Cumulative Pain Scores Research Articles

Greater ischiatic notch plane versus parasacral block in dogs undergoing pelvic limb surgery: a retrospective noninferiority cohort study on perioperative opioid consumption

ObjectiveTo compare perioperative opioid consumption in dogs undergoing pelvic limb surgeries and receiving a lumbosacral plexus block by combining a lumbar [lateral pre-iliac (LPI)] block with a lumbosacral trunk [i.e. parasacral (PS group) or greater ischiatic notch plane (GIN group)] block.Study design Retrospective, descriptive, exploratory, noninferiority cohort study. MethodsMedical records of 37 client-owned dogs were analyzed. Intraoperative (primary outcome) and postoperative (24 hours) opioid use, 24 hour cumulative pain scores and prevalence of complications were compared between the two groups. Opioid use was quantified in morphine equivalents (ME, mg kg–1 ). The noninferiority limit for intraoperative opioid consumption was set at 0.05 ME kg–1 hour–1. Demographic data, procedure duration, surgery type and perioperative dexmedetomidine and ketamine use were also collected. A t-test or Wilcoxon rank-sum test, a Fisher's exact test and multivariable linear regression were used. Significance was set at p < 0.05. ResultsThe GIN and PS groups comprised 17 and 20 dogs, respectively. Total intraoperative ME consumption was 0.17 (0.11–0.21) and 0.22 (0.16–0.30) mg kg–1 hour–1 for the GIN and PS groups, respectively (p = 0.077). The noninferiority analysis adjusted by surgery type and body mass revealed that the mean difference between the groups (GIN – PS) was –0.039 (95% CI –0.11–0.03, p = 0.247) ME mg kg–1 hour–1, indicating that the GIN group was not inferior to the PS group regarding intraoperative ME consumption. Dexmedetomidine and ketamine use, postoperative ME consumption and pain scores were similar between groups. Conclusions and clinical relevanceThis retrospective study and preliminary observations support the clinical use of the GIN plane block, demonstrating its noninferiority to the PS block when combined with the LPI block for multimodal perioperative analgesia in dogs undergoing pelvic limb surgeries.

Randomised controlled trial of tourniquet associated pain generated in lower limb after exsanguination by Esmarch bandage versus limb elevation

BackgroundTourniquets are common adjuncts in the operating theatre but can be associated with post-operative pain. This study was designed to compare what effect pre-tourniquet Esmarch bandage exsanguination has on pain, compared to pre-tourniquet exsanguination by elevation alone.Methods52 volunteers (104 lower limbs) were included in this study with each volunteer acting as their own matched control. The primary outcome was patient reported pain, measured in both legs simultaneously using area under curve. Secondary outcomes were pain score during inflation and deflation, cumulative pain score, duration of recovery and blood pressure during testing.ResultsPain after Esmarch was superior to elevation as measured by area under pain curve (68.9 SD 26.1 vs 77.2 SD 27.3, p = 0.0010), independent of leg dominance. Cumulative pain scores demonstrated the same superiority after inflation (50.7 SD 17.1 vs 52.9 SD 17.0, p = 0.026) but not after deflation (p = 0.59). Blood pressure was not significantly different. Time to full recovery of the lower limb was the same for both groups—7.6 min (SD 2.1 min, p = 0.80).ConclusionPrevious studies describe a positive effect on pain when Esmarch bandage was used prior to tourniquet inflation for upper limb. Our findings suggest the same benefit from Esmarch when it was used on lower limbs—particularly during inflation of tourniquet. In addition to pain profiles, surgeon preference and patient factors need to be considered when deciding between elevation and Esmarch bandage.

