Postoperative Pain Management Research Articles

238 - Preventive analgesia in postoperative pain management following transvaginal pelvic reconstructive surgeries: A systematic review and Bayesian meta-analysis

238 - Preventive analgesia in postoperative pain management following transvaginal pelvic reconstructive surgeries: A systematic review and Bayesian meta-analysis

Periarticular Injection With or Without Adductor Canal Block for Pain Control Following Total Knee Arthroplasty

Periarticular injections (PAIs) have become a critical part of multimodal anesthetic regimens for total knee arthroplasty (TKA). This study assessed the effect of adductor canal blocks (ACBs) alone, periarticular injections (PAIs) alone, and the combination of both ACBs and PAIs on postoperative pain management in patients undergoing primary TKA. We hypothesized that there would be no significant difference in postoperative outcomes, including pain scores and narcotic use. Patients who underwent primary TKA were retrospectively identified from February 2022 to February 2023. Patients were stratified based on perioperative local/regional anesthetic regimen (PAI only, PAI with an ACB, and ACB only) and matched in a 1:1:1 ratio. Patients were propensity score matched based on age, American Society of Anesthesiologists (ASA) score, body mass index (BMI), and preoperative narcotic usage. Patient demographics, as well as intra- and postoperative variables including narcotic refills, postoperative morphine requirements, pain scores, and readmissions, were compared. After successful matching, there were 40 patients in each cohort. First post-anesthesia care unit (PACU) visual analog pain scale (VAS) scores after surgery were not significantly different across all groups (P = 0.082). Pair-wise comparisons of patients receiving either PAI alone or ACB alone showed that patients receiving PAIs had lower narcotic usage at six hours (P = 0.037). A PAI alone also demonstrated a shorter length of stay compared to ACB alone (P = 0.001). Postoperative narcotics refills were similar between ACB only and PAI only (P = 0.056); however, PAI with an ACB had lower postoperative narcotic refills (P = 0.017). The rate of same-day physical therapy (PT) clearance was lowest in the ACB only group (37.5% [15 of 40]) (P = 0.002). As hypothesized, there was no difference in pain scores immediately after surgery; however, postoperative morphine requirements at six hours, same-day physical therapy clearance, and length of stay were better in the PAI group. The use of PAIs may confer a benefit for both patients and healthcare systems as an adjunct to perioperative pain control.

Efficacy of dexmedetomidine as an adjuvant in transverse abdominal plane blocks for cesarean section pain management: A systematic review and meta-analysis

Postoperative pain management is a key component of care for women undergoing cesarean section. Although the use of dexmedetomidine (DMD) as an adjuvant to local anesthetics in transverse abdominal plane (TAP) blocks has been investigated, its conclusive evidence on its efficacy and safety remains unclear. A standardized data extraction form, under the guidance of the PRISMA protocol, was devised for selecting relevant studies across eight databases, without restrictions on the publication period. In most of the eight studies reviewed, the group receiving DMD demonstrated a significant extension of the duration of analgesia compared to the control group [mean difference (MD) = -3.37 hours, 95% confidence interval (CI) = -6.10 to -0.65 hours, Z = 2.43, P = 0.02]. The DMD group also showed a significant decrease in Visual Analogue Scale pain scores (MD = -1.38, 95% CI = -2.52 to -0.24, Z = 2.37, P = 0.02) in comparison to the control group. Nevertheless, significant heterogeneity was observed across the studies, potentially due to differences in study design, patient demographics, and dosing protocols, among other factors. The results of this meta-analysis indicate that DMD could be an effective adjuvant to local anesthetics in TAP blocks, potentially improving postoperative pain management and decreasing the need for additional analgesia. Nevertheless, the considerable heterogeneity among the studies warrants cautious interpretation of these results.

Intravenous Lidocaine Compared with Quadratus Lumborum Block on Postoperative Analgesia Following Laparoscopic Renal Surgery: Protocol for a Randomized Noninferiority Trial.

