Greater Postoperative Pain Research Articles

Preoperative decreased physical activity is associated with greater postoperative pain: the mediating role of preoperative sleep disturbance.

Engagement in physical activity (PA) is often associated with better sleep quality and less pain severity among patients diagnosed with breast cancer. However, less research has focused on whether patients' PA prior to breast surgery, including their perceived decrease in PA level, is associated with worse preoperative sleep quality, and subsequently, greater postoperative pain. This longitudinal study investigated whether patients' preoperative PA was associated with their postoperative pain. We also explored whether preoperative sleep disturbance partially mediated the relationship between preoperative PA and postoperative pain. Prior to breast surgery, patients self-reported both their overall level of PA and whether they perceived a decrease in their PA since the diagnosis/onset of treatment for cancer. Patients also completed a measure of preoperative sleep disturbance. Two weeks after surgery, patients completed a measure of postoperative surgical-area pain severity. Our results showed that preoperatively perceiving a decrease in PA level was significantly associated with greater preoperative sleep disturbance and postoperative pain. A mediation analysis revealed that the association between preoperative decreased PA and postoperative pain was partially mediated by preoperative sleep disturbance. Notably, patients' overall preoperative level of PA was not related to preoperative sleep disturbance or postoperative pain. These findings suggest that maintaining, or even increasing, PA after diagnosis/treatment may be more important than the absolute amount of PA that women engage in during the preoperative period. Potentially, some patients with breast cancer may benefit from a preoperative intervention focused on both maintaining PA and bolstering sleep quality.

Aesthetic Perceptions Regarding a Thyroidectomy Scar and Transvestibular Approach in Brazil.

We investigated motivation levels across the general Brazilian population and subgroups and their willingness to spend for surgery without a cervical scar. This random-sample survey was performed by a specialized third-party research institute. In this study, we created a hypothetical thyroidectomy scenario, and the transcervical and transoral endoscopic thyroidectomy vestibular approach (TOETVA) were used. The survey included sociocultural data and questions regarding participants' surgical preferences. Data were obtained from 1250 participants; 42.4% were of the opinion that a cervical scar affects social or professional life. Young and childless women were most likely to be affected (p <0.001). All respondents accepted the transoral approach to avoid cervical scarring. However, 30.7% and 31.9% of respondents maintained their preference for TOETVA despite understanding the risks of a hypothetical increase in complications and unfavorable oncological outcomes and 98.6% were of the opinion that this approach was likely associated with greater postoperative pain. Only 16.2% were unwilling to spend for TOETVA. The variable that most affected patients' willingness to spend was a salary greater than 10 Brazilian minimum wages (odds ratio 9.797, 95% confidence interval, p <0.005). Upper class respondents were 10 times more likely to spend for TOETVA than lower class patients. This study highlights patients' interest in TOETVA. Cervical scar perception is affected by concerned about appearance, particularly in certain societal subgroups. Our study population showed significant motivation to undergo TOETVA, which was emphasized by their acceptance of the complication rate, poor postoperative outcomes, greater postoperative pain, and willingness to spend on surgery with an invisible scar. 4 Laryngoscope, 134:3862-3867, 2024.

Vaginal Hysterectomy Compared With Laparoscopic Hysterectomy in Benign Gynecologic Conditions