Effects of postoperative environmental noise on surgery induced pain: Evidence based on a prospective observational study

ContextMany patients recovering from surgery in wards are disturbed by environmental noise. However, the effects of environmental noise on postoperative pain are unclear. ObjectivesThis study aimed to assess the association between postoperative noise and pain. MethodsThis prospective study included 182 women who underwent cesarean sections. Postoperative noise was continuously recorded, and pain intensity at rest was assessed using a numerical rating scale (NRS) for 0–6, 6–12, 12–18, and 18–24 h after the patients were returned to the ward. Cumulative pain scores were calculated by summing the NRS scores at each time point and comprised the primary outcome. The maximum pain NRS score and analgesic consumption during the 24 h after surgery were also recorded. ResultsMean environmental noise intensity during the daytime was an independent factor for cumulative pain scores, maximum pain scores, and analgesic use during the first postoperative 24 h (β, 0.37; 95% CI, 0.21–0.53 and β, 0.12; 95% CI, 0.07–0.17; P < 0.001 for both; β, 0.86; 95% CI, 0.25–1.46; P = 0.006). Cumulative and maximum NRS pain scores as well as the incidence of NRS ≥ 4 were significantly higher in patients under mean daytime environmental noise of ≥58, than <58 decibels (dB) (8.0 [6.0–11.3] vs. 6.0 (5.0–7.0); 3.0 [2.0–4.0] vs. 2.0 [2.0–2.0, and 25.6% vs. 11.0%; RR, 2.32; 95% CI, 1.19–4.54, respectively; P < 0.001 for all). ConclusionsHigher-level postoperative noise exposure was associated with more severe postoperative pain and increased analgesic needs, as well as a higher incidence of moderate-to-severe pain in patients recovering from cesarean delivery. Our findings indicate that reducing environmental ward noise might benefit for postoperative pain management.

Comparison of the analgesic efficacy of two different fascial blocks in patients undergoing laparoscopic inguinal hernia surgery: A randomized control trial.

Moderate-to-severe intensity pain is reported on the first day following lower abdominal surgery. No study has compared transversus abdominis plane (TAP) block with retrolaminar block (RLB) in laparoscopic inguinal hernia surgery for postoperative pain relief. In this prospective, randomized trial, 42 male patients of American Society of Anesthesiologists (ASA) physical status I and II, aged 18-65 years, and having a BMI <40 kg/m2 received TAP or RLB following laparoscopic inguinal hernia surgery. A standard general anesthetic technique was performed. Patients were randomized into two groups: single-shot TAP block (group I) (n = 21) or the RLB (group II) (n = 21) with bilateral 20 ml of 0.375% ropivacaine. Postoperatively, IV paracetamol 1 g was administered as rescue analgesia. Postoperative cumulative Visual Analogue Scale (VAS) score 24 hours after surgery was considered as the primary outcome. Postoperative cumulative VAS score at rest at 24 h, represented as mean ± S.D (95% CI), in the TAP block group was 3.54 ± 3.04 (2.16-4.93) and in the RLB group was 6.09 ± 4.83 (3.89-8.29). P value was 0.112 and VAS on movement was 7.95 ± 3.41 (6.39-9.50 [2.5-15.0]) in TAP block group, whereas P value was 0.110 and VAS on movement was 10.83 ± 5.51 (8.32-13.34) in the RLB group. Similar postoperative cumulative pain score on movement at 24 h was present in patients receiving TAP block or RLB. However, VAS score at rest and on movement was reduced in patients receiving TAP block at 18 and 24 h postoperatively.

Effects of Gabapentin on Postoperative Pain and Opioid Consumption Following Laparoscopic Cholecystectomy: A Systematic Review and Meta-analysis

PurposeExamine the efficacy of gabapentin on postoperative pain scores and opioid consumption in laparoscopic cholecystectomy. DesignSystematic review and meta-analysis. MethodsPubMed, EBSCO, CINAHL, the Cochrane Central Register of Controlled Trials, Google Scholar, and gray literature was used to search the literature. Only randomized controlled trials were included. Outcomes were reported using the risk ratio and mean difference (MD). Risk of bias and the grades of recommendation, assessment, development, and evaluation (GRADE) system was used to the assessed quality of evidence. FindingsNineteen trials involving 2,068 patients were analyzed. Compared to placebo, gabapentin reduced the cumulative pain scores in the first 24 hours after surgery (MD, –1.19; 95% CI, –1.39–0.99; P < .00011), opioid consumption (MD, –3.51; 95% CI, –4.67 to –2.35; P < .00001), and the incidence of postoperative nausea and vomiting (risk ratio, 0.64; 95% CI, 0.52–0.78; P < .00001) with prolonged time to first analgesic rescue (MD, 210.9; 95% CI, 76.90–344.91; P = .002). However, gabapentin has little to no effect on the incidence of sedation, somnolence, and respiratory depression. ConclusionsGabapentin can be added as part of the multimodal pain management for patients undergoing laparoscopic cholecystectomy. Extrapolation of these findings to clinical settings must take into consideration the limitations identified in this review.

