Analgesic Administration Research Articles

At-home Administration of Opioid Analgesia in Children After Reduction of Forearm Fracture

Objective Controversy exists surrounding which agents best provide analgesia in children with fractures. Prior studies have demonstrated that ED visits for fracture-related pain have the highest rates of opioid prescribing. Studies have also found that NSAIDs are equivalent at controlling acute fracture-related pain. In a time when one must balance the risk of inadequate pain control with potential opioid misuse, providers have little data to guide them in terms of the best recommendations for adequate pain control at home. Methods This prospective observational study investigates parental pain management practices after ED discharge for children who underwent a forearm fracture reduction. Surveys filled out by parents were used to gather data on the proportion of children discharged with an opioid prescription, the number of doses of opioid that were administered after discharge, and parental satisfaction with their child's pain control. Results We analyzed data for 61 patients who completed the postdischarge survey. Of these, 62% received a prescription for oxycodone at discharge, and 50% used at least 1 dose of oxycodone at home. The median number of doses administered at home, 1.5 (IQR, 0–3), was significantly lower than the number of doses of oxycodone prescribed, 10 (IQR, 5–12) (P < 0.001). Parents reported a high level of satisfaction with the medications received at discharge with nearly all ranging between 4 (satisfied) and 5 (very satisfied) (median, 5; IQR, 4–5). No significant difference was detected in the satisfaction between families who received a prescription for oxycodone at discharge (median, 5; IQR, 4–5) and those who did not (median, 5; IQR, 4–5) (P = 0.28). Conclusions We observed a large range in the number of doses of oxycodone prescribed at discharge and a significant difference between the number of doses being prescribed and those being used by families. A prescription of 2 doses of oxycodone would be sufficient to treat postreduction pain in the majority of children.

Multimodal analgesics after adult cardiac surgery; a systematic review

Abstract Background Moderate to severe pain is frequently reported during the acute recovery phase following adult cardiac surgery. Multimodal analgesics are recommended for adult patients post cardiac surgery, but the optimal combination of multimodal analgesics is unknown. Purpose To synthesise the best available evidence about the effectiveness of multimodal analgesics on pain after adult cardiac surgery. Methods A systematic review was conducted according to the PRISMA-P statement and the published review protocol. Inclusion criteria were full-text papers or abstracts with adequate reporting, in any language, of randomised controlled trials (RCTs) in adult patients undergoing cardiac surgery that investigated the effect of multimodal postoperative analgesic regimens, compared to a control group. The highest mean level of patient self-reported pain intensity at rest, captured using a validated pain assessment tool, was the primary outcome measure. Results Of 3754 citations identified in the initial search to the 12th of December 2022, there were 1605 duplicates leaving 2149 citations for title and abstract screening, of which 2027 were irrelevant. There were 122 full-text papers assessed and 29 included in the review. Data were independently extracted by 2 reviewers in Covidence®. Participants (N = 2360), aged 59.5 + 8.2 years, were primarily male (N = 1561, 66.1%), weighing 78.1 +9.2 kilograms. Risk of bias was high and reporting quality was poor. Pain at rest reported in 18 (62%) studies was 3.5 (SD 1.2) in the control and 2.7 (SD 0.9) in the intervention groups respectively. Nurse-led versus patient-controlled analgesic administration was tested in 14 (48.3%) trials. All trials tested different analgesic combinations, none of which compared a combination of non-opioids, opioid agonist-antagonist agents, or full opioid agonists. Conclusions Poorly managed pain is associated with postoperative complications, unplanned readmissions, and the development of chronic pain. Robust RCTs are urgently needed to inform optimal combinations of multimodal analgesics to optimise patient recovery after adult cardiac surgery.Risk of Bias

Investigating predictors in parenteral to oral switch of Analgesia in postoperative patients: An observational study