OBJECTIVE: To compare surgical efficacy outcomes and complications after laparoscopic hysterectomy and vaginal hysterectomy performed for benign gynecologic conditions. DATA SOURCES: We performed an online search in major databases, including PubMed, Scopus, Web of Science, ClinicalTrials.gov, and the Cochrane Library from 2000 until February 28, 2023. METHODS OF STUDY SELECTION: We searched for randomized controlled trials (RCTs) that compared vaginal hysterectomy with laparoscopic hysterectomy in benign gynecologic conditions. We located 3,249 articles. After reviewing titles and abstracts, we identified 32 articles that were eligible for full-text screening. We excluded nine articles as not-RCT or not comparing vaginal hysterectomy with laparoscopic hysterectomy. Twenty-three articles were included in the final systematic review, with 22 articles included in the meta-analysis. TABULATION, INTEGRATION, AND RESULTS: Twenty-three eligible RCTs included a total population of 2,408, with 1,105 in the vaginal hysterectomy group and 1,303 in the laparoscopic hysterectomy group. Blood loss and postoperative urinary tract infection rates were lower in the vaginal hysterectomy group than in the laparoscopic hysterectomy group (mean difference −68, 95% CI −104.29 to −31.7, P&lt;.01, I 2=95% and odds ratio 1.73, 95% CI 0.92–3.26, P=.03, I 2=0%, respectively). Vaginal hysterectomy was associated with less total operative time, less recovery time, and greater postoperative pain on the day of surgery. Other complications, including conversion to laparotomy, visceral organ damage, or wound dehiscence, were uncommon. Because of insufficient data, we were not able to stratify by surgical indication. CONCLUSION: Vaginal hysterectomy had a shorter total operative time and recovery time but greater postoperative pain on day of surgery compared with laparoscopic hysterectomy. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42023338538.

The Relationship of Postoperative Pain and Opioid Consumption to Postoperative Delirium After Spine Surgery.

To examine the relationship between postoperative pain and opioid use and the development of postoperative delirium (POD), with attention to the preoperative opioid use status of patients. This was a secondary analysis of data from a prospective observational study of patients (N = 219; ≥70 years old) scheduled to undergo elective spine surgery. Maximal daily pain scores (0-10) and postoperative morphine milligram equivalents per hour (MME/hr) were determined for postoperative days 1-3 (D1-3). POD was assessed by daily in-person interviews using the Confusion Assessment Method and chart review. Patients who reported regular preoperative opioid use (n = 58, 27%) reported significantly greater maximal daily pain scores, despite also requiring greater daily opioids (MME/hr) in the first 3 days after surgery. These patients were also more likely to develop POD. Interestingly, while postoperative pain scores were significantly higher in patients who developed POD, postoperative opioid consumption was not significantly higher in this group. POD was associated with greater postoperative pain, but not with postoperative opioid consumption. While postoperative opioid consumption is often blamed for delirium, these findings suggest that uncontrolled pain may actually be a more important factor, particularly among patients who are opioid tolerant. These findings underscore the importance of employing multimodal perioperative analgesic management, especially among older patients who have a predilection to developing POD and baseline tolerance to opioids.

Dependent factors in the adult patient and their relationship with post-tonsillectomy bleeding and pain in an outpatient setting

Introduction and objectiveTonsillectomy performed on an outpatient basis in adult patients presents bleeding and pain as main postoperative complications.Following rules such as cold surgical technique, analgesic protocols, preoperative interview, and postoperative follow-up help to better control the process. However, there are patient-dependent factors such as sex, age, indication for tonsillectomy and the time elapsed between the last tonsil infection and surgical intervention that can influence postoperative complications and should be considered.The objective of this work is to evaluate the influence of age, sex, the indication for tonsillectomy and the period elapsed between the last tonsil infection and surgery on bleeding and pain control. MethodsA prospective, descriptive, and observational study was carried out in 96 adult patients who underwent outpatient surgery under general anaesthesia, using cold surgical technique, evaluating these complications based on age, sex, indication for tonsillectomy and time elapsed after the last tonsillitis. ResultsThe patients operated on during the 4 weeks after an episode of tonsillitis presented more postoperative pain. No relationship was found between this period and postoperative bleeding. ConclusionsMale patients had a higher incidence of bleeding than women.The period elapsed between the last tonsil infection and the surgical procedure was associated with greater postoperative pain, but not with greater postoperative bleeding.