Erector Spinae Plane Block on Postoperative Pain and Opioid Consumption After Lumbar Spine Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials

PurposeEvaluate the effectiveness of the erector spinae plane (ESP) block in lumbar spine surgeries. DesignSystematic review with meta-analysis. MethodsPubMed, Cochrane Library, CINAHL, Google Scholar, and other gray literature were searched for eligible studies. Risk ratio (RR), mean difference (MD), and standardized mean difference were used to estimate outcomes with suitable effect models. The quality of evidence was assessed using the Risk of Bias algorithm and the grades of recommendation, assessment, development, and evaluation (GRADE) approach. FindingsTwenty-two randomized controlled trials involving 1,327 patients were included. The erector spinae plane (ESP) block demonstrated a lower cumulative pain score within the first 48 hours at rest (MD, –1.03; 95% CI, –1.19 to –0.87; P < .00001) and during activity (MD, –1.16; 95% CI, –1.24 to –1.08; P < .00001). In addition, ESP block decreased opioid consumption (MD, –6.25; 95% CI, –8.33 to –4.17; P < .00001) and prolonged the time to first analgesic rescue (MD, 5.66; 95% CI, 3.11-8.20; P < .0001) resulting in fewer patients requesting rescue analgesic (RR, 0.33; 95% CI, 0.13-0.83; P = .02), lower incidence of postoperative nausea and vomiting (RR, 0.29; 95% CI, 0.10-0.79; P = .02) with improved patient satisfaction score (standardized mean difference, 2.17; 95% CI, 1.40-2.94; P < .00001). ConclusionsESP block can provide effective postoperative pain control for lumbar spine surgery, improve patient satisfaction, and reduce the amount of postoperative opioid use.

NETO2-GluK2 interaction contributes to postoperative pain hypersensitivity through inducing PKCγ activation and synaptic incorporation of AMPA receptor GluR1 subunits in rat dorsal horn

Important roles in the initiation and maintenance of postoperative pain are played by the functional control of kainate (KA) and α-amino-3-hydroxy-5-methyl-4-isoxazole propionate (AMPA) receptors in the rat dorsal horn (DH). However, the mechanisms underpinning the cross-talk between spinal KA and AMPA receptors in postoperative pain are poorly understood. We hypothesized that after the rat’s plantar incision, the synaptic incorporation of AMPA receptor GluR1 subunits in the DH ipsilateral to the incision would increase due to the interaction between GluK2 and neuropilin tolloid-like 2 (NETO2). Our findings showed that incision stimuli caused severe pain responses, as measured by cumulative pain scores. GluK2-NETO2 but not GluK2-NETO1interaction was upregulated in ipsilateral dorsal horn neurons (DHNs) at 6 h post-incision. At 6 h post-incision, NETO2 small interfering ribonucleic acid (siRNA) intrathecal pretreatment increased mechanical withdrawal thresholds to von Freys and decreased ipsilateral paw cumulative pain scores. Further, PKCγactivation and synaptic abundance of GluK2 and GluR1 subunits in the ipsilateral DH were decreased by intrathecal pretreatment with NETO2 siRNA at 6 h post-incision. In conclusion, our findings imply that GluK2-NETO2 interaction could trigger PKCγactivation and the synaptic incorporation of AMPA receptor GluR1 subunits in rat DHs, which in turn led to the enhanced pain hypersensitivity after surgery. It sheds light on the interplay between KA and AMPA receptors in DHNs, which is thought to contribute to postoperative pain.