Patients undergoing laparoscopic renal surgery often experience significant postoperative pain. Quadratus lumborum block (QLB) provides effective postoperative pain control after laparoscopic procedures, while lidocaine administered intravenously also exerts analgesic effects for surgical patients. We design this trial to compare the effects of i.v. lidocaine infusion with QLB on postoperative analgesia in patients undergoing laparoscopic renal surgery. In this randomized noninferiority trial, a total of 120 adult patients undergoing laparoscopic renal surgery will be randomized to receive either i.v. lidocaine or unilateral QLB for postoperative pain management. Lidocaine will be i.v. administered at 1.5 mg/kg (ideal body weight) over 10min during anesthesia induction, followed by an infusion of 1.5 mg/kg/h intraoperatively and in a post-anesthesia care unit. Ultrasound-guided anterior QLB with 0.375% ropivacaine 30 mL will be conducted before the start of surgery. Patient-controlled i.v. sufentanil will be used for pain relief during the first 48h after surgery. The primary outcome is the cumulative sufentanil consumption during 0-24h postoperatively, with a noninferiority margin of 5μg. Secondary outcomes include pain intensity at rest and on coughing at 1, 6, 24, and 48h postoperatively; sufentanil consumption within 24-48h after surgery; rescue analgesic use within 0-48h after surgery; nausea and vomiting within 0-48h postoperatively; and quality of recovery at 24 and 48h after surgery. The results of this trial will add to the clinical evidence for improving postoperative pain management in patients who undergo laparoscopic renal surgery. Chinese Clinical Trial Registry (ChiCTR2400082974).

Practice Advisory for Postoperative Pain Management of Cardiac Surgical Patients: Executive Summary: A Report by Society of Cardiovascular Anesthesiologists

Practice Advisory for Postoperative Pain Management of Cardiac Surgical Patients: Executive Summary: A Report by Society of Cardiovascular Anesthesiologists

Magnesium sulfate as an adjuvant in serratus anterior plane block for postoperative pain management in modified radical mastectomy: A randomized controlled trial

Magnesium sulfate as an adjuvant in serratus anterior plane block for postoperative pain management in modified radical mastectomy: A randomized controlled trial

Practice Advisory for Postoperative Pain Management of Cardiac Surgical Patients - A Report by Society of Cardiovascular Anesthesiologists

Practice Advisory for Postoperative Pain Management of Cardiac Surgical Patients - A Report by Society of Cardiovascular Anesthesiologists

Perioperative Quality Improvement in Children's Hospitals Neonatal Consortium NICUs.

Infants admitted to NICUs in children's hospitals represent a different population than those in a traditional birth hospital. The patients in a children's hospital NICU often have the most complex neonatal diagnoses and are cared for by various subspecialists. The Children's Hospitals Neonatal Consortium is a collaborative of more than 40 NICUs that collect data and perform quality improvement (QI) work across the United States and Canada. The collaborative's database provides an opportunity to benchmark clinical outcomes for this specialized population and to support the QI efforts. In this review, we summarize the success of individual collaborative QI projects focused on improving the care of the neonate in the perioperative period related to clinical team handoffs, postoperative hypothermia prevention, and improvement of postoperative pain management. The collaborative's experience can serve as a model for other national collaboratives seeking to support QI efforts.

Dexmedetomidine versus dexamethasone as an adjuvant in erector spinae plane block for postoperative pain management in open nephrectomy: A randomized controlled trial

Dexmedetomidine versus dexamethasone as an adjuvant in erector spinae plane block for postoperative pain management in open nephrectomy: A randomized controlled trial