The impact of postoperative pain and pain management following sacrospinous ligament fixation on trial of void failure

Postoperative urinary retention (POUR) and the need to be discharged with a urinary catheter after trial of void (TOV) failure are significant sources of distress for patients. These patients may also be at higher risk of postoperative urinary tract infections. Concomitant midurethral sling, anterior repair, and intraoperative blood loss have been shown to increase the risk of TOV failure following surgery for pelvic organ prolapse. Postoperative pain has not been previously investigated as it relates to TOV failure. This study assessed whether pain and pain management affected TOV failure in patients who underwent sacrospinous ligament fixation (SSLF). We hypothesized that patients with greater postoperative pain are more likely to have POUR. This was a retrospective cohort study of patients who underwent SSLF from January 2014 to September 2021 at five hospitals within a health system. Patients were identified using CPT code 57282. They were included if they were over the age of 18 and underwent SSLF; and were excluded if they did not undergo a trial of void on postoperative day 1 and did not have pain scores or pain medications recorded electronically. Demographics and intraoperative characteristics were collected based on previous studies. Our primary outcome was the impact of mean and highest verbal pain score on TOV failure. Secondary outcomes were the impact of oral morphine equivalents, acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) per hour, time from last pain medication, and whether pain medication was scheduled on TOV failure. Statistical significance was set at a p-value of 0.05. Statistical analyses were completed using Mann-Whitney U and Fisher’s Exact tests. Two hundred and eighteen (218) patients were identified. Of those, 29 were duplicates and 47 met exclusion criteria. One hundred and forty-two (142) patients were included in the analysis, of which 26.8% failed TOV on postoperative day 1. Age and concomitant hysterectomy were associated with TOV failure (p=0.05 and p=0.003). Other demographic and intraoperative factors were not significantly different. Mean and highest verbal pain scores were not significantly different (mean: 3.00 vs. 2.70, p=0.24; highest: 6.00 vs. 6.00, p=0.36). NSAID use per hour was higher in patients who passed their TOV (60.15 vs. 0.0, p=0.03), and patients whose NSAIDs were scheduled were more likely to pass their TOV versus those whose NSAIDs were given as needed or were not given at all (p=0.02). All other secondary outcomes were not significantly different. In patients who underwent SSLF, there was no difference in pain scores between the two groups. Scheduled NSAID administration and NSAIDs consumed per hour postoperatively were significantly associated with higher TOV pass rates. This suggests that the anti-inflammatory properties of NSAIDs may help decrease POUR.

Near-Infrared Imaging With Indocyanine Green for the Treatment of Endometriosis: Results From the Gre-Endo Trial.

IntroductionA current challenge for endometriosis surgery is to correctly identify the localizations of disease, especially when small or hidden (occult endometriosis), and to exactly define their real extension. The use of near-infrared radiation imaging (NIR) after injection of indocyanine green (ICG) represents one of the most encouraging method. The aim of this study is to assess the diagnostic value of NIR-ICG imaging in the surgical treatment of endometriosis compared with the standard of treatment.Material and MethodsThe Gre-Endo trial is a prospective, single-arm study (NCT03332004). After exploring the operatory field using the white light (WL) mode, patients were injected with ICG and then observed in NIR mode. All suspected areas were classified and chronicled according to lesions visualized only in WL, NIR-ICG, or in the combination of both. Lesion not visualized in WL was considered as suspect occult lesion (s-OcL). In addition, a random control biopsy from an apparent negative peritoneum visualized in WL and NIR-ICG imaging was taken for all patients (control cases). All lesions removed were considered “suspect endometriosis” until pathology.ResultsFifty-one patients were enrolled between January 2016 and October 2019. A total of 240 suspected lesions have been identified with both methods (WL + NIR-ICG). Two hundred and seven (86.2%) lesions out of the overall 240 were visualized with WL imaging, and 200 were confirmed to be pathologic (true positive for WL). The remaining 33/240 (13.75%) (false negative for WL) lesions were identified only with NIR-ICG imaging and collected as s-OcL. All 33 s-OcLs removed were confirmed to be pathologic (c-OcL = 100%). NIR-ICG vision showed PPV of 98.5%, NPV of 87.1%, Se of 87%, and Sp of 98.5%, confirming that this kind of imaging is an excellent diagnostic and screening test (p = 0.001 and p = 0.835, according to McNemar’s and Cohen’s kappa tests, respectively).ConclusionsThe use of NIR-ICG vision alone and combined with WL showed good results in intraoperative detection rate and fluorescence-guided surgery of endometriosis. Furthermore, NIR-ICG allowed surgeons to remove occult lesions that otherwise would remain, leading to possible greater postoperative pain and a higher risk of persistence and relapse.