Association Between Mobilization and Composite Postoperative Complications Following Major Elective Surgery

Mobilization after surgery is a key component of Enhanced Recovery after Surgery (ERAS) pathways. To evaluate the association between mobilization and a collapsed composite of postoperative complications in patients recovering from major elective surgery as well as hospital length of stay, cumulative pain scores, and 30-day readmission rates. This retrospective observational study conducted at a single quaternary US referral center included patients who had elective surgery between February 2017 and October 2020. Mobilization was assessed over the first 48 postoperative hours with wearable accelerometers, and outcomes were assessed throughout hospitalization. Patients who had elective surgery lasting at least 2 hours followed by at least 48 hours of hospitalization were included. A minimum of 12 hours of continuous accelerometer monitoring was required without missing confounding variables or key data. Among 16 203 potential participants, 8653 who met inclusion criteria were included in the final analysis. Data were analyzed from February 2017 to October 2020. Amount of mobilization per hour for 48 postoperative hours. The primary outcome was a composite of myocardial injury, ileus, stroke, venous thromboembolism, pulmonary complications, and all-cause in-hospital mortality. Secondary outcomes included hospital length of stay, cumulative pain scores, and 30-day readmission. Of 8653 included patients (mean [SD] age, 57.6 [16.0] years; 4535 [52.4%] female), 633 (7.3%) experienced the primary outcome. Mobilization time was a median (IQR) of 3.9 (1.7-7.8) minutes per monitored hour overall, 3.2 (0.9-7.4) in patients who experienced the primary outcome, and 4.1 (1.8-7.9) in those who did not. There was a significant association between postoperative mobilization and the composite outcome (hazard ratio [HR], 0.75; 95% CI, 0.67-0.84; P < .001) for each 4-minute increase in mobilization. Mobilization was associated with an estimated median reduction in the duration of hospitalization by 0.12 days (95% CI, 0.09-0.15; P < .001) for each 4-minute increase in mobilization. The were no associations between mobilization and pain score or 30-day readmission. In this study, mobilization measured by wearable accelerometers was associated with fewer postoperative complications and shorter hospital length of stay.

The Effects of Preoperative Pain Education on Pain Severity in Cardiac Surgery Patients: A Pilot Randomized Control Trial

BackgroundThere is minimal research on the effect of individualized preoperative education on postoperative pain and postoperative pain medication intake. AimThe study objective was to assess the effect of individually tailored preoperative education on postoperative pain severity, number of pain breakthroughs, and use of pain medication in participants receiving the intervention compared to controls. MethodsA pilot study with 200 participants was conducted. The experimental group received an informational booklet and discussed their ideas surrounding pain and pain medication with the researcher. Controls received no intervention. Postoperative pain severity was measured by a Numerical Rating System (NRS), which was divided into mild (NRS 1-3), moderate (NRS 4-6), and severe (NRS 7-10). ResultsIn the participant cohort, 68.8% of participants were male, and the average age was 60.48±10.7. Average postoperative 48-hour cumulative pain scores were lower in those who received the intervention compared to controls; 50.0 (IQR 35.8-60.0) vs. 65 (IQR 51.0-73.0; p < .01) participants who received the intervention had less frequent pain breakthroughs when compared to controls (3.0 [IQR 2.0-5.0] vs. 6.0 [IQR 4.0-8.0; p < .01]). There was no significant difference in the amount of pain medication taken by either group. ConclusionsParticipants who receive individualized preoperative pain education are more likely to have decreased postoperative pain.

Therapeutic effects of different doses of peroperative intravenous dexmedetomidine for postoperative incision pain in rats

It is essential to minimize postoperative pain immediately after an operation. We compared the effects of different doses of preoperative intravenous dexmedetomidine (DMED) on treating postoperative incision pain in rats. Forty healthy, male, and clean-grade Sprague-Dawley rats were randomly divided into five groups: group C, group B, group D1, group D2, and group D3. The rat hind-limb incision pain model was implemented. The cumulative pain score of each group was determined at two h after surgery. Western blotting was used to determine the spinal cord expression of PKC γ, and high-performance liquid chromatography was used to determine spinal cord glutamate levels. Compared with group C, group B had a significantly greater cumulative pain score and greater spinal cord levels of PKCγ and glutamate. There were significantly lower pain scores and levels of PKCγ and glutamate in groups D2 and D3 than in group D1. Perioperative DMED reduced the release of glutamate and inhibited the expression of PKCγ in the rat spinal cord and these changes correlated with reduced postoperative pain. The treatment effect was most evident at the highest tested dose of DMED (1 µg/kg).

The analgesic effects of dezocine in rats with chronic constriction injuries.