Introduction: A thorough understanding of various routes of analgesic administration and their limitations enables pain therapists to effectively manage postoperative pain, reduce the risk of chronic pain development, and enhance patient satisfaction. Considerations such as pain type, patient preferences and medical conditions guide the selection of the most appropriate administration method and dosage form for optimal outcomes. This observational study aimed to investigate the factors associated with the switch of analgesic medication from parenteral to oral in postoperative patients. Methods: This study was conducted for six months among 305 patients at a tertiary care teaching hospital, Davangere, India. The data about patient was collected through case sheets and was analyzed with IBM SPSS Version 25 for windows. Results: The study conducted on 305 patients found that the switch was mostly done within the time interval of 2-4 days. The combination of paracetamol and tramadol (22.6%) was the main drug of choice for switch. The switch from parenteral to oral analgesia was not found to be significantly associated with age, severity of pain, or length of hospital stay. Conclusion: Although switching between parenteral and oral routes of analgesic administration appears to be effective in managing surgical patients, but the decision to switch does not seem to be influenced by the hypothesized factors.

Rescue analgesia with a transversus abdominis plane block alleviates moderate-to-severe pain and improves oxygenation after abdominal surgery: a randomized controlled trial

BackgroundAbdominal surgery is a common surgical procedure that is frequently associated with substantial postoperative pain. However, rescue analgesia using opioids is associated with several adverse effects. The transversus abdominis plane block (TAPB) has been demonstrated to be effective as part of multimodal analgesia. This study aims to evaluate the effects of rescue analgesia using the TAPB following abdominal surgery.MethodsNinety patients undergoing abdominal surgery and reporting a numeric rating scale (NRS) score of cough pain ≥4 on the first postoperative day were randomized to receive either sufentanil or TAPB for rescue analgesia. Pain scores and arterial oxygen pressure (PaO2) were evaluated before and after the administration of rescue analgesia. Sleep quality and gastrointestinal function were assessed postoperatively. The primary outcome was the degree of pain relief on coughing 30 min after the administration of rescue analgesia.ResultsPatients of both groups reported a significantly reduced NRS score on coughing 30 min after receiving rescue analgesia (Ppaired < 0.001 for both groups). Notably, the degree of pain relief was significantly higher in the TAPB group than in the sufentanil group [median (interquartile range), −3 (−4 to −2) vs. −2 (−2 to −1), median difference = −1; 95% confidence interval, −2 to −1; P < 0.001]. Moreover, patients in the TAPB group experienced less pain than those in the sufentanil group during the following 24 h. When evaluated, PaO2 increased significantly after rescue analgesia was administered in the TAPB group (Ppaired < 0.001); however, there were no significant intragroup differences in the sufentanil group (Ppaired = 0.129). Patients receiving the TAPB experienced better quality of sleep than those receiving sufentanil (P = 0.008), while no statistical differences in gastrointestinal function were observed between the two groups.ConclusionRescue analgesia with the TAPB on the first postoperative day alleviated pain, enhanced oxygenation, and improved sleep quality in patients undergoing abdominal surgery; however, its effect on gastrointestinal function requires further research.Clinical Trial RegistrationThis study was registered in the Chinese Clinical Trial Registry (https://www.chictr.org.cn/showproj.html?proj=170983, ChiCTR2200060285) on 26 May 2022: Patients were recruited during the period between 30 May 2022 and 14 February 2023, and a follow-up of the last enrolled patient was completed on 16 March 2023.

TREATMENT OF TOOTH AVULSION: A CASE REPORT

Dental trauma (DT) refers to injuries caused by impacts to the teeth and/or the hard and soft tissues within or outside the oral cavity. Among the various types of DT, avulsion, characterized by the complete displacement of the tooth from its socket. The success of treatment depends on timely management and proper professional care during and after reimplantation in preserving the tooth in the oral cavity. This study describes a case report of an avulsion of the upper left central incisor (21) that underwent reimplantation. The patient, a 10-year-old boy, had a history of bicycle fall, presenting with extraoral injuries to the cheek and chin, lip abrasions, and avulsion of tooth 21. The tooth was stored in milk and reimplanted 30 minutes after the accident. Clinical and radiographic examinations showed no bone fractures but revealed mobility of teeth 11 and 12 and avulsion of tooth 21. Treatment included cleaning, repositioning of the avulsed tooth, stabilization with a semi-flexible splint, and administration of antibiotics and analgesics. Endodontic therapy with mechanical instrumentation was successfully initiated after 20 days. This case highlights the importance of proper tooth storage and timing of reimplantation, leading to the restoration of patient’s aesthetics, chewing function, and self-esteem.