Preoperative Anxiety and Postoperative Pain in Patients With Laparoscopic Hysterectomy.

Objective: This study was designed to investigate preoperative anxiety situations and postoperative pain degree in Chinese patients undergoing laparoscopic hysterectomy and to analyze the related factors of preoperative anxiety and the correlation between preoperative anxiety and postoperative pain to provide a reference for effective postoperative analgesia management.Methods: A total of 100 female patients undergoing laparoscopic hysterectomy were enrolled in this study and randomly divided into two groups (n = 50, each). In group A, the patients were treated with dexmedetomidine and sufentanil for postoperative analgesia. In group B, the patients were treated with sufentanil alone for postoperative analgesia. All patients were evaluated with a self-rating anxiety scale (SAS) 1 day before the operation. The patients’ pain was evaluated using the numerical rating scale (NRS) 1 day after the operation, and data were recorded.Results: In these 100 patients, the highest preoperative SAS score was 48, and the average score was 40.99 ± 4.55 points, which is higher than the norm in China. There were significant differences in preoperative SAS scores among patients with different occupations and previous surgical experience (P < 0.05). There was no significant difference in SAS scores among patients with different education levels (P > 0.05). The postoperative NRS score of group A was significantly higher than that of group B, and the difference was statistically significant (P < 0.05). The correlation coefficients between SAS scores and NRS scores in groups A and B were 0.836 and 0.870, respectively, presenting with a significantly positive correlation.Conclusion: Preoperative anxiety is an important predictor of postoperative pain. Patients undergoing laparoscopic hysterectomy have preoperative anxiety. The degree of anxiety is influenced by the occupation and previous operation experience of the patients, and patients with higher preoperative anxiety have greater postoperative pain. In addition, we should not neglect the management of postoperative pain because of the small trauma of laparoscopic surgery, and dexmedetomidine combined with sufentanil can improve the postoperative analgesic effect.

Postoperative Pain After Different Root Canal Irrigant Activation Postoperative Pain After Different Root Canal Irrigant Activation Methods; (Randomized Clinical Trial) Methods; (Randomized Clinical Trial)

Objective: This study was designated to evaluate postoperative pain in irreversible symptomatic teeth after different irrigation activation methods using visual analogue scale. Materials and Methods:78 Patients having symptomatic irreversible pulpitis in mandibular first molar (vital pulp) with no periapical involvement were involved in the study. Cases were classified into three groups according to the the final irrigation agitation method used, twenty-six patients each group (n=26). Group A: Root canals were irrigated using NaOCl2* 2.6% with NaviTip (31-gauge 27mm) with double side port irrigator tip (SVN). Group B: Root canals were irrigated using 2.6% NaOCl with manual dynamic agitation using master cone for 60 seconds. Group C: Root canals were irrigated using 2.6% NaOCl with mechanical agitation using ultrasonic device ultra-x for 60 seconds. Postoperative pain was evaluated after 6,12,24, 48, and 72 hours and 1 week. Data were explored for normality using Kolmogorov-Smirnov and Shapiro-Wilk tests and showed parametric (normal) distribution. Statistical analysis was performed with IBM® SPSS® Statistics Version 20 for Windows. Results: Severity of postoperative pain was more intense at 6- 12and 24-hour time intervals in group 2 patients than those patients in groups 1and 3 (P &lt; .05). There was no significant difference among the groups at the other time intervals (P &gt; .05). Severity of postoperative pain in all groups decreased over time. Conclusion: After endodontic therapy in lower molars with acute pulpitis manual dynamic agitation caused greater postoperative pain in comparison with the other methods in the first 24 hours.

