Early Postoperative Pain Research Articles

Transversus abdominis plane (TAP) block for postoperative pain management after ventral hernia repair: an updated systematic review and meta-analysis.

Postoperative pain remains a common concern following ventral hernia repair (VHR), especially for open procedures. We aim to assess the effectiveness of the Transversus Abdominis Plane (TAP) block for the management of postoperative pain following VHR. Cochrane, EMBASE, and PubMED, MEDLINE, and Web of Science were systematically searched for studies comprising adults undergoing VHR with preoperative TAP block, compared to placebo and epidural analgesia. The outcomes selected for analysis were postoperative pain with the numeric rating scale (NRS), postoperative morphine milligram equivalents (MME) per day, and hospital length of stay (LOS). Subgroup analysis was performed for studies using the Liposomal Bupivacaine (Exparel®) for TAP block. 1,460 results were screened, and 14 included, comprising 9 retrospective cohort studies and 5 RCTs, totaling 1,617 patients. TAP block was associated with a shorter LOS compared to conventional pain measures (MD -1,14 days; 95% CI -2.05, -0.22; P = 0.014) and to epidural analgesia (MD -2.02 days; 95% CI -2.67, -1.37; P < 0.001), and lower NRS scale in the day of surgery (MD -1.24; 95% CI -1.81, -0.68; P < 0.001) and in the POD1 (MD -0.63; 95% CI -1.18, -0.08; P = 0.025) compared to placebo. No benefit was seen for TAP block regarding opioid consumption compared to epidural analgesia and placebo. No differences were seen between TAP block and epidural analgesia for the NRS scores. Subgroup analysis of Exparel® compared to simple bupivacaine showed no benefit for Exparel®. The TAP block is associated with shorter LOS compared to placebo and epidural analgesia and is related to less early postoperative pain compared to the conventional pain measures. The TAP block should be considered as a pain management modality for VHR, however cost-effective analysis is required to address the feasibility of the routine utilization of this approach and to balance the financial benefits of its application.

Clinical Outcomes and Complications of Total Knee Arthroplasty with Posterior-Stabilized and Cruciate-Retaining Prostheses in Osteoarthritis Patients with Valgus Deformity

AIM: This study aimed to evaluate the short- and long-term outcomes and complications of total knee arthroplasty (TKA) using posterior-stabilized (PS) and cruciate-retaining (CR) prosthesis in patients with osteoarthritis (OA) and valgus knee deformity. METHODS: A retrospective analysis was conducted on 200 patients with OA and valgus knee deformity who underwent TKA between February 2021 and November 2023. The cohort was divided into the PS group (n = 108) and the CR group (n = 92). Clinical outcomes, including Range of Motion (ROM), Hospital for Special Surgery (HSS) knee score, and Visual Analog Scale (VAS) score, were assessed at 1 week, 1 month, 3 months, 6 months, and 1 year postoperatively. Pre- and postoperative valgus angles were measured, and the incidence of complications was recorded. RESULTS: Both groups exhibited significant postoperative improvements in ROM, HSS scores, and VAS scores compared to preoperative (p &lt; 0.001). The CR group demonstrated superior early postoperative outcomes, with higher HSS scores, greater ROM, and lower VAS scores at 1 week, 1 month, and 3 months (p &lt; 0.001). However, no significant differences were observed between the groups at 6 months and 1 year (p &gt; 0.05). Radiographic analysis indicated effective correction of valgus angles in both groups postoperatively (p &lt; 0.001), with no significant intergroup differences (p &gt; 0.05). The complication rate was significantly lower in the CR group compared to the PS group (p &lt; 0.05). CONCLUSIONS: CR and PS prostheses effectively correct valgus deformity, alleviate pain, and improve knee function. However, the CR prosthesis offers advantages in reducing early postoperative pain, swelling, and complications, facilitating faster functional recovery. The selection of the appropriate prosthesis based on patient-specific characteristics is critical to optimizing TKA outcomes.

A comparative study of early postoperative pain: robotic-assisted versus conventional total knee arthroplasty.