Neuropathic pain (NP) is caused by diseases or dysfunction of nervous system and has a considerable negative impact on patients' quality of life. Opioid analgesics can be used for NP treatment. However, the effect of dezocine on NC remains unknown. In this study, we aimed to investigate the analgesic and intestinal effects of various doses of dezocine in rats with chronic constriction injuries (CCI). 100 rats were equally divided into 5 groups: the low (D1 group), medium (D2 group), and high (D3 group) doses of dezocine, and sham operation and model groups. The effects of dezocine on pain, analgesic effect, pain response, and tension and contraction frequencies of intestinal smooth muscles were assessed. With an increase in the dezocine dosage, the cumulative pain scores of rats decreased and analgesic effect significantly increased; mechanical withdrawal threshold (MWT) and thermal withdrawal latency (TWL) improved in varying degrees. The expression of the NP-related proteins glial fibrillary acidic protein (GFAP) and connexin 43 (Cx43) was also improved by dezocine treatment. The results of western blot and ELISA showed that IL-6, and monocyte chemotactic protein-1 (MCP-1) levels also decreased significantly with an increase in the dezocine dose, indicated that dezocine alleviated the inflammatory microenvironment. The dezocine exhibited no significant effect on the tension or contraction frequencies of intestinal smooth muscles of rats. In conclusion, the analgesic effect of dezocine on rats with CCI is dose-dependent and has little effect on the tension or contraction frequencies of intestinal smooth muscles. Our research proved the analgesic effect of dezocine in rats with CCI, and provided further insights into new therapies for NP treatment.

Comparison of pain perception caused by aligner and conventional fixed orthodontic treatments

The aim of this study was to compare the pain perceived in fixed orthodontic and aligner treatments during the first seven days of treatment. Forty patients who had 3–6 mm maxillary dental crowding and a non-extraction treatment plan were included in this study. The subjects were randomly divided into two groups: the fixed orthodontic group and the aligner group, with ten females and ten males in each. In the fixed orthodontic group, treatment was started with 0.014-inch round nickel-titanium archwire, and a 0.018×0.025-inch preadjusted edgewise appliance was used. In the aligner group, treatment was started with a polyurethane aligner. Throughout the study, teeth in the upper jaw were treated in both groups. The pain scores of the subjects were measured with the visual analog scale at the second and sixth hours and on the first, second, third, and seventh days of treatment. The pain scores of the fixed orthodontic group were significantly higher than those of the aligner group at the sixth hour, on the first, second, and third day. The differences at the second hour and on the seventh day were not statistically significant. According to the study outcomes, less pain was felt during the aligner treatment compared to the fixed orthodontic treatment. However, it should be considered that the force activation interval is shorter in the aligner treatment, and the cumulative pain score may be higher.

Efficacy and Safety of Gabapentin on Postoperative Pain Management After Bariatric Surgery: A Systematic Review and Meta-Analysis

PurposeExamine the efficacy and safety of perioperative gabapentin in bariatric surgical patients. DesignSystematic Review and Meta-analysis. MethodsAn exhaustive search was conducted using PubMed, Cochrane Library, MEDLINE, CINAHL, Google Scholar, and other gray literature. Only randomized controlled trials evaluating the use of gabapentin in bariatric surgery were included. Risk ratio (RR) and mean difference (MD) were used to estimate outcomes with suitable effect models. Quality of evidence was assessed using the Risk of Bias and GRADE system. FindingsFour trials consisting of 283 patients were analyzed. The use of gabapentin significantly lowered the cumulative pain score in the first 24 hours after surgery by an average of 1.04 (MD, –1.04; 95% CI, –1.45 to –0.63; P < .00001). Gabapentin also reduced the overall morphine equivalent consumption by 7.89 mg (MD, –7.89; 95% CI, –13.56 to –2.2; P = .006). However, gabapentin did not affect the incidence of PONV (RR, 0.61; 95% CI, 0.38-1.00; P = .05), somnolence (RR, 1.25; 95% CI, 0.57-2.73; P = .57), dizziness (RR, 1.01; 95% CI, 0.40-2.54; P = .99), and headache (RR, 0.76; 95% CI, 0.25-2.30; P = .62). Substantial heterogeneity, imprecision of the effect size, and potential publication bias were limitations of this review. ConclusionsThe use of gabapentin is effective in the management of postoperative pain in bariatric surgery. However, there is limited data regarding the opioid-sparing effect and adverse effect profiles of gabapentin in the bariatric surgical population.