CHRONIC POSTOPERATIVE PAIN AFTER ANTERIOR INGUINAL HERNIA REPAIR

Abstract INTRODUCTION Chronic postoperative pain after inguinal hernia repair is one of the most prevalent sequel after inguinal hernioplasty. MATERIAL AND METHODS A retrospective descriptive study was done, studying 414 patients who underwent programmed anterior inguinal hernioplasty in our centre between 01/01/18 and 12/31/19. Laterality, the type of mesh used and fixation method are studied, as well as the appearance of early postoperative pain, at one month and after the third month. P &amp;lt; 0.05 is considered a statistically significant value. RESULTS Of 414 patients, 90.6% were male, with a mean age of 65.5 years. In 89.1% the surgery was unilateral and 8.7% was hernia recurrence. 46.1% presented pre-surgical pain. 10.4% presented pain in the first check-up and 1.9% chronic pain. In 81.4%, flat mesh was placed, fixing it with suture in 83.6%. Greater pain was observed in the first review in patients operated on for bilateral hernia (22%, p 0.006). No differences were found regarding age, sex or recurrent hernias. In bilateral hernias, recurrent hernias and hernioplasty with plug, more postoperative complications were observed with a p &amp;lt; 0.05. In those patients who present complications, postoperative pain was observed in the first review in 16% (p &amp;lt; 0,05). CONCLUSIONS Patients who underwent bilateral hernioplasty present more complications and greater postoperative pain in the first revision, but not after the third postoperative month. No differences were observed in chronic pain in primary vs recurrent hernias. Post-surgical complications are related to greater initial postoperative pain but not to chronic pain.

Effect of manual versus mechanical irrigation agitation protocols on postoperative pain in patients with irreversible pulpitis and symptomatic apical periodontitis

Aim This study was intended to compare syringe irrigation versus two irrigation agitation protocols [manual dynamic agitation (MDA) and passive ultrasonic irrigation] regarding postoperative pain (PP) after chemo-mechanical preparation of mandibular first molars with irreversible pulpitis and symptomatic apical periodontitis using numerical rating scale. Participants and methods Ninety patients with mandibular first molars diagnosed as symptomatic irreversible pulpitis with apical periodontitis were included in this study. Teeth were classified into three groups (n = 30) according to the final irrigation agitation protocol used. Root canals were irrigated using 5.25% sodium hypochlorite using the following protocols; group A: NaviTip (31-G 27 mm) with double side-port irrigator tip (side vented needle). Group B: MDA with well fitted master cone. Group C: ultrasonic activation using Endo ultra. PP was evaluated after 6, 12, 24, 48, and 72 h and 1 week. Level of confidence at 95% was used for statistical significance. Results Severity of PP was significantly more intense at 6–12 and 24-h time intervals in group B patients than groups A and C (P 0.05). Conclusion After chemo-mechanical preparation in mandibular first molars with symptomatic irreversible pulpitis and apical periodontitis, MDA caused greater PP in comparison with the other irrigation agitation protocols in the first 24 h. Severity of PP in all groups decreased over time.

Prevalence of Preoperative Anxiety and Its Relationship with Postoperative Pain in Foot Nail Surgery: A Cross-Sectional Study.

Preoperative anxiety has been studied in different medical disciplines, but it is unknown in minor surgical procedures such as foot nail surgery. This study aimed to determine the prevalence of preoperative anxiety and postoperative pain in foot nail surgery. The validated Amsterdam preoperative anxiety and information scale (APAIS) was used to evaluate preoperative anxiety and the need for information in 155 patients undergoing foot nail surgery. In addition, a questionnaire was used to collect other variables such as age, sex and educational level. The verbal numeric scale was employed to value the postoperative pain after 24 h. Age and sex influenced (p < 0.05) preoperative anxiety, which had a prevalence of 22.6%. More than 43% of patients needed more information and this was correlated with anxiety (r = 0.629; p < 0.001). There was a significant difference when comparing the total anxiety between the group of participants who had more pain and that who had less pain (p < 0.001). The prevalence of anxiety was high in the participants of this study, being greater in young patients and in women. There was a deficit of information, increasing the level of preoperative anxiety, which in turn was related with greater postoperative pain.