While robotic-assisted total knee arthroplasty (RA-TKA) has demonstrated improved surgical precision, its impact on early postoperative pain management remains unclear. This study compared early postoperative pain outcomes between RA-TKA and conventional TKA (C-TKA). In this retrospective study, 230 consecutive patients (309 knees) who underwent primary TKA were analyzed: 143 patients (181 knees) in the C-TKA group and 87 patients (128 knees) in the RA-TKA group. Pain scores at rest and during movement were assessed using the Numerical Pain Rating Scale for 72h postoperatively. Secondary outcomes included opioid consumption and length of hospital stay. While pain scores at rest showed no significant differences between groups, RA-TKA patients reported significantly lower pain scores during movement at 24h post-surgery (p = 0.023). The RA-TKA group demonstrated significantly reduced opioid consumption during the first 48 postoperative hours (p = 0.001 for 0-24h; p = 0.03 for 24-48h) and shorter length of hospital stay (p = 0.011). Subgroup analysis of unilateral procedures showed similar advantages in the RA-TKA group. RA-TKA was associated with reduced pain during movement, decreased opioid consumption, and shorter hospital stay in the early postoperative period compared to C-TKA.

Robotic-Assisted Primary Total Knee Arthroplasty Requires Fewer Soft-Tissue Releases and is Associated with a Larger Reduction in Early Postoperative Pain.

Robotic-Assisted Primary Total Knee Arthroplasty Requires Fewer Soft-Tissue Releases and is Associated with a Larger Reduction in Early Postoperative Pain.

Prospective Survey of Postoperative Pain in Japan: A Multicenter, Observational Study.

Background/Objectives: Postoperative analgesia is important for reducing biologically invasive reactions to surgery. In Japan, postoperative analgesia, including indices of analgesia, has not been adequately addressed. This study aimed to determine the relationship between postoperative pain and postoperative course and the importance of analgesia for early recovery. Methods: Patients who underwent any of seven surgical procedures in gastrointestinal, thoracic, and cardiac surgery were enrolled. The primary endpoint was a median Prince Henry Pain Scale score from postoperative days 1 to 3. Secondary endpoints were the quality of recovery on postoperative day 7 (Quality of Recovery-15 [QoR-15]) and the length of postoperative hospital stay. Results: Median postoperative pain levels among surgeries were 3 on day 1, 2 on days 2 and 3, 1 on day 7, and 1 at discharge. In both univariate and multivariate analyses, the use of postoperative epidural analgesia and intravenous patient-controlled analgesia (IV-PCA) were significant predictors of early postoperative pain. Only early postoperative pain was a significant predictor of QoR-15 score. Regular use of acetaminophen, early postoperative pain, no appetite, and postoperative complications were significant in affecting the length of postoperative hospital stay. In the comparison of early postoperative pain according to whether epidural analgesia and IV-PCA were used, the group that used both methods had the least pain. Conclusions: In Japan, early postoperative pain persists after major surgical procedures and affects postoperative quality of recovery and length of hospital stay. The use of epidural analgesia, IV-PCA, or both appeared to be effective in overcoming early postoperative pain, thereby enhancing early postoperative recovery.

Early Clinical Outcomes (ECO) in the Era of Rapid Recovery Total Joint Arthroplasty: A Comparative Evaluation of Three Bearing Surfaces.