Pulsed electromagnetic fields for post-appendicectomy pain management: a randomized, placebo-controlled trial

BackgroundThe value of pulsed electromagnetic field (PEMF) in postoperative pain management, due to the inconsistent findings so far, remains unclear. We extended the evaluation of PEMF on postoperative pain and intravenous (IV) analgesic use to a group of post-appendicectomy Asian patients.MethodsThis is a double-blinded, randomized trial. Adults with a clinical diagnosis of acute appendicitis were enrolled. Patients were allocated randomly to receive an active-PEMF device or an inactive device after the surgery in addition to the standard postoperative pain management. The primary outcome measure was the 12-h cumulative postoperative pain intensity measured at four different time points using the visual analogue scale. The secondary outcome measure was the total amount of IV fentanyl used (in mg) via PCA over the first 12 postoperative hours. The primary analysis in this trial compared the two study groups for the reported cumulative pain score (both at rest and on movement) and the cumulative amount of IV fentanyl uses over the first 12 postoperative hours using the Wilcoxon rank sum test. Analyses were performed based on the intention-to-treat principal. Multiple imputation was used to handle the missing data assuming that the data were missing at random.FindingsOne hundred eighteen subjects were randomized; 58 were allocated to the active-PEMF group and 60 to the inactive control group. Pooled mean pain score of both intervention groups by time point declined in a similar fashion over the course of 12 postoperative hours. The 12-h cumulative postoperative pain score at rest and on movement did not differ significantly after the procedure. (W = 1832.5 ~ 1933.0, p-value 0.6192 ~ 0.2985 for resting pain score comparison; W = 1737.0 ~ 1804.5, p-value 0.9892 ~ 0.7296 for movement pain score comparison). For the secondary outcome measure of 12-h total fentanyl use, a comparison between the PEMF vs. placebo arm also revealed no statistically significant difference across all the 20 imputed datasets (W = 1676.5 ~ 1859.0, p-value 0.7344 ~ 0.5234).DiscussionPEMF was not superior to placebo as an adjunct pain management for up to 12 h post-appendicectomy. Previously reported effect of PEMF on postoperative pain intensity and analgesia uses in similar surgical settings cannot be verified.Trial registrationNational Medical Research Register Malaysia (NMRR-15–670-25,805) and Thai Clinical Trials Registry (retrospectively registered on November 01, 2019, Study ID—TCTR20191102002).

Local infiltration of HYR-PB21, a sustained-release formulation of bupivacaine, provides analgesia and reduces opioid requirement after haemorrhoidectomy: a randomised controlled trial

BackgroundHYR-PB21 is a new sustained-release formulation of bupivacaine indicated for controlling postoperative pain. The objectives of this study were to investigate the analgesic efficacy and safety profile of HYR-PB21 in patients after haemorrhoidectomy. MethodsThis was a multicentre, randomised, double-blind, positive-controlled trial. Patients were assigned randomly to receive a single dose of HYR-PB21 (150 mg or 300 mg) or bupivacaine HCl (75 mg) after surgery for prolapsing haemorrhoids. Postoperative pain was evaluated using a numeric rating scale at rest to calculate a cumulative pain score. Total rescue opioid usage and the proportion of subjects receiving rescue opioid were also assessed. ResultsWe enrolled 72 patients with haemorrhoidectomy, and 71 patients completed the study. The average cumulative pain score through 72 h after surgery in the 300 mg HYR-PB21 group (87 scores) was lower than in the bupivacaine HCl group (166 scores) in an intention-to-treat analysis (P<0.001). There was a dose–response effect in reducing total opioid usage and the proportion of rescue opioid use between the 150 mg and 300 mg HYR-PB21 groups, with bupivacaine HCl as a reference group. The HYR-PB21 groups did not show more adverse effects than the bupivacaine HCl group. ConclusionsLocal infiltration of a single dose of HYR-PB21 sustained-release bupivacaine had better efficacy in controlling postoperative pain, with similar adverse effects, compared with a single dose of bupivacaine HCl in patients after haemorrhoidectomy. Clinical trial registrationChiCTR2000041318 (Chinese Clinical Trial Registry).