Impact of Patient Choice for Different Postcesarean Delivery Analgesic Protocols on Opioid Consumption: A Randomized Prospective Clinical Trial

(Reg Anesth Pain Med. 2019;44:578–585) Pain management after cesarean delivery is typically selected by the physician without patient input. Shared decision-making between provider and patient may improve patient care. A recent study showed patients who requested a higher intrathecal morphine dose for cesarean delivery had increased opioid requirements and greater postoperative pain, regardless of the actual dose administered. This study aimed to determine whether postoperative oxycodone requirements and pain scores could be reduced and satisfaction increased when patients were given a choice for their postcesarean delivery analgesic protocol.

The identification of risk factors for increased postoperative pain following minimally invasive transforaminal lumbar interbody fusion.

To evaluate specific demographic and perioperative variables associated with higher inpatient pain scores following minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). Patients who underwent a single-level, primary MIS TLIF were retrospectively reviewed. Perioperative outcomes were collected, and postoperative inpatient VAS pain scores were measured. Both bivariate and stepwise multivariate Poisson regressions with robust error variance were used to assess risk factors for average inpatient pain score ≥ 5.0. A final backward stepwise regression model was created using age, gender, smoking status, diabetes status, insurance status, BMI, comorbidity burden, pedicle screw laterality, operative time, and estimated blood loss. A total of 255 patients undergoing primary, single-level MIS TLIF were included. Age less than 50years, workers' compensation insurance, preoperative VAS pain score ≥ 7, and operative duration ≥ 110min were associated with greater postoperative pain. However, other variables such as gender, BMI, smoking status, comorbidity burden, diabetes status, and pedicle screw laterality were not associated with increased postoperative pain. The results of this study suggest that younger age, workers' compensation, elevated preoperative pain scores, and longer operative times are independently associated with greater inpatient pain following TLIF. Surgeons can use this information to better assess which patients may require additional pain control following TLIF. Patient expectations of postoperative outcomes in regard to pain and recovery may also be better managed. These slides can be retrieved under Electronic Supplementary Material. (paragraph). Then process the ppt slide as graphical image.

Should compression bandage be performed after total knee arthroplasty? A meta-analysis of randomized controlled trials

BackgroundCompression bandage often is used after total knee arthroplasty (TKA) to alleviate pain, ameliorate swelling, and reduce bleeding. However, there is controversy about its application due to conflicting clinical outcomes and potential compression-related complications. This meta-analysis aimed to answer the question of if compression bandage should be implemented routinely after TKA.MethodsRelevant randomized controlled trials (RCTs) on compression bandage were comprehensively retrieved utilizing search engines such as PubMed, EMBASE, Web of Science, and the Cochrane Library, up to September 2019. Studies included in the meta-analysis were those that compared post-operative pain score, swelling, total blood loss, pre- and post-operative hematocrit levels differences, range of motion (ROM), and complications, using Review Manager 5.3.0.ResultsIncluded were seven RCTs, which reported on 511 knees. The pooled results showed the compression bandage group was associated with a greater post-operative pain score during ambulation at 48 h (WMD = 0.70, 95% CI 0.07 to 1.34, P = 0.03), compared with the non-compression bandage group. No statistically significant differences were found between the groups in post-operative pain scores at the other times, swelling, blood loss, ROM, or other complications (P > 0.05).ConclusionsThe current evidence is unable to conclude that compression bandage is necessary after primary TKA. Surgeons routinely undertaking compression bandage should deliberate whether there is enough clinical evidence.

