliveries and to describe the current postoperative analgesia practices. A retrospective cohort study using nationwide health insurance claims databases was conducted from 2005 to 2020 in Japan. Pregnant women who had undergone cesarean deliveries were included. The annual rate of neuraxial morphine use was extracted and analyzed. Additionally, we explored the patient- and facility-level factors associated with neuraxial morphine use through a multilevel logistic regression analysis. The cohort included 65,208 cesarean delivery cases from 2275 institutions. The prevalence of neuraxial morphine use was 16.0% (95% confidence interval [CI], 15.8–16.3) in the overall cohort. Intrathecal morphine was used in 20.6% (95% CI, 20.2–21.0) of spinal anesthesia cases. The trend in neuraxial morphine use steadily increased from 2005 to 2020. The significant predictors of neuraxial morphine use included spinal anesthesia, recent surgery, large medical facilities, and academic hospitals. Variations in the utilization of postoperative analgesia were observed. Our study described the current trend of neuraxial morphine use and the variation in postoperative analgesia practice in Japan.

Pain-free DrEaMing – the impact of a 7-day inpatient pain team on colorectal recovery in a postoperative care unit

Background: An ageing colorectal surgical population has resulted in an increasing emphasis on the minimisation of postoperative complications. The advent of enhanced recovery programmes1 coupled with postoperative or post-anaesthetic care units, support the delivery of multi-modal analgesia whilst prioritising mobilisation and oral intake in the postoperative period. Integral to this perioperative pathway is a dedicated inpatient pain team as safe and effective analgesia is vital to facilitate mobilisation and oral intake. Adapting enhanced recovery strategies enabled us to focus on encouraging drinking, eating, and mobilisation (DrEaM). Methods: Patients for colorectal surgery were screened for suitability for the enhanced recovery programme at the time of booking, with data shared between colorectal secretaries and the inpatient pain team when patients were identified. All eligible elective colorectal surgery patients were seen regularly by the inpatient pain team for up to 5 days postoperatively (including weekends) either on the postoperative care unit or subsequent surgical ward. Data were collected prospectively via an electronic pain team database over a 42-week period between June 2020 and May 2021. Results: There were 136 colorectal surgical patients enrolled onto the enhanced recovery programme in the 42-week period: 55% were female with 86% undergoing laparoscopic surgery. There were no patients who reported severe pain at rest throughout the postoperative period. The facilitation of good pain management ensured that all patients were drinking free fluids and 60% were eating by the first postoperative day. The analgesia regimen facilitated early mobilisation of 18.5% of patients on the day of surgery and 85.9% by the first postoperative day (Fig. 4). Conclusions: Postoperative pain remains a major factor in limiting mobilisation for the colorectal surgery patient population. The formation of enhanced recovery pathways with an integrated inpatient pain team facilitated an optimisation of analgesia, which then encourages early mobilisation and nutrition resulting in a decreased length of stay. 1.Gustafsson UO, Scott MJ, Hubner M, et al. World J Surg 2019; 43: 659

Initial Pain Assessment and Management in Pediatric Burn Patients Presenting to a Major Trauma Center in Saudi Arabia.

Pediatric burn injury is a traumatic experience for affected children and their families. Burn pain is frequently undertreated and may adversely affect patient experience and outcomes. The aim of this study was to investigate the current practice of initial pediatric burn pain assessment and management at a major trauma center in Riyadh, Kingdom of Saudi Arabia. We conducted a retrospective cohort study that included children 14 years and younger who visited King Saud Medical City in the Kingdom of Saudi Arabia with a presenting complaint of burn injury from January 01, 2017 to August 30, 2018. Variables were reported using descriptive statistics as appropriate. The 309 patients who were analyzed were classified into 3 age groups ranging from 0 to younger than 3 years (61%), 3 to 7 years (24%), and older than 7 years (15%). They included 145 (47%) female and 164 (53%) male patients. Pain levels of 182 patients (59%) were documented using an age-appropriate tool. In 75 children (24%), pain levels were documented using an alternate tool, and the tool used was not defined for 44 children (14%). Pain assessment was not documented for 8 children. Of those with an age-appropriate tool, the median initial pain score was 4 (interquartile range [IQR], 2-4). Analgesia was recorded to have been administered to 139 patients (45%), within a median time of 50 minutes (IQR, 17-154 minutes) to first analgesia. Among patients who had appropriate assessment of pain, 92 (50.3%) received analgesia compared with 52 (41.3%) who did not have appropriate assessment (P = 0.12). Among patients who had appropriate pain assessment, time to analgesia was 42 minutes (IQR, 15-132 minutes) compared with 53 minutes (IQR, 17-189 minutes) among patients who did not have appropriate assessment (P = 0.48). Most pediatric patients presenting with burns had pain assessment, but a substantial proportion of children were not managed using recommended age-specific tools. The use of age-specific tools was not necessarily associated with delivery of analgesia. For pediatric burns, prompt delivery of analgesia should be prioritized with pain assessment using age-appropriate tools being recommended, but optional.