Journal-related Activities and Other Special Activities at the 2022 American Society of Anesthesiologists Meeting

Journal-related Activities and Other Special Activities at the 2022 American Society of Anesthesiologists Meeting

Comparative analysis of opioid use between robotic and open pancreatoduodenectomy.

Risk-stratified pancreatectomy clinical pathways using regional anesthesia and multimodality analgesia have decreased overall opioid use, but the additional benefits of robotic surgery in opioid reduction for pancreatoduodenectomy (PD) are unknown. We compared the inpatient opioid use between robotic PD and open PD. Patients undergoing open PD within a protocol evaluating preincisional regional anesthetic block bundles were compared to consecutively-treated patients undergoing robotic PD identified from a prospectively maintained single-institutional database. Clinical characteristics, operative outcomes, pain scores and inpatient oral morphine equivalent (OME) use were compared between patients treated with robotic or open PD. Patients with a history of continuous-release opioid dependence were excluded. Of 114 total patients, 25 underwent robotic PD and 89 underwent open PD. Intraoperative opioid use was not different (P=.87), nor were cumulative pain scores. Robotic PD patients used significantly fewer OMEs per day on postoperative days 1-4 (P=.039), used fewer total OMEs during hospitalization (robotic: median=79, IQR 42.5-141; open: median=126, IQR 61.3-203.8; P=.0036) and were discharged with fewer OMEs (robotic: median=0, IQR 0-43.8; open: median=25, IQR 0-75; P=.009) despite a shorter length of stay (robotic: median=4, open: median=5, P=.002). Robotic PD patients required fewer inpatient OMEs than open PD while maintaining similar pain scores. A higher percentage of robotic PD patients tapered off of opioids prior to discharge than open surgery patients treated with a standardized opioid reduction protocol despite a shorter length of stay. These results provide a rationale for choosing robotic PD when feasible to minimize opioid use.

Upregulation of Hevin contributes to postoperative pain hypersensitivity by inducing neurexin1β/neuroligin1-mediated synaptic targeting of GluA1-containing AMPA receptors in rat dorsal horn

The astrocytes-secreted active molecule, Hevin considerably contributes in the transsynaptic bridge of neurexin1β/neuligin1 in excitatory synapse. Previous studies have demonstrated that activity-dependent synaptic recruitment of spinal neuroligin1 and GluA1-containing AMPA receptors (AMPARs) is involved in incisional, inflammatory and neuropathic pain. Here, we hypothesized that Hevin induced postoperative pain hypersensitivity by enhancing the neurexin1β/neuroligin1-mediated synaptic targeting of GluA1-containing AMPARs in spinal dorsal horns (DH). Our results showed that plantar incision induced significant postoperative pain behavior, which was described by the cumulative pain scores. At 1 d and 3 d post-incision, Hevin expression was considerably elevated in ipsilateral DHs, although it recovered to baseline value at 5 d following the incision. At 1 d post plantar incision, the neurexin1β/neuroligin1 interactions significantly increased in ipsilateral DHs in rats subjected to incision when compared with those in control rats. Intrathecal pretreatments of small interference RNA targeting Hevin substantially suppressed postoperative pain hypersensitivity and reduced the neurexin1β/neurolgin1 interaction as well as the synaptic targeting of GluA1 in ipsilateral spinal DHs. These data suggest that Hevin induced postoperative pain hypersensitivity by enhancing the neurexin1β/neuroligin1 interaction and subsequent synaptic targeting of GluA1-containing AMPARs in ipsilateral spinal DHs. It provides new insights into the role of Hevin-mediated trans-synaptic regulation in postoperative pain hypersensitivity, which would help develop a novel therapeutic strategy.

Clinical research on minimally invasive rotary resection in the treatment of lactational breast abscess.