Postoperative analgesic effectiveness of ultrasound-guided bilateral erector spinae plane block vs. rectus sheath block for midline abdominal surgery in a low- and middle-income country: a randomised controlled trial.

The use of erector spinae plane block and rectus sheath block for postoperative analgesia in midline abdominal procedures is becoming more common. However, the most effective and appropriate method remains unclear. We aimed to compare the postoperative analgesic effecacy of ultrasound-guided bilateral erector spinae plane blocks with rectus sheath blocks for midline abdominal surgery in a low- and middle-income country. We allocated randomly 72 patients aged 18-65 y undergoing midline abdominal surgery to an erector spinae plane block (n = 36) or a rectus sheath block (n = 36) utilising a prospective, parallel study design. Patients, care providers and outcome assessors were blinded to the interventions. The primary outcome measures were total postoperative analgesia consumption, postoperative pain severity and time to first rescue analgesic administration. Secondary outcomes included the incidence of postoperative complications and adverse events. Of 78 patients assessed for eligibility, six were excluded, leaving 72 for analysis. Patients allocated to erector spinae plane block had a lower mean (SD) postoperative opioid consumption compared with those allocated to rectus sheath block (3.5 (8.7) morphine milligram equivalents vs. 8.2 (2.8) morphine milligram equivalents, respectively; p = 0.003). Time to first analgesic request was greater in patients allocated to erector spinae plane block compared with those allocated to rectus sheath block (mean (95%CI) 16 (13-17) h vs. 12 (11-13) h, respectively; p < 0.001). There were no block-related complications in either group. Erector spinae plane blocks are more effective than rectus sheath blocks for the management of postoperative pain following midline abdominal surgery. Integration of erector spinae plane blocks into multimodal opioid-sparing analgesic strategies after midline abdominal surgeries may promote enhanced patient recovery in low-and middle-income countries.

SAFE: Safety of procedural sedation and analgesia administration in the fast-track area of the emergency department.

To determine whether undertaking procedural sedation in the low-acuity fast-track area is safe and effective in improving patient flow. A retrospective cohort study reviewed patients who underwent procedural sedation in the Royal Brisbane and Women's Hospital Emergency and Trauma Centre between December 2020 and December 2021. A total of 411 cases were included. Performing sedation in the fast-track area was not associated with increased complication rates but was associated with reduced time to sedation (difference = 44.24 min, P < 0.001) and length of stay (difference = 60.64 min, P < 0.01). The sedation of patients outside a high-acuity area is safe and significantly improves patient flow.

Deep Neuromuscular Block with Low Pressure Pneumoperitoneum in Laparoscopic Abdominal Surgeries: A Randomized Controlled Trial