Clinical Study on Analgesic Delivery Combined with Posture Nursing during Labor

Clinical Study on Analgesic Delivery Combined with Posture Nursing during Labor

Respiratory depression after administration of single-dose neuraxial morphine for post-cesarean delivery analgesia: a retrospective cohort study

BackgroundNeuraxial administration of long-acting opioid is the “gold standard” for the management of postoperative pain following cesarean delivery. Respiratory depression, however, remains a concerning complication. MethodsThis retrospective single-center study of 4963 patients evaluated the frequency of respiratory depression after neuraxial morphine administration in a post-cesarean delivery population. The spinal dose of morphine varied from 100 to 450 µg intrathecally, and from 3 to 5 mg epidurally. The primary outcome was the initiation of a Rapid Response Team (RRT) event for respiratory failure due to neuraxial opioid in the 24 h following morphine administration. Secondary outcomes studied included oxygen desaturation events (SpO2 <90%), initiation of oxygen therapy and naloxone administration. ResultsThere were no respiratory RRT events within the study period (95% confidence interval [CI] 0 to 7 per 10 000). There were no desaturation events recorded and no patients received supplemental oxygen therapy or naloxone (95% CI 0 to 7 per 10 000). ConclusionClinically significant respiratory depression is rare among patients receiving neuraxial morphine for post-cesarean delivery analgesia.

Factors Associated with Failed Trial of Labor after Cesarean, among Women with Twin Gestation-A Multicenter Retrospective Cohort Study.

Objective: Twin trial of labor after a cesarean section (TOLAC) is associated with a lower success rate of vaginal delivery than singleton TOLAC, and a higher rate of adverse outcomes in comparison to an elective repeat cesarean delivery. This study aims to investigate the factors associated with failed TOLAC, among women with twin gestation. Study design: A multicenter retrospective cohort study was undertaken. All women with twin pregnancies attempting a trial of labor after a previous cesarean in two university-affiliated obstetrical centers, between 2005 and 2021 were included. The study population included women with a twin gestation where twin A presented in the vertex position, a single previous low segment transverse section, and those who were eligible for a vaginal delivery. Labor, maternal, and neonatal characteristics were compared. A univariate analysis was undertaken, followed by multivariate analysis (aORs; [95% CI]). Results: A total of 160 women attempting a twin TOLAC were included. Vaginal birth after cesarean was achieved in 86.3% of these cases. Assisted reproductive technology (ART), the lack of oxytocin use for augmentation during labor, the lack of epidural analgesia, and preterm birth before 34, 32, and 28 gestational weeks were all found to be associated with failed TOLAC. In the multivariate analysis, cervical dilation on admission (aOR 0.6 [0.40–0.82], p < 0.01), no use of oxytocin (aOR 5.2 [1.36–19.73], p = 0.02), gestational age at delivery (aOR 0.8 [0.65–1.00], p = 0.047) and lack of epidural analgesia (aOR 4.5 [1.01–20.16], p = 0.049), were all found to be significantly associated with failed TOLAC. Conclusion: In the investigated population of women with twins undergoing TOLAC, the use of epidural analgesia, the use of oxytocin and increased cervical dilation to the delivery room are associated with a higher rate of vaginal delivery, and may reduce the risk of repeat cesarean delivery.

Closed-loop stimulation using a multiregion brain-machine interface has analgesic effects in rodents.

Effective treatments for chronic pain remain limited. Conceptually, a closed-loop neural interface combining sensory signal detection with therapeutic delivery could produce timely and effective pain relief. Such systems are challenging to develop because of difficulties in accurate pain detection and ultrafast analgesic delivery. Pain has sensory and affective components, encoded in large part by neural activities in the primary somatosensory cortex (S1) and anterior cingulate cortex (ACC), respectively. Meanwhile, studies show that stimulation of the prefrontal cortex (PFC) produces descending pain control. Here, we designed and tested a brain-machine interface (BMI) combining an automated pain detection arm, based on simultaneously recorded local field potential (LFP) signals from the S1 and ACC, with a treatment arm, based on optogenetic activation or electrical deep brain stimulation (DBS) of the PFC in freely behaving rats. Our multiregion neural interface accurately detected and treated acute evoked pain and chronic pain. This neural interface is activated rapidly, and its efficacy remained stable over time. Given the clinical feasibility of LFP recordings and DBS, our findings suggest that BMI is a promising approach for pain treatment.