Usefulness of Abdominal Drain in Laparoscopic Roux-en-Y Gastric Bypass: A Randomized Controlled Trial

Background: Laparoscopic Roux-en-Y gastric bypass (RYGB) is one of the most common procedures to treat morbid obesity. Abdominal drains are often placed during the operation to detect complications earlier. The aim of this study was to assess the benefit of routine drain placement during laparoscopic RYGB. Materials and Methods: A consecutive series of patients undergoing laparoscopic RYGB between 2017 and 2018 was analyzed. The sample was randomized before the procedure into two groups: with abdominal drain (G1) and without abdominal drain placement (G2). Patients with intraoperative complications were excluded from the randomization. Postoperative complications and pain (visual analogue scale) were compared between groups. Results: A total of 84 patients were included; 45 belonged to G1 and 39 to G2. Mean age (G1 44 years versus G2 48 years) and body mass index (G1 43 kg/m2 versus G2 44 kg/m2) were similar in both groups. There were no significant differences between groups in preoperative comorbidities. Mean operative time was 92 minutes in both groups. Mean pain score at postoperative day 0 was similar in both groups (G1 3.2 versus G2 3.5, P = .58), but was higher in G1 at postoperative day 1 (G1 3.1, G2 1.1, P = .02). Postoperative Clavien-Dindo I-II complications were similar in both groups (G1 9% versus G2 1%, P = .37). No major complications, reoperations, or 30-day mortality occurred in the entire cohort. Conclusions: Drain placement in laparoscopic RYGB was associated with greater postoperative pain and did not show benefits in early detection of postoperative complications. Routine placement of abdominal drain in laparoscopic RYGB might not be recommended.

Association of Body Mass Index and Serum Markers of Tissue Damage with Postoperative Pain. The Role of Lactate Dehydrogenase for Postoperative Pain Prediction.

i) To analyze the association of body mass index (BMI) and some serum tissue damage markers with postoperative pain. ii) To establish a biochemical marker cutoff point able to predict moderate to severe postoperative pain. Cross-sectional study. Ninety-six adult male patients from Southern Spain (55 ± 13 years old) who underwent an inguinal hernioplasty. Postoperative pain (eight hours after surgery) was assessed through a visual analog scale (VAS). Moderate to severe pain was defined as a VAS > 50 mm. BMI was calculated and medication, alcohol consumption, and smoking habit registered. Eight hours after surgery, some serum markers such as fibrinogen, lactate dehydrogenase (LDH), C-reactive protein, cortisol, creatine kinase, glutamic-pyruvic, glutamic oxaloacetic, and gamma-glutamyltransferase transaminases were determined by standard procedures. After adjusting for potential confounders, BMI was not associated with postoperative pain (P > 0.05). Serum fibrinogen was associated with greater postoperative pain (β = 0.333, P < 0.05). Serum LDH concentration was strongly associated with greater postoperative pain (β = 0.606, P < 0.001). Alcohol consumption was associated with higher postoperative pain (β = 0.212, P < 0.05). No associations were observed regarding age, tobacco consumption, and the rest of serum markers studied. Serum LDH concentration was able to discriminate between presence/absence of moderate to severe postoperative pain (receiver operating characteristic area under the curve = 0.655, P ≤ 0.01). An LDH concentration >204 IU/L was associated with a three-times increased odds ratio of moderate to severe postoperative pain. Contrary to expectations, greater BMI was not associated with higher postoperative pain. Notwithstanding, the assessment of serum LDH might provide useful information to predict moderate to severe postoperative pain.

Robotic-assisted ventral hernia repair with surgical mesh: how I do it and case series of early experience.