Background: Postoperative pain management remains a challenge in laparoscopic abdominal surgeries. Objectives: The purpose of this research was to determine the effects of deep neuromuscular blockade (NMB) in conjunction with low-pressure pneumoperitoneum )PP) on postoperative pain, surgical parameters, and recovery outcomes. Methods: This randomized controlled double-blind study included 44 participants undergoing laparoscopic abdominal surgery. Patients were randomized equally into two groups (22 each): Group D received deep NMB, while group M received moderate NMB using cis-atracurium, through the utilization of computer-generated random numbers enclosed within sealed, opaque envelopes, following a parallel approach. Regarding deep NMB, following an initial dose of 0.15 mg/kg, a continuous infusion of 0.06 - 0.12 mg/kg/hr was administered to maintain a post-tetanic count between 1 and 2, with low PP pressure of 10 - 12 mmHg. Conversely, for moderate NMB, after the same initial dose of 0.15 mg/kg, the continuous infusion commenced upon the train-of-four count returning to 2, with the rate adjusted to sustain a count between 1 and 3, and standard PP pressure of 15 mmHg. The primary outcome was postoperative pain intensity as measured by Numerical Rating Scale (NRS) scores in the post-anesthesia care unit (PACU). The secondary outcomes included postoperative pain intensity measured by NRS scores from 2 hours to 48 hours post-surgery, time to first analgesic administration, cumulative opioid consumption within the initial 48-hour postoperative period, and patient-reported satisfaction with postoperative pain management. Statistical analysis using SPSS v26 included tests for normality (Shapiro-Wilks), with parametric data analyzed by t-test, non-parametric data by Mann-Whitney, and qualitative data by chi-square/Fisher's test. Results: Group D experienced a considerably longer time until the first analgesic rescue compared to group M (9.82 ± 1.5 hours vs. 7.23 ± 1.19 hours, P &lt; 0.001). Morphine consumption in the first 24 hours was lower in Group D (10.77 ± 1.51 mg vs. 13.09 ± 1.74 mg, P &lt; 0.001). At 6, 8, and 12 hours postoperatively, group D exhibited significantly lower pain scores (P &lt; 0.05). Surgical duration, surgical field quality, complication rates, and patient satisfaction were comparable between groups. Conclusions: Deep NMB combined with low-pressure PP provided superior postoperative analgesia without compromising surgical field quality or increasing complications in laparoscopic abdominal surgeries.

Implementing Evidence-Based Pain Management Interventions Into an Emergency Department: Outcomes Guided by Use of the Ottawa Model of Research Use.

To implement strategies to improve the care of patients with acute pain in the emergency department (ED). Pre-post implementation study using a Type 2 hybrid effectiveness-implementation design. Implementation strategies were introduced and monitored through the Ottawa Model of Research Uses' assessment, monitoring and evaluation cycles, supported by focused and sustained facilitation. Improvements in time-to-analgesia within 30 min (21%-27%), administration of nurse-initiated analgesia (NIA) (17%-27%) and measurement of pain (65%-75%) were achieved post-implementation. NIA was the strongest predictor of receiving analgesia within 30 min. Adoption of pain interventions into practice was not immediate yet responded to sustained facilitation of implementation strategies. Collaboration with local clinicians to introduce simple interventions that did not disrupt workflow or substantially add to workload were effective in improving analgesia administration rates, and the proportion of patients receiving analgesia within 30 min. The assessment, monitoring and evaluation cycles enabled agile and responsive facilitation of implementation activities within the dynamic ED environment. Improvements took time to embed into practice, trending upward over the course of the implementation period, supporting the sustained facilitation approach throughout the study. Sustained adoption of evidence-based pain interventions into the care of people presenting to the ED with acute pain can be achieved through sustained facilitation of implementation. NIA should be at the centre of acute pain management in the ED. This study addressed the lingering gap between evidence and practice for patients with acute pain in the ED. Implementation of locally relevant/informed implementation strategies supported by focused and sustained facilitation improved the care of patients with acute pain in the ED. This research will have an impact on people presenting to EDs with acute pain, and on clinicians treating people with acute pain in the ED. Relevant equator guidelines were followed and the StaRI reporting method used. No Patient or Public Contribution in this study.