Efficacy of epidural anesthesia in minimally invasive cardiac surgery

Introduction: The most commonly performed minimally invasive cardiac surgery (MICS) is lateral minithoracotomy, which requires one of the most painful incisions. Adequate postoperative pain management is essential for cardiac surgery to prevent perioperative complications. Thoracic epidural analgesia (TEA) is the gold standard for thoracotomy; however, it is still controversial because of the risk of epidural hematoma following systematic heparinization. The objective of our study was to investigate the safety and efficacy of TEA following MICS. Methods: The clinical data of patients aged over 18 years who underwent elective MICS and received epidural analgesia along with general anesthesia between January 2014 and March 2019 were reviewed. Data were collected, including patient demographics, operative data, postoperative pain, postoperative course, and complications. Chronic pain was evaluated 6 months after discharge, and we defined it as a NRS score ≧3. Postoperative complications included epidural-related complications. Results: Seventy patients were included in the analysis. The mean NRS score was below 2. We collected chronic pain data from 52 patients and found that 11 patients had chronic pain. TEA-related complications were not observed. Conclusion: The current observational study revealed that TEA following lateral thoracotomy was effective for acute pain as well as chronic pain without causing any severe epidural-related complications. Protocols to prevent potential devastating complications, including epidural hematoma, should follow the American Society of Regional Anesthesia and Pain Medicine recommendation. If the rules are strictly followed, TEA can be a safe and effective pain management method for patients who undergo MICS.

Prevalence and risk factors for postpartum depression two months after cesarean delivery: a prospective multicenter study

BackgroundThe prevalence and risk factors of postpartum depression after cesarean delivery remain unclear. ObjectiveTo assess the prevalence of postpartum depression and its risk factors 2 months after cesarean delivery. MethodsProspective ancillary cohort study of the Tranexamic Acid for Preventing Postpartum Hemorrhage after Cesarean Delivery (TRAAP2) trial, conducted in 27 French hospitals in 2018-2020 and enrolling women undergoing cesarean delivery before or during labor at 34 or more weeks of gestation. After randomization, characteristics of the cesarean delivery, postpartum blood loss, and immediate postpartum period, including memories of delivery and postoperative pain, were prospectively collected. Women's characteristics, particularly any psychiatric history, were collected from medical records. Two months after childbirth, a postpartum depression provisional diagnosis was defined as a score of 13 or higher on the Edinburgh Postnatal Depression Scale, a validated self-administered questionnaire. The corrected prevalence of postpartum depression was calculated with the inverse probability weighting method to take nonrespondents into account. Multivariate logistic regression analyzed associations between potential risk factors and postpartum depression. A sensitivity analysis used an EPDS cutoff value of 11 or higher. ResultsThe questionnaire was returned by 2793/4431 women (63.0% response rate). The corrected prevalence of postpartum depression provisional diagnosis was 16.4% (95% confidence interval (CI), 14.9-18.0%) with an EPDS score of 13 or higher and 23.1% (95%CI, 21.4-24.9%) with a cutoff value of 11 or higher. Characteristics associated with a higher risk of postpartum depression were pre-pregnancy characteristics such as young age (aOR 0.83, 95%CI 0.74-0.93 for each 5-year increase in maternal age) and non-European country of birth (aOR 2.58, 95%CI 1.85-3.59 for North Africa; aOR 1.57, 95%CI 1.09-2.26 for Sub-Saharan Africa and aOR 1.99, 95%CI 1.28-3.10 for other country of birth; reference: Europe) and some aspects of the cesarean delivery, notably its timing and context, emergency before labor (aOR 1.70, 95%CI 1.15-2.50; reference: before labor without emergency) and during labor after induction of labor (aOR 1.36, 95%CI 1.03-1.84; reference: before labor without emergency). Also at higher risk were women reporting high intensity pain during the postpartum stay (aOR 1.73, 95%CI 1.32-2.26) and bad memories of delivery on day 2 postpartum (aOR 1.67, 95%CI 1.14-2.45). Conversely, women who had social support in the operating room had a lower risk of postpartum depression (aOR 0.73, 95%CI 0.53-0.97). ConclusionAround one woman in six had postpartum depression symptoms 2 months after cesarean delivery. Some cesarean-related obstetric factors may increase this risk: cesareans before labor for emergency situations or during labor after medically indicated induction of labor, severe postoperative pain and bad memories of delivery before discharge. Specific subgroups of at-risk women could benefit from early screening or intervention to reduce the onset of postpartum depression. Perinatal professionals should pay particular attention to postoperative pain management.