Background and objective Outpatient total knee arthroplasties (TKAs) for low-risk patients are growing in popularity, thanks to expedited recovery and reduced hospital stays. Early postoperative pain reduction has been associated with improved long-term functional outcomes. This study aimed to comparethree knee implant systems - posterior-stabilized, medial-pivot, and rotating platform cruciate-retaining (RPCRF) - in terms of their impact on early postoperative pain and opioid use. Methods A retrospective analysis was conducted, involving 94 posterior-stabilized TKAs, 104 medial-pivot TKAs, and 101 RPCRF TKAs by a single surgeon at two hospitals from June 2020 to March 2022. Pain levels per the Numerical Rating System were obtained from the patients' preoperative and postoperative visits at two weeks, six weeks, and 12 weeks. The daily milligram morphine equivalents (MME) in opioid-naive patients were calculated and compared between the three systems. The Kruskal-Wallis and Dunn tests were employed for all calculations to obtain p-values. Results Posterior-stabilized knees had a significantly larger reduction in pain levels compared to medial-pivot and RPCRF systems at two and six weeks postoperatively. There were no significant differences at the 12-week assessment. The daily MMEs prescribed were similarly reduced with posterior-stabilized knees at two and six weeks, with no difference at 12 weeks. Conclusions Our findings suggest that posterior-stabilized knee implants may offer superior short-term pain reduction and reduced opioid use requirements after outpatient TKA. Further research with randomized and blinded prospective trials is needed to elucidate improvements in patient satisfaction andfunctional outcomes.

Relationship Between Preoperative Fasting Duration and Anxiety Levels With Postoperative Pain, Nausea-Vomiting, and Sleep Quality in Orthopedic Surgical Patients: A Cross-Sectional Study.

This study is a cross-sectional study aimed to determine the association between preoperative fasting time and anxiety level and early postoperative pain intensity, nausea-vomiting severity, and sleep quality in patients undergoing orthopedic surgery. The study was conducted between March and June 2024 and completed with 188 patients. In the study, patient information form, Amsterdam Preoperative Anxiety and Information Scale, and Richards-Campbell Sleep Questionnaire were used. Correlation analysis indicated a significant negative correlation between postoperative sleep quality and pain intensity. There was a significant positive correlation between preoperative anxiety level and preoperative solid food fasting and fluid fasting times. According to the multiple linear regression model, preoperative anxiety level was found to have a significant effect on pain severity, and pain severity at the postoperative 24th hour significantly affected postoperative sleep quality. Adjusting patients' fasting durations prior to surgical interventions according to evidence-based guideline recommendations and monitoring anxiety closely are simple, practical, and safe measures that could alleviate postoperative pain and nausea-vomiting and improve sleep quality, potentially enhancing outcomes, comfort, and the quality of care.

Impact of Specimen Extraction Site and Gallstone Size on Early Postoperative Pain Following Laparoscopic Cholecystectomy: A Prospective Randomized Controlled Study.

Laparoscopic cholecystectomy (LC) is widely performed with generally favorable outcomes, but postoperative pain remains a significant issue, influenced by various factors including the specimen extraction site and gallstone size. A prospective randomized controlled study was conducted on 100 patients undergoing LC. Participants were randomized to have the specimen removed through either the epigastric or umbilical trocar. Postoperative pain was assessed using the visual analog scale (VAS) on postoperative days 1, 3, and 7. Statistical analyses were performed to evaluate the impact of trocar site and gallstone size on pain levels. Patients whose specimens were extracted through the umbilical trocar experienced significantly less pain on postoperative days 1 and 3 ( P =0.006 and 0.014, respectively) than those with epigastric trocar extraction. In addition, patients with gallstones larger than 10mm reported higher pain levels on day 3 ( P =0.001) irrespective of the extraction site. The umbilical trocar site for specimen extraction and smaller gallstone size is associated with reduced early postoperative pain following LC. These findings suggest the importance of considering extraction site and gallstone size in managing postoperative pain in LC patients.

Preoperative thoracic epidural analgesia with and without erector spinae plane block for thoracotomy: A retrospective study.

Preoperative thoracic epidural analgesia with and without erector spinae plane block for thoracotomy: A retrospective study.

Liposomal bupivacaine after arthroscopic rotator cuff repair moderately decreases early postoperative pain and demonstrates equivocal opioid consumption compared to traditional interscalene nerve blocks: A systematic review and meta-analysis of level 1 studies.

Liposomal bupivacaine after arthroscopic rotator cuff repair moderately decreases early postoperative pain and demonstrates equivocal opioid consumption compared to traditional interscalene nerve blocks: A systematic review and meta-analysis of level 1 studies.