Perioperative Pain Management in Hemophilic Patient Undergoing Orthopedic Surgery: A Narrative Review

Background: Hemophilia type A and B is associated with spontaneous bleeding in muscle tissues and joints. Acute hemarthrosis, representing 70–80% of all bleedings in severe hemophilia patients, is extremely painful. When surgical procedures are needed in hemophiliac patients, perioperative management should be planned with a multidisciplinary team. Our narrative review, through a rigorous analysis of the current literature, focuses on pain management in hemophiliac patients. Methods: The report synthesizes a literature review on hemophilia, adapting PRISMA guidelines. It identifies a research question on surgical procedures and perioperative pain management. Various sources, including electronic databases, are utilized. Study inclusion criteria are defined based on the research question. Forty studies are included. A detailed study selection is illustrated. Results: Guidelines for managing acute postoperative pain in the general population advocate for a multimodal analgesic administration to enhance synergistic benefits, reduce opioid requirements, and minimize side effects. Recent recommendations from the World Federation of Hemophilia (WFH) for postoperative pain management in hemophilia patients suggest tailoring treatment based on pain levels, in coordination with anesthesiologists. Conclusions: Pain management in hemophiliac patients undergoing orthopedic interventions requires a multidisciplinary approach, with further research needed to define a reliable global standard of treatment.

Bilateral Ultrasound-Guided Erector Spinae Plane Block for Management of Acute Postoperative Surgical Pain After Pediatric Cardiac Surgeries Through a Midline Sternotomy.

Ultrasound (US) guided erector spinae plane block (ESPB) is a safe and effective technique in providing perioperative pain management in pediatrics with a high success rate. Was to compare the efficacy of bilateral ultrasound-guided erector spinae plane block for management of acute postoperative surgical pain after pediatric cardiac surgeries through a midline sternotomy. One hundred patients aged 4-12 years were randomly assigned into two groups, both groups received general anesthesia followed by bilateral sham erector spinae plane block at the level of T6 transverse process using 0.4 ml/kg normal saline on each side in the control group (group C) or bilateral ultrasound-guided erector spinae plane block at the level of T6 transverse process using 0.4 ml/kg ropivacaine 0.2% with a maximum dose of 2 mg/kg mixed with adrenaline 2 mcg/ml in erector spinae plane block group (group E). The postoperative pain scores were evaluated immediately post-extubation, at 1 hour, 2, 4, 6, 8, 10, 12, 14, 16, 18, 20, 22, and 24 hours after extubation, total consumption of intraoperative fentanyl and time to first rescue analgesic administration were also recorded. There was a statistically high significant delay in the group E (314.72 ± 45.94) compared with the group C (36.7 ± 7.22) as regards to the mean (SD) of the time of the rescue analgesia (P < 0.001) (with 95% CI), moreover; the number of rescue analgesic was significantly higher in the group C compared with the group E (P < 0.001) (with 95% CI) and the mean (SD) of total intraoperative and postoperative levels fentanyl requirements in the group C were significantly higher compared with the group E (6.47 ± 0.98 and 5.09 ± 0.83) (with 95% CI) in group C versus (4.69 ± 0.71 and 2.31 ± 0.66) (with 95% CI) in group E respectively (P < 0.001) (with 95% CI). Ultrasound-guided bilateral ESPB with ropivacaine and adrenaline delays the postoperative need of analgesia and reduces postoperative fentanyl consumption at 24 h in pediatric patients undergoing cardiac surgery through midline sternotomy.

Association between postoperative pain and analgesic use in minimally invasive cardiac surgery.

This study aimed to investigate the effects of surgical methods on pain duration and oral analgesic administration in patients who underwent cardiac surgery using various minimally invasive methods. We included 90 patients who underwent an anterior incision with costal cartilage transection, lateral incision without costal cartilage transection, or total endoscopic cardiac surgery using a lateral incision and no retractor. Oral analgesics were postoperatively administered upon patient request. All the patients were instructed to rate their pain during the daytime 3 and 7 days postoperatively. Between-group differences included surgical method, wound size, operation/cardiopulmonary bypass time/cardiac arrest time, and intraoperative fentanyl dose. No differences were found in sex, age, diabetes status, paravertebral block use, or blood loss. The number of postoperative days, postoperative analgesic use, and pain 3 days postoperatively demonstrated no difference. Pain ratings were most severe for the costal cartilage resection group and least severe for the total endoscopic cardiac surgery group 7 days postoperatively. Similarly, patients who underwent costal cartilage research exhibited the highest rate of analgesic use for 30 days postoperatively, whereas patients who underwent total endoscopic cardiac surgery demonstrated the lowest. We revealed significant between-group differences in pain prevalence and postoperative oral analgesic administration in patients who underwent cardiac surgery relative to the minimally invasive surgical method used.

