Average Postoperative Pain Score Research Articles

A Genetic Association Study of the Functional A118G Polymorphism of the Human ??-Opioid Receptor Gene in Patients with Acute and Chronic Pain

In this prospective, observational study we explored whether A118G single nucleotide polymorphism in the human mu-opioid receptor (MOR) gene could explain the inter-individual differences in opioid analgesic requirements in patients with acute postoperative pain and chronic pain. The frequency of the wild-type A118 MOR (major) and variant G118 MOR (minor) alleles in the subjects with chronic, noncancer pain (n = 121) and opioid-naïve subjects with acute postoperative pain (n = 101), serving as the control group, were examined. The relationships among the A118G MOR genotype, opioid requirements, and the numerical pain score were analyzed in both groups. The frequency of the minor allele was significantly lower in the subjects with chronic pain when compared with the group with acute postoperative pain (0.079 versus 0.158; P = 0.009 by chi2 test). No statistically significant association was observed between the presence of A118G MOR polymorphism and the average postoperative pain score or the doses of morphine used in the immediate postoperative period. In the high-quartile, opioid utilization, chronic pain patients, the homozygotic carriers of the major allele required significantly higher opioid dose than did the carriers of the minor allele. The results indicate that although the presence of the minor allele does not appear to affect opioid analgesic use in acute postoperative pain, the minor allele is less common in chronic pain patients, especially in those requiring higher doses of opioid analgesics.

Ergebnisse frischer osteosynthetisch verschraubter Skaphoidfrakturen nach postoperativer CT-Kontrolluntersuchung

Currently screw fixation of the scaphoid is a well-established method to treat unstable scaphoid fractures. Between June 1995 and December 2000, 68 patients with an unstable acute scaphoid fracture were treated with screw fixation; 46 patients were reexamined on an average 35 months postoperatively. Range of motion and grip strength (Jamar dynamometer) were measured. The total data rating resulted from the Krimmer wrist score. The subjective results were evaluated with the DASH questionnaire. The average postoperative pain score was documented with a visual analogous pain scale from zero to 100 (VAS 0-100). X-rays as well as computed tomography were performed postoperatively. The average range of motion was 124 degrees for extension/flexion (92% of the opposite site), 57 degrees for radial/ulnarduction (=90%), and 177 degrees for pronation/supination (=98%). Postoperative strength was 47 kg (=90% of the opposite site). The postoperative pain score was 13 (0-100) after stress and 2 during resting conditions. Bony consolidation was reached in 44 cases. The Krimmer wrist score demonstrated a very good result in 39 cases, a good result in 5 cases, and a satisfactory result in 3 cases. The average DASH score was 8.3 points. The results demonstrate the reliability of internal screw fixation as treatment for acute scaphoid fractures. Functional results as well as subjective satisfaction of the patients are very good. Postoperative CT scans help to evaluate exact bony consolidation, position of the screw, and postoperative morphology of the scaphoid.

Thoracic Epidural Versus Intercostal Nerve Catheter Plus Patient-Controlled Analgesia: A Randomized Study