The Relationship Between Preoperative Anxiety Level and Postoperative Pain Outcomes in Total Hip and Knee Replacement Surgery: A Cross-sectional Study

The Relationship Between Preoperative Anxiety Level and Postoperative Pain Outcomes in Total Hip and Knee Replacement Surgery: A Cross-sectional Study

Intravenous Carbazochrome Sodium Sulfonate Improves Visual Clarity in Patients Undergoing Arthroscopic Rotator Cuff Repair: A Randomised Controlled, Triple-Blinded, Prospective Study.

Intravenous Carbazochrome Sodium Sulfonate Improves Visual Clarity in Patients Undergoing Arthroscopic Rotator Cuff Repair: A Randomised Controlled, Triple-Blinded, Prospective Study.

Effect of parecoxib on postoperative cognitive function and analgesic safety in elderly patients undergoing gastrointestinal tumor resection: A retrospective study.

Neuroinflammation is associated with the development of postoperative cognitive dysfunction (POCD). Parecoxib has powerful anti-inflammatory and analgesic effects, which may reduce the occurrence of POCD. We hypothesized that parecoxib could reduce the incidence of POCD and relieve postoperative pain without increasing postoperative complications in elderly patients with gastrointestinal cancer. The study analyzed the effect of parecoxib on elderly patients undergoing elective radical resection of gastrointestinal tumors. Patients were divided into the NSAIDs group and the non-NSAIDs group according to whether parecoxib was administered. Demographic and clinical data were collected and compared. The incidence of POCD was set as the primary outcome, and postoperative pain as the secondary outcome. Among the 440 enrolled patients, the POCD incidence rates within 7 days after surgery in the NSAIDs and non-NSAIDs groups were 42.60% and 40.30%, respectively, with no statistically significant difference (P > 0.05). Patients in the NSAIDs group experienced significantly less pain on the first and second days after surgery compared to the non-NSAIDs group (P < 0.05). There were no statistically significant differences in postoperative adverse events between the two groups (P > 0.05). Parecoxib had no significant negative effect on early postoperative cognitive function, effectively alleviating early postoperative acute pain without increasing postoperative complications. The findings have implications for the broader use of parecoxib in postoperative pain management in elderly patients undergoing major surgery.

Compare the Effects of Infiltration of Bupivacaine in Liver Bed with Preperitoneal Nerve Block in Laparoscopic Cholecystectomy

Background: Laparoscopic cholecystectomy is now considered the preferred treatment for symptomatic gallstone diseases, establishing itself as the gold standard method. Nevertheless, pain remains the sole grievance responsible for delaying discharge. Objective: To compare the effectiveness of bupivacaine infiltration into the liver bed and peritoneal cavity in reducing pain after laparoscopic cholecystectomy. Material and Methods: This prospective comparative study was done at the Department of General Surgery of Akbar Niazi Teaching Hospital, Islamabad. The study included 100 patients who were admitted for elective laparoscopic cholecystectomy between June and November 2023.Patients were consecutively assigned to received either bupivacaine preperitoneal nerve block. After gallbladder was removed, 20 ml bupivacaine 0.5% was administered in liver bed. For preperitoneal nerve block bupivacaine 0.5% was infiltrated into port sites to block the preperitoneal nerves. Postoperative pain assessment was conducted at 1, 6, 12, and 24 hours utilizing the Visual Analog Scale (VAS). Results: The mean patients ages were43.88±7.8 years. Postoperative mean VAS at 1, 6 and 12 hours were decreased in Bupivacaine compare to preperitoneal nerve block (p ≤ 0.05). Postoperatively no difference was observed in VAS at 24 hours between the patients (p ≥ 0.05). The total doses mean of SAID utilized in first 24 hours postoperatively were lower in Bupivacaine patients than in preperitoneal nerve block patients (p ≤ 0.05). Conclusion: The infiltration of bupivacaine in the liver bed following laparoscopic cholecystectomy effectively reduces pain as compare to preperitoneal nerve block. This straightforward, cost-effective technique should be adopted to diminish early postoperative pain in all elective cases.