Cover Feature: Electrospun Nanofibers for Wound Management (ChemNanoMat 7/2022)

Electrospun nanofibers have been widely examined for various biomedical applications. This review reports recent advances in electrospun nanofibers for wound management. We first describe how to use nanofiber materials and incorporate clotting factors can stop bleeding. Then, we show how to use nanofiber materials for delivery of antimicrobial agents and analgesics, to combat infection and relieve the pain. We further discuss how to combine the delivery of therapeutics (e.g., growth factors, cells, skin tissues) with nanofiber materials for enhancing wound healing. Finally, we present the conclusions and future perspectives in terms of the use of electrospun nanofibers for wound management. More information can be found in the Minireview by Jingwei Xie et al.

Determinants of Place of Delivery during the COVID-19 Pandemic-Internet Survey in Polish Pregnant Women.

Background and Objectives: COVID-19 is a pandemic disease, and its unpredictable outcome makes it particularly dangerous, especially for pregnant women. One of the decisions they have to make is where they will give birth. This study aimed to determine the factors influencing the choice of place of delivery and the impact of the COVID 19 pandemic on these factors. Materials and Methods: The study was conducted on 517 respondents from Poland. The research methods comprised the authors’ own survey questionnaire distributed via the Internet from 8 to 23 June 2021. The survey was fully anonymous, voluntary, and addressed to women who gave birth during the pandemic or will give birth shortly. Results: A total of 440 (85.1%) respondents were afraid of SARS-CoV-2 infection. The most frequently indicated factors were fear of complications in the newborn, fear of intrauterine fetal death, and congenital disabilities in a newborn. A total of 74 (14.3%) women considered home delivery. The main factors that discouraged the choice of home birth were the lack of professional medical care 73.1% (N = 378), the lack of anesthesia 23.6% (N = 122), and the presence of indications for caesarean section 23.4% (N = 121). The possibility of mother–child isolation caused the greatest fear about hospital delivery. During the COVID-19 pandemic, pregnant women concerned about SARS-CoV-2 infection were more likely to consider home delivery than those without such fears. The most important factors affecting the choice of the place of delivery included the possibility of a partner’s presence, excellent sanitary conditions and optimal distance from the hospital, and the availability of epidural analgesia for delivery. Conclusions: Our study identifies the determinants of place of delivery during the COVID-19 pandemic. The data we obtained can result in the healthcare system considering patients’ needs in case of similar crisis in the future.

Comparison of Opioid-Based Patient-Controlled Analgesia with Physician-Directed Analgesia in Acute Pancreatitis: A Retrospective Cohort Study.

Patient-controlled analgesia (PCA) is commonly used for acute postoperative pain management. Clinicians may also use PCA in the management of acute pancreatitis (AP); however, there is limited data on its impact on patient outcomes. We aimed to characterize a cohort of patients receiving PCA therapy for pain management in AP compared to those patients receiving standard physician-directed delivery of analgesia. We conducted a retrospective cohort study of adult patients admitted with AP at a tertiary care center from 2008 to 2018. Exclusion criteria included patients with chronic opioid use, chronic pancreatitis and pancreatic cancer. Primary outcomes include length of stay (LOS) and time to enteral nutrition. Secondary outcomes include proportion of patients discharged with opioid and complications. Multivariate regression analysis and t-test were used for analysis. Among 656 AP patients who met the criteria, patients receiving PCA (n = 62) and standard delivery (n = 594) were similar in admission pain score, Charlson Comorbidity Index, and pancreatitis severity. There were significantly greater proportion of women, Caucasians and nonalcoholics who received PCA therapy (p < 0.01) than standard delivery. Multivariate regression analysis revealed that patients in the PCA group have a longer LOS (7.17 vs. 5.43days, p < 0.007, OR 1.03; 95% CI 1.01-1.07), longer time to enteral nutrition (3.84days vs. 2.56days, p = 0.012, OR 1.11; 95% CI 1.02-1.20), and higher likelihood of being discharged with opioids (OR 1.94; 95% CI 1.07-3.63, p = 0.03). The use of PCA in AP may be associated with poorer outcomes including longer LOS, time to enteral intake and a higher likelihood of being discharged with opioids.

Battlefield pain summit 2022: Expert consensus statements.