Laparoscopic ventral hernia repair provides several benefits over the open approach. Intraperitoneal surgical mesh placement without fascial defect closure is associated with increased seroma formation and other adverse hernia-site outcomes. Transfascial sutures and tacs for fascial closure and surgical mesh fixation are associated with greater post-operative pain. Robotic-assisted ventral hernia repair (rVHR) may afford benefits of the laparoscopic approach while facilitating a more robust and less painful repair. Consecutive patients managed by rVHR from May 2015 to August 2018 were identified from a prospectively maintained robotic database. Retrospective review of this data was performed. Fifty patients underwent rVHR during the study period. Median body mass index was 31 (interquartile range (IQR) 29-34). Forty-eight had previous abdominal surgery. Forty-seven hernias were midline and three were lateral. Regarding hernia width, 15 were <4 cm wide, 32 were 4-10 cm and three were >10 cm. Median total anaesthetic time, docking time and surgical console time were 214 min (IQR 182-252), 5 min (IQR 4-8) and 144 min (IQR 104-174), respectively. No major intra-operative complications occurred. No documented cases of adhesional complications or chronic post-operative pain have occurred. To date, two recurrences have occurred in our series. Median length of hospital stay was 3 days (IQR 2-4). We describe our rVHR technique and report on our series and early experience, showing that rVHR can be performed safely with good patient outcomes. We demonstrate a team approach to achieving a safe transition to new technology.

The Effect of Different Irrigation Agitation Techniques on Postoperative Pain in Mandibular Molar Teeth with Symptomatic Irreversible Pulpitis: A Randomized Clinical Trial

IntroductionThis study compared the effect of several final irrigation agitation techniques (sonic agitation, passive ultrasonic irrigation, and manual dynamic agitation [MDA]) in comparison with needle irrigation on postoperative pain in mandibular molar teeth with symptomatic irreversible pulpitis. MethodsOne hundred sixty-eight patients with a single tooth diagnosed as symptomatic irreversible pulpitis were selected. Teeth were randomly assigned to 4 groups based on the final irrigation methods. In group 1 (needle irrigation), irrigation was conducted without agitation with a side-port needle; in group 2, sonic agitation was used; in group 3, passive ultrasonic irrigation was used; and in group 4, MDA was used. Teeth were then obturated with gutta-percha and a resin-based sealer using the cold lateral compaction technique. The presence of postoperative pain was assessed after 6, 24, 48, and 72 hours and 1 week. ResultsAt the 6- and 24-hour time intervals, group 4 patients reported more intense postoperative pain than those patients in groups 1, 2, and 3 (P < .05). There was no significant difference among the groups at the other time intervals (P > .05), and in all groups the intensity of postoperative pain decreased over time. ConclusionsMDA caused greater postoperative pain after endodontic therapy in mandibular molar teeth with symptomatic irreversible pulpitis compared with the other methods in the first 24 hours.

Recovery characteristics of total intravenous anesthesia with propofol versus sevoflurane anesthesia: a prospective randomized clinical trial.

BackgroundPediatric dental procedures are performed under anesthesia because children may be uncooperative in the dental clinic due to their young age. Emergence delirium (ED), which involves a variety of behavioral disturbances that are frequently observed in children following emergence from general anesthesia, remains an unclear phenomenon. The aim of this randomized controlled trial is to compare the incidence of ED in children who underwent full mouth dental rehabilitation under either sevoflurane (SEVO) anesthesia or propofol-based total intravenous anesthesia (TIVA).Patients and methodsOne hundred and twenty children with American Society of Anesthesiologists status I–II, aged ≥3 and ≤6 years, undergoing dental rehabilitation were assigned to receive either TIVA or SEVO. ED and postoperative pain were evaluated by a blinded investigator using the Pediatric Anesthesia Emergence Delirium scale and the Face, Legs, Activity, Cry, Consolability scale every 5 min. The recovery time, satisfaction levels of parents or guardians, extubation time, duration of the operation, and type of dental procedure were also recorded.ResultsData of 116 subjects were analyzed. The incidence of ED was higher after SEVO than after TIVA (65.5 vs 3.4%, P=0.00). Greater postoperative pain was observed in the SEVO group (median 3 vs 1, P=0.000). A statistically significant, moderate correlation (rs=0.46, P<0.0001) was found between the Face, Legs, Activity, Cry, Consolability and Pediatric Anesthesia Emergence Delirium scores. A higher parental satisfaction level was observed in the TIVA group.ConclusionA lower incidence of ED and a higher parental satisfaction level were observed after TIVA. Moreover, TIVA resulted in a more comfortable postoperative period due to reduced postoperative pain, and the extubation time and recovery time were not increased.