Comparative study of the role of pronator quadratus repair versus no pronator quadratus repair in volar plate fixation of distal radius fractures

Background: There is a controversy regarding the merits of repairing pronator quadratus (PQ) following volar plate fixation of distal radius fracture via Henry’s approach. The aim of this study was to evaluate and compare the post-operative functional outcome between those with PQ repair vs those without PQ repair. Methods: The 41 patients (33 males and 8 females) were included in this randomized controlled trial as per our inclusion and exclusion criteria. Of these 21 patients were in group A in which PQ repair was done and 20 patients were in group B in which PQ repair was not done. Both groups were compared with DASH score, wrist range of motion, post-operative pain and grip strength. Results: The patients were followed up for minimum 1 year. Patients in both the groups shared similar baseline and demographic characteristics. There was no significant difference in the mean DASH score and mean grip strength at any point of time in follow up. However, wrist flexion at 6 weeks was better in group A (p=0.03) along with post-operative pain at 2nd and 6th week (p=0.035, 0.039). Conclusions: PQ repair during volar plating of distal radius fractures does not provide any significant better functional outcome, range of motion and grip strength, especially in long run. But it reduced early post-operative pain significantly.

Minimally Invasive Versus Open Surgery for Thoracolumbar Fractures Treatment : A Meta-analysis of Randomized Controlled Trials and Prospective Studies.

Meta-analysis. The purpose of this systematic review and meta-analysis was to pool the available data comparing MIS to open surgery for thoracolumbar fractures and provide a more comprehensive assessment of this topic. There remains a debate over whether minimally invasive surgery (MIS) or open fixation provides superior outcomes for patients with thoracolumbar fractures. While several randomized controlled trials and prospective studies have compared these two approaches, the published studies are limited by sample size. Following PRISMA guidelines, a systematic review of the PubMed, Cochrane, and Google Scholar (pages 1-20) databases was performed on October 1, 2024. The extracted data consisted of complications, surgery-related parameters, early and late postoperative back pain, and postoperative regional kyphosis. Five RCTs and five prospective studies were included in the meta-analysis, including 584 patients, with 299 in the MIS group and 285 in the open group. MIS patients were shown to have less EBL (MD=-155.86; 95% CI: -217.97 to -93.76, P <0.001), a shorter LOS (MD=-3.34; 95% CI: -4.62 to -2.06, P <0.001), lower pain scores during the early postoperative period (MD=-1.14; 95% CI: -1.56 to -0.71, P <0.001), and less regional kyphosis (MD=-5.17; 95% CI: -7.17 to -3.16, P <0.001), even when stratifying by study type. In addition, fluoroscopy time was longer in the MIS group (MD=0.60; 95% CI: 0.21-0.98, P =0.003), although this difference was not seen when looking at RCTs only. Among patients with thoracolumbar fractures, treatment with MIS was associated with decreased EBL, shorter LOS, earlier pain reduction, and less regional kyphosis compared with treatment with open fixation. In addition, higher radiation exposure was seen among patients treated with MIS. While MIS offers several potential benefits, both MIS and open fixation remain safe and reliable options for the treatment of thoracolumbar fractures.

Efficacy of transversus abdominis plane block in postoperative pain management of laparoscopic totally extraperitoneal inguinal hernia repair: a propensity score-matched analysis.

Transversus abdominis plane (TAP) block is a promising technique for postoperative pain control. In this study, we aimed to evaluate the efficacy of the TAP block in managing postoperative pain after laparoscopic totally extraperitoneal (TEP) inguinal hernia repair. In this retrospective study, medical records of patients who had received ultrasonography-guided TAP blocks after surgery from January 2019 to August 2023 were reviewed and compared with those of patients who had not received. Propensity score matching was controlled for age as a confounder. Postoperative pain levels were measured using the numeric rating scale (NRS). After matching, 95 patients were included in each group. The TAP block group (2.7 vs. 4.0, P < 0.001) had significantly lower NRS scores immediately and early postoperative pain than the control group (1.9 vs. 2.5, P < 0.001). However, there was no significant difference between the 2 groups in terms of postoperative complications (P > 0.05). TAP block is effective and safe for managing immediate and early postoperative pain in laparoscopic TEP inguinal hernia repair and does not increase the risk of complications.