Pain control is an important issue after thoracotomy. Ideal methods should have a high success rate, with easy implementation and minimal complications. Debate exists over the optimal pain control method. This randomized trial was designed to compare epidural (EPI) and intercostal nerve catheter with patient-controlled analgesia (ICN-PCA) for pain control after thoracotomy. The study included 124 randomized patients; 91 had sufficient data for analysis (44 EPI, 47 ICN-PCA). The primary endpoint was pain measurement using a composite of a visual analogue scale, numerical rating, and categorical rating. A second endpoint was the success rate of each method. Pulmonary function tests, antibiotics, intensive care unit (ICU), and hospital days, and use of nonprotocol pain medications were also compared. There were 12 pain observations per patient (90% completed on days 1 to 5). The pain composite revealed an average postoperative pain score of 2.4 on a scale from 0 (no pain) to 10 (worst pain). There was no difference between the groups. Failures of the planned method of analgesia included 9 in the EPI group and 4 in the ICN group (p = 0.23). Another 20 patients were excluded (no difference between groups) due to unsuspected mediastinal metastases precluding thoracotomy (n = 13), and other miscellaneous factors precluding follow-up (n = 7). The EPI group had an increased number of urinary catheter days (2.5 days vs 1.7, p = 0.002) and increased narcotic supplements (p = 0.03) compared with ICN. Mean ICU days (0.9) and hospital days (6.2) were similar for both groups, and there were no differences in arrhythmias, pneumonias, transfusions, and antibiotic use. Significant differences were seen (p = 0.001) between preoperative and postoperative pulmonary function tests in both groups. However, there were no differences in pulmonary function when the groups were compared with each other. Satisfactory pain control was achieved after thoracotomy using either EPI or ICN-PCA. The ICN-PCA achieved equivalent pain control compared with EPI, and was placed by the surgeon with no delays in surgery, and demonstrated a decreased requirement for Foley catheter duration.

Semiconstrained total elbow arthroplasty in the context of treated previous infection

Previous infection has been considered a strict contraindication to implantation or reimplantation of an elbow prosthesis. The purpose of this study was to investigate whether these patients can in fact be successfully treated with a prosthetic arthroplasty given previous treatment of the infection. Ten consecutive prosthetic arthroplasties performed in patients with documented infections in the elbow were retrospectively reviewed. Seven of the patients had infectious complications of total elbow arthroplasties that led to resection. Two patients had previous infections from septic joints and 1 from open reduction internal fixation. The median interval of time from infection treatment to final implant was 45 months (3.8 years). All arthroplasties were performed by the same surgeon with a modified Coonrad-Morrey, semiconstrained prosthesis. Patients were monitored for clinical signs of infection including radiographic and serologic studies and clinical evaluation based on the Mayo Elbow Performance Score. Mean surveillance was 4 years (range 2.8 to 5.4 years). Eight of the 10 cases have not shown signs of infection at the latest assessment. Two have had recurrent infections. The time interval from the original infection to latest implantation did not correlate with infection recurrence. Among those 8 without recurrent infection, 7 had excellent and 1 had satisfactory results according to the Mayo Elbow Performance Score. The recurrent infections were rated as failures. The average score was 32 before and 81 after surgery. The average pain score was 15 before surgery, and the average postoperative pain score was 40. Salvage of previously infected elbows with prosthetic arthroplasty can provide excellent results in a significant proportion of patients. Although the procedure offers superior functional outcomes compared with the alternative treatment options, it is technically demanding.

Miller—Galante unicompartmental knee arthroplasty at 2- to 5-year follow-up evaluations

A consecutive series of 62 Miller—Galante (Zimmer, Warsaw, IN) unicompartmental knee arthroplasties were evaluated. Patients had unicompartmental degenerative arthritis or osteonecrosis, a sagittal plane deformity of 15° or less, and minimal patellofemoral involvement. The average age was 69, with osteoarthritis in 85% and osteonecrosis in 15%. Ninety-five percent were medial and 5% lateral compartment replacements. The Hospital for Special Surgery knee score averaged 56 ± 11 before surgery and 96 ± 5 at the final follow-up evaluation, with an average postoperative pain score of 48 ± 2. Three patients suffered intra-operative or immediate postoperative tibial plateau fractures without apparent sequelae, one patient required a postoperative manipulation under anesthesia, and one patient required an arthroscopic debridement for retained cement in the posterior capsular space. Limb alignment was corrected to within 5° of the neutral mechanical axis in 77%, with 19% undercorrected and 3% overcorrected. Seventy percent of knees showed at least a single radiolucent line. Complete radiolucent lines were noted about three tibial components (6%) and progressive partial radiolucency was noted about four additional components (8%).