Inhaled analgesics for the treatment of prehospital acute pain-A systematic review.

Many prehospital emergency patients receive suboptimal treatment for their moderate to severe pain. Various factors may contribute. We aim to systematically review literature pertaining to prehospital emergency adult patients with acute pain and the pain-reducing effects, adverse events (AEs), and safety issues associated with inhaled analgetic agents compared with other prehospital analgesic agents. As part of an initiative from the Scandinavian Society of Anaesthesia and Intensive Care Medicine, we conducted a systematic review (PROSPERO CRD42018114399), applying the PRISMA guidelines, Grading of Recommendations Assessment, Development, and Evaluation (GRADE), and Cochrane methods, searching the Cochrane Library, Epistemonikos, Centre for Reviews and Dissemination, PubMed, and EMBASE databases (updated March 2024). Inclusion criteria were the use of inhaled analgesic agents in adult patients with acute pain in the prehospital emergency care setting. All steps were performed by minimum of two individual researchers. The primary outcome was pain reduction; secondary outcomes were speed of onset, duration of effect, and relevant AEs. We included seven studies (56,535 patients in total) that compared inhaled agents (methoxyflurane [MF] and nitrous oxide [N2O]) to other drugs or placebo. Study designs were randomized controlled trial (1; n = 60), randomized non-blinded study (1; n = 343), and randomized open-label study (1; n = 270). The remaining were prospective or retrospective observational studies. The evidence according to GRADE was of low or very low quality. No combined meta-analysis was possible. N2O may reduce pain compared to placebo, but not compared to intravenous (IV) paracetamol, and may be less effective compared to morphine and MF. MF may reduce pain compared to paracetamol, ketoprofen, tramadol, and fentanyl. Both agents may be associated with marked but primarily mild AEs. We found low-quality evidence suggesting that both MF and N2O are safe and may have a role in the management of pain in the prehospital setting. There is low-quality evidence to support MF as a short-acting single analgesic or as a bridge to IV access and the administration of other analgesics. There may be occupational health issues regarding the prehospital use of N2O.

Effect of Preemptive Analgesia on Pain Perception in Children: A Randomized Controlled Trial.

Efforts have been made to minimize pain, prevent the development of needle fear, and promote positive experiences for children. The present study is designed to evaluate the effect of premedication with Ibugesic Plus before the administration of local anesthesia and extraction in children. The aim of the study is to assess the efficacy of preemptive analgesia on pain perception during local anesthesia administration and extraction in pediatric patients. A total of 104 patients aged 7-10 years were selected who needed primary molar extraction. Group -Ibugesic Plus syrup was given 30 minutes prior to extraction. Group II-Placebo solution (B-Folcin syrup) was given 30 minutes prior to extraction. Pain level, pulse rate, and SpO2 were assessed using the Wong-Baker Faces Pain Rating Scale (WBFS) and pulse oximeter after injection, after extraction, and postoperatively. The highest scores of pain were recorded after the time of injection and extraction. The patients who received preemptive analgesics (group I) reported significantly less pain than the placebo group (group II) at the time immediately after injection, after extraction, and 2 hours after extraction. The present study showed that preemptive analgesic administration may be considered a routine and rational pain management strategy in primary tooth extraction procedures in children. Preemptive analgesia can be given to patients prior to dental procedures to reduce postoperative pain. Virda M, Panda A, Kataria K. Effect of Preemptive Analgesia on Pain Perception in Children: A Randomized Controlled Trial. Int J Clin Pediatr Dent 2024;17(8):913-917.

Validation of a novel medical device (Chloe SED®) for the administration of analgesia during manual vacuum aspiration: a randomized controlled non-inferiority pilot study.