Current concepts of fourth-generation minimally invasive and open hallux valgus surgery.

Hallux valgus (HV) presents as a common forefoot deformity that causes problems with pain, mobility, footwear, and quality of life. The most common open correction used in the UK is the Scarf and Akin osteotomy, which has good clinical and radiological outcomes and high levels of patient satisfaction when used to treat a varying degrees of deformity. However, there are concerns regarding recurrence rates and long-term outcomes. Minimally invasive or percutaneous surgery (MIS) has gained popularity, offering the potential for similar clinical and radiological outcomes with reduced postoperative pain and smaller scars. Despite this, MIS techniques vary widely, hindering comparison and standardization. This review evaluates the evidence for both open Scarf and Akin osteotomy and newer-generation MIS techniques. Fourth-generation MIS emphasizes multiplanar rotational deformity correction through stable fixation. While MIS techniques show promise, their evidence mainly comprises single-surgeon case series. Comparative studies between open and MIS techniques suggest similar clinical and radiological outcomes, although MIS may offer advantages in scar length and less early postoperative pain. MIS may afford superior correction in severe deformity and lower recurrence rates due to correcting the bony deformity rather than soft-tissue correction. Recurrence remains a challenge in HV surgery, necessitating long-term follow-up and standardized outcome measures for assessment. Any comparison between the techniques requires comparative studies. Surgeons must weigh the advantages and risks of both open and MIS approaches in collaboration with patients to determine the most suitable treatment.

Tramadol-based multimodal pain protocols after arthroscopic rotator cuff repair are similarly effective as oxycodone-based protocols with fewer morphine milligram equivalents prescribed and lower risk of refills.

Tramadol-based multimodal pain protocols after arthroscopic rotator cuff repair are similarly effective as oxycodone-based protocols with fewer morphine milligram equivalents prescribed and lower risk of refills.

A Prospective Randomized Controlled Study of Ultrasound-Guided Rectus Sheath Block for Pain Management in Laparoscopic Umbilical Hernia Repair with Intraperitoneal Onlay Mesh.

To evaluate the clinical efficacy and safety of ultrasound-guided rectus sheath block (RSB) in laparoscopic umbilical hernia repair with intraperitoneal onlay mesh (IPOM). A total of 139 patients scheduled for laparoscopic umbilical hernia repair with IPOM were selected and randomly assigned to either the group receiving general anesthesia combined with bilateral rectus sheath block (Group GR, 71 patients) or the group receiving general anesthesia alone (Group G, 68 patients). We monitored the patients' heart rate (HR) and mean arterial pressure (MAP) at four time points: before anesthesia induction (T1), at the start of surgery (T2), during mesh fixation (T3), and upon removal of the laryngeal mask (T4). Postoperative pain levels were evaluated using the Visual Analogue Scale (VAS) at 1 hour (T5), 6hours (T6), and 12hours (T7) after surgery while resting, as well as at 24hours (T8) during activity. We also compared the number of times the patient-controlled intravenous analgesia (PCIA) pump was pressed and the use of additional analgesics within 24hours post-surgery, along with recording any adverse reactions and complications associated with RSB. At time points T2 and T3, the HR and MAP in Group GR were significantly lower than those in Group G (P < 0.05). Additionally, VAS scores at various postoperative intervals were lower in Group GR, with significant differences noted at T5, T7, and T8 (P < 0.05). Group GR also had significantly fewer presses on the analgesia pump within 24hours post-surgery compared to Group G, while the incidence of adverse events was similar between the two groups. Ultrasound-guided RSB is a straightforward and safe technique for laparoscopic umbilical hernia repair with IPOM. It offers clear analgesic benefits and significantly reduces early postoperative pain.