This study sought to compare the efficacy of minimally invasive rotatory resection plus catheter drainage and puncture abscess aspiration in the treatment of lactational breast abscess. The data of 80 patients with lactational breast abscess at the Department of Mammary Gland, Tianjin Central Hospital of Gynecology Obstetrics, from January 2019 to January 2020 were retrospectively collected. The patients were divided into the minimally invasive group (n=30) and the abscess aspiration group (n=50). Clinical data, including age, parity, preoperative body temperature, postpartum time, time of abscess cavity generation, diameter and position of abscess cavity, intraoperative drainage, bleeding, recovery time, and satisfaction score, were collected and compared between the 2 groups of patients. The baseline data between the 2 groups were not significantly different. The minimally invasive group had a higher single drainage volume and single bleeding volume (P<0.05), and lower cumulative pain score (P<0.05); the cumulative bleeding volume did not differ significantly between the 2 groups (P>0.05). For the abscess cavities with a diameter ≤5 cm, the single drainage volume, single bleeding volume, and single pain score in the minimally invasive group were significantly higher than those in the abscess aspiration group (P<0.05); the total drainage volume was similar between the 2 groups (P>0.05). For the abscess cavities with a diameter >5 cm, the single drainage volume and single bleeding volume in the minimally invasive group were significantly higher than those in the abscess aspiration group (P<0.05), while the cumulative bleeding volume, single pain score, and cumulative pain score were lower in the minimally invasive group (P<0.05). There was no significant difference in total drainage between the 2 groups (P>0.05). When the abscess cavity is ≤5 cm in diameter and the abscess is superficial, puncture and abscess aspiration may be more advantageous than the minimally invasive rotatory resection plus catheter drainage. When the abscess cavity is >5 cm in diameter and there are multiple abscesses or deep large abscess, the efficacy of minimally invasive rotary resection plus catheter drainage may be better than the puncture and abscess aspiration.

Abstract No. 230 Percutaneous ablation for the treatment of osteoid osteomas: a systematic review and meta-analysis

To evaluate the safety and efficacy of percutaneous ablative therapy for the treatment of osteoid osteomas. PubMed database, Web of Science, and SCOPUS were searched from their inception until November 2019 for articles describing osteoid osteoma. Inclusion criteria were as follows: studies reporting > 5 patients, and pre- and post-procedure pain assessment recorded with Visual Analog Scale (VAS). Demographic data, procedural details, technical success rates, pre- and post-procedure VAS scores, and procedural complications were recorded. A random-effects meta-analyses of the VAS pain score pre-procedurally, at 24-48 hours, at 3-6 months, and at 12 months were calculated. For radiofrequency ablation, VAS scores for pain at pre-procedure, 24-48 hours, and 3-6 months yielded cumulative pain scores of 7.64 ± 0.175 (1023 patients), 0.78 ± 0.186 (1009 patients), and 0.02 ± 0.0196 (1009 patients), respectively. For cryoablation, VAS scores for pain at pre-procedure, 24-48 hours, and 3-6 months yielded cumulative pain scores of 8.46 ± 0.549 (75 patients), 0.975 ± 0.66 (75 patients), and 0.112 ± 0.08 (75 patients), respectively. For laser ablation, VAS scores for pain at pre-procedure and 24-48 hours yielded cumulative pain scores of 4.94 ± 1.42 (59 patients), and 0.506 ± 0.268 (276 patients), respectively. Though the mean follow-up time for patients undergoing laser ablation was 49.15 ± 25.25 months, VAS scores were not reported 3-6 months post-procedure. For microwave ablation, VAS scores for pain at pre-procedure, 24-48 hours, and 3-6 months yielded cumulative pain scores of 6.14 ± 1.07 (7 patients), 1.636 ± 1.215 (44 patients), and 0 ± 0.0 (24 patients), respectively. All ablation methods resulted in a significant immediate and lasting pain reduction (P< 0.001). Overall recurrence of bone pain at the same site occurred in 4.07% of all patients an average of 11 months post-procedure. Percutaneous ablative therapies are safe and result in significant and lasting pain reduction as demonstrated through Visual Analog Scale pain scores.Tabled 1VAS PreprocedureVAS 24-48 Hours PostprocedureVAS 3-6 Months PostprocedureRadiofrequency ablation7.64 ± 0.175 (n = 1023)0.78 ± 0.186 (n = 1009)0.02 ± 0.0196 (n = 1009)Laser ablation4.94 ± 1.42 (n = 59)0.506 ± 0.268 (n = 276)-Cryoablation8.46 ± 0.549 (n = 75)0.975 ± 0.66 (n = 75)0.112 ± 0.08 (n = 75)Microwave ablation6.14 ± 1.07 (n = 7)1.636 ± 1.215 (n = 44)0 ± 0.0 (n = 24) Open table in a new tab