Millions of women worldwide annually undergo manual vacuum aspiration (MVA) with no pain medication, which is a violation of their basic human dignity. We designed a novel device (Chloe SED®) to administer paracervical block (PCB) during MVA in countries where pain medication is not typically given due to the high cost of the necessary tools. We conducted a single-blinded, randomized controlled non-inferiority trial including 61 patients at two hospitals in Kisumu, Kenya, to validate Chloe SED® for administration of PCB during MVA. PCB administered with Chloe SED® was compared to PCB administered with a standard spinal needle. Patients requiring MVA were block randomized in blocks of six, each provider completing six PCBs-three with the Chloe SED® and three with the standard spinal needle. The trial was registered with the Kenya Pharmacy and Poisons Board, ECCT/19/03/01 (https://ctr.pharmacyboardkenya.org/applications/index/protocol_no:RUNDVC8xOS8wMy8wMQ__/filter:/investigator:/sites:/pages:5/start_date:/end_date:/disease_condition:/users:/ercs:/stages). An intention-to-treat analysis was completed. The primary outcome was the non-inferiority of the pain score during uterine evacuation with a non-inferiority margin of 2 points on an 11-point numerical rating scale. Secondary outcomes included the non-inferiority of the pain score at four other time points and patient satisfaction. Chloe SED® showed non-inferiority of the primary outcome with a mean pain score during evacuation of 3.8 [90% confidence interval (CI): 3.1-4.6] compared with the spinal needle at 4.1 (90% CI: 3.5-4.7). Non-inferiority of the pain score was shown at all time points. Most patients expressed a desire for the continued use of the device to administer PCB for MVA. No adverse events were noted. In summary, the Chloe SED® appears non-inferior to the spinal needle and desirable for the administration of PCB during MVA.

Validation of the Japanese version of Algoplus® for the assessment of acute postoperative pain in older patients with cancer.

This study aimed to validate a Japanese version of the Algoplus® tool by assessing postoperative pain in older Japanese patients with cancer and examining the scale's psychometric properties. After translating Algoplus® into Japanese, we conducted a cross-sectional study of patients aged 65 years or older who underwent surgery to remove malignant tumors. Two registered nurse-certified investigators used the Numerical Rating Scale, the Japanese version of Algoplus®, and the Japanese version of the Abbey Pain Scale before and after analgesic use on postoperative days 3 and 5 to evaluate response to pharmacologic therapy. Validity was tested by a correlation analysis between the Japanese version of Algoplus®, two pain scales, and nine hypotheses related to demographic variables and surgical invasions. The Kuder-Richardson-20 test and Cohen's Kappa coefficient were used for internal consistency and inter-rater reliability, respectively. The total score of the Japanese version of Algoplus® showed strong to moderate correlations with the two pain scales. Demographic characteristics were not associated with the total score of the Japanese version, but significant correlations with operative time and postoperative analgesia administration existed. The scale demonstrated good internal consistency (Kuder-Richardson-20 α: .70) and inter-rater reliability (Kappa coefficient .72). The total score of the Japanese version decreased significantly after analgesic use in both postoperative assessments. The Japanese version of Algoplus® is a reliable and valid instrument for nurses to easily assess acute postoperative pain in older Japanese patients with cancer and shows good responsiveness for detecting the change in pain status.