Battlefield pain occurs in combat casualties who experience multiple severe injuries. The nature of battlefield scenarios requires a distinct approach to battlefield pain research. A battlefield pain summit was thus convened to identify shortcomings in the current understanding of battlefield pain management, review the current state of battlefield pain research, and shape the direction of future research. On January 10 to 11, 2022, a hybrid in-person and virtual meeting hosted by the US Army Institute of Surgical Research defined research priorities for the Combat Casualty Care Research Program's Battlefield Pain research portfolio. Summit participants identified the following key focus areas under the umbrella of battlefield pain research: battlefield injury patterns; use of ketamine and nonopioid analgesics; analgesic delivery systems; the impact of analgesia on performance, cognition, and survival; training methods; battlefield regional anesthesia; and research models. Preliminary statements presented during the summit were refined and rank ordered through a Delphi process. Consensus was achieved on 7 statements addressing ideal analgesic properties, delivery systems, operational performance concerns, and pain training. Ketamine was identified as safe and effective for battlefield use, and further research into nonopioid analgesics represented a high priority. The 7 consensus statements that emerged from this battlefield pain summit serve as a template to define the near-term research priorities for military-specific battlefield pain research.

Що потрібно змінити для підвищення ефективності знеболювання після кесаревого розтину? Аналіз результатів опитування анестезіологів Вінницької області

Postoperative pain control after cesarean delivery is an important issue for patients and health care providers. The incidence of inadequate рost-cesarean delivery analgesia can be as high as 50%. Pain after caesarean section is often under-treated due to unfounded fears that analgesic drugs or interventions might induce maternal and neonatal side-effects and because the severity of post-caesarean section pain is often underestimated. Purpose - to analyze the compliance of postoperative anesthesia in obstetric hospitals and departments of Vinnytsya and Vinnytsya region with current treatment protocols. Materials and methods. We conducted a multicenter regional survey among 21 medical institutions with the participation of 69 anesthesiologists who provide care to obstetric patients in Vinnytsya and Vinnytsya region. The e-questionnaire included questions about the assessment of pain intensity and choice of analgesic (s) for women who give birth by caesarean section and timing of its conduction. The obtained results reflect the practice of 21/23 (91.3%) obstetric hospitals and departments in the city of Vinnytsya and Vinnytsya region. Data analysis was performed using the statistical package «SPSS 20» (SPSS Inc.) version 21.0.0 for Windows. Results. The results of our study show that the majority (87%) of anesthesiologists in Vinnytsya region evaluate postoperative pain using a description of the intensity of pain by the parturients or the Visual Analog Scale. It was found that among anesthesiologists who provide care to obstetric patients, 81.1% support the principles of multimodal analgesia. The basis of multimodal analgesia is the appointment of acetaminophen and nonsteroidal anti-inflammatory drugs with or without opioids. Conclusions. The prospect of increase the effectiveness of post-caesarean section analgesia is the development and implementation in Vinnytsya and Vinnytsya region of a clear unified strategy for the treatment of postoperative pain. At the same time, it is necessary to implement the concept of preventive analgesia and the planned administration of non-opioid analgesics at fixed intervals (every 6 hours). The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors. Key words: caesarean section, рost-cesarean delivery analgesia, pain assessment, multimodal analgesia.

Use of a buprenorphine-based pain management protocol is associated with reduced opioid requirements and pain on swallowing in oral mucositis: a retrospective cohort study.

The aim of this study is to ascertain the analgesic efficacy and total oral morphine equivalent daily dose (OMEDD) effect of a buprenorphine-based analgesic protocol in the treatment of severe Oral Mucositis (OM). This is a retrospective cohort study. This study was done in a single Quaternary Referral Centre, Haematology Unit. Fifty-four stem cell transplant patients suffering at least grade 3 oral mucositis (OM), 24 prior to [Pr-I] and 30 subsequent to [Po-I] a buprenorphine-based OM analgesic protocol. We analysed data from the above subjects with the primary outcome measure of difference in total OMEDDs from all opioid types and administration routes, and secondary outcome measures of area under the curve (AUC) of 11-point Numerical Rating Scale (NRS-11) pain assessments, sedation scores and respiratory rate. Post-protocol patients' total OMEDD requirements were significantly reduced [Pr-I: 1961 (1365)mg; Po-I: 928 (625)mg, p = 0.02], as were total NRS-11:hours AUC on swallowing [Pr-I: 54(24) score-hours; Po-I: 41(18) score-hours, p < 0.001]. There were no significant differences in objective measures of OM severity between groups (Number of Grade 3 or 4 OM severity assessments [mean (SD)] Pr-I: 5 (6.2); Po-I: 7 (5.1) or number of days Neutrophil count 0.0 or 0.1 × 109/L; Pr-I: 13 (5.4); Po-I: 15 (4.7)). 5 Pr-I and 4 Po-I patients required ketamine infusions, with 1 Pr-I patient also requiring IV lignocaine. Use of Buprenorphine via transdermal, sublingual and intravenous Patient Controlled Analgesia (PCA) delivery as part of an analgesic protocol for severe post stem cell transplant oral mucositis in adult patients appears to significantly reduce opioid requirements and pain on swallowing. Further randomised prospective work is required to confirm these associations.