EP467 - Bowel obstruction due to colonic lithobezoar in a patient with PICA

Abstract A 16-year-old girl was admitted with complaints of abdominal distension, severe pain, vomiting, chest discomfort, and an inability to pass gas. She disclosed a history of PICA, regularly consuming brick and cement. She had no significant medical history but reported suffering from constipation for over two years. Physical examination revealed a markedly distended, tender abdomen with hyper-resonance. Digital rectal examination detected soft, breakable stool in the rectum. A chest X-ray demonstrated massive bowel distension, causing lung compression. Clinical impression was of bowel obstruction secondary to constipation, leading to NG tube insertion, NBM status, and analgesia administration. A CT abdomen and pelvis confirmed a markedly distended rectum with impacted faeces, proximal faecal loading, and colon dilatation consistent with severe pseudo-obstruction. Other abdominal organs were compressed but otherwise normal, with no signs of ischemia, free air, or free fluid. Patient was taken to emergency theatre for examination under anaesthesia and manual evacuation. Six litres of stool were manually evacuated, along with removal of ingested stone-like substances, leading to suspicion of lithobezoar. This was followed by a four-litre saline washout. Postoperatively, patient received regular enemas, laxatives, and monitoring. She spent three days in the Intensive Care Unit due to persistent metabolic acidosis, necessitating ventilatory support. Afterward, she was transferred to the surgical ward, where she was monitored overnight before being discharged with laxatives and dietary advice. Patient was referred to dietitians for addressing her PICA and eating habits, with plans for psychiatric follow-up initiated through a referral from her GP.

Avoiding Invasive Measures: Sphenopalatine Ganglion Block as a Substitute for Epidural Blood Patch in Post-dural Puncture Headache: A Case Report

Introduction: Post-dural puncture headache (PDPH) is a well-known consequence of neuraxial anesthesia that can impede patient recovery and delay early discharge. Traditional remedies include hydration and the administration of simple analgesics for symptom relief. When symptoms persist despite conservative interventions, an epidural blood patch (EBP) is typically recommended. However, this invasive procedure carries risks and complications. Our case report aims to explore a potential alternative treatment for PDPH. Case Presentation: We present the case of a 22-year-old female who experienced PDPH following spinal anesthesia. Despite initial attempts at conservative management, her symptoms persisted. She then opted for a trans-nasal sphenopalatine ganglion (SPG) block, which resulted in remarkable pain relief and eliminated the need for an EBP. Conclusions: The SPG block emerges as a minimally invasive option for treating PDPH. Multiple studies have demonstrated that patients undergoing SPG block therapy did not require EBP.

Rapidly progressive malignant glomus tumor of the breast: a case report and review of the literature.

The glomus tumor is a rare neoplasm that is typically found subungually in the extremities and functions as a specialized neurovascular organ. An extremely rare site for glomus tumors is the breast, with only a few reported cases. Breast glomus tumors present with three typical clinical signs: dull pain, focal tenderness, and cold sensitivity. Less than 10% of all glomus tumors are malignant. We herein present a case of a malignant glomus tumor originating in the breast. Distant metastasis was ruled out, and the tumor was completely resected. However, the patient unexpectedly developed rapid systemic metastasis, detected 5 weeks after tumor removal. Despite the administration of analgesics and targeted therapy, the patient died 1 month later. When treating patients with undiagnosed breast tumors, clinicians should pay attention to unexplained and repeatedly reported symptoms and consider the possibility of a rare disease. Our literature search revealed no cases of malignant glomus tumors originating in the breast, making this case the first of its kind.

Video-based compilation of acute pain behaviours in cats.

The aim of this work was to create a video-based compilation of acute pain behaviours in cats as an open-access online resource for training of veterinary health professionals. A database comprising 60 h of video recordings of cats was used. Videos were previously recorded after ethical approval and written client consent forms, and involved cats with different types (eg, medical, surgical, trauma, orofacial) and degrees (eg, from no pain to severe pain) of acute pain, before and after surgery or the administration of analgesia. The database included videos of cats of different coat colours, ages, sex and breeds. Video selection was based on a published ethogram of acute pain behaviours in cats. Videos were selected by one observer (SM) according to their definition and quality, followed by a second round of screening by two observers (SM and PVS). Video editing included a standardised template (ie, watermark and titles). A total of 24 videos (mean length 33 ± 17 s) with each acute pain-related behaviour described in the ethogram were uploaded to an open-access online video-sharing platform (http://www.youtube.com/@Steagalllaboratory) with an individual hyperlink. Videos were provided with a short description of the behaviour for the public. This video-based compilation may promote better training of veterinary health professionals on acute pain assessment while improving feline health and welfare and the understanding of cat behaviours.