Comparison Between Ketamine and Dexmedetomidine in Achieving Opioid Sparing Sedoanalgesia in Patients Following Open Heart Surgery: A Randomized Clinical Trial

Background: Opioid-sparing sedoanalgesia relies on non-opioid multimodal analgesic and sedative agents. It is being developed to decrease or eliminate opioid use for the management of acute postoperative pain to avoid opioid complications. This study aimed to compare ketamine and dexmedetomidine for their efficiency and safety in inducing opioid-sparing sedoanalgesia in patients following open heart surgery. Methods: Ninety adult cardiac patients who underwent open heart surgery were enrolled. They were randomly divided into three groups. Group D received a dexmedetomidine infusion of 0.1– 0.2 μg/kg/hour, group K received a ketamine infusion of 1–2 μg/kg/min while group C received a placebo as a control group. Drugs were given after the operation in the surgical intensive care unit. Total postoperative opioid consumption was the primary outcome. Richmond agitation sedation scale, visual analog pain scale, time to first analgesic request, patient satisfaction, and incidence of any complications were recorded. Results: In this study, we found that the median (interquartile range) postoperative opioid consumption was significantly lower in groups D and K than in group C (156 (40), 140 (83), 185 (110); p < 0.001). Richmond agitation sedation scale was statistically significant until 6 hours postoperative (p-value: < 0.05). Patient satisfaction score was higher in groups D and K than in group C (p-value: 0.005). On the other side, there is no statistically significant difference between the three study groups regarding time to first analgesic request (minutes) (p-value: 0.064) or visual analog pain scale (p-value: > 0.05). Incidence of complications was highly significant between the study groups (p-value: < 0.001). Conclusions: To decrease postoperative opioid use with their multiple side effects and improve patient satisfaction scores in patients undergoing open heart surgery under general anesthesia, the use of either ketamine or dexmedetomidine is recommended in the postoperative period as an adjuvant modality and a good idea with observation of possibility of some preventable side effects.

IPACK Block and Adductor Canal Catheter vs Adductor Canal Catheter for Total Knee Arthroplasty: A Randomized Controlled Trial

Background: Regional anesthetic techniques including the adductor canal catheter (ACC) have aided management of post-operative pain for total knee arthroplasty (TKA). The interspace between the popliteal artery and posterior capsule of the knee (iPACK), has been introduced to address posterior knee pain that is not well covered by the ACC. Studies have looked at the addition of the iPACK block to subjects who received an ACC with and without periarticular local infiltration with varying results. We hypothesized that adding the iPACK block to subjects who also received an ACC and periarticular injection (PAI) would significantly decrease opioid consumption compared to the ACC alone in TKA. Methods: Sixty subjects were randomized to receive an ACC alone (control group) or ACC plus single shot iPACK block (iPACK group) for TKA. All subjects were operated on by the same surgeon and received the same PAI. For the primary outcome of postoperative pain, we used opioid consumption as measured by morphine milligram equivalent (MME). Secondary outcomes included pain scores determined by the visual analog scale (VAS), distance ambulated, time to physical therapy (PT) and length of hospital stay. Results: We did not observe a significant difference between groups for opioid consumption, pain scores, distance ambulated (p > 0.05 across all time points), length of hospital stay (p = 0.64), or time to PT (p = 0.32). Conclusion: When combined with an ACC and PAI, the iPACK block did not significantly decrease opioid consumption, pain scores, time to first PT session or increase distance ambulated.

Research Progress of Virtual Reality Technology in Postoperative Pain Management

Research Progress of Virtual Reality Technology in Postoperative Pain Management

Comparing modalities of opioid education in patients undergoing total knee arthroplasty: a randomized pilot trial

BackgroundPatients undergoing total knee arthroplasty (TKA) experience significant postoperative pain and routinely require opioids, yet they often lack knowledge regarding appropriate use and handling of these medications. Evidence suggests that...

Impact of opioids on hospital stay and mortality in patients undergoing abdominal surgeries

PurposePostoperative pain management is a critical aspect of surgical care, significantly influencing patient recovery and outcomes. This study aims to evaluate the impact of opioid use on hospital stay and mortality rates among patients undergoing abdominal surgeries in Brazil, where healthcare disparities may affect postoperative outcomes.MethodsThis observational cross-sectional study was conducted at the University Hospital Onofre Lopes in Natal, Brazil. We included 385 patients aged 18 years or older who underwent abdominal surgery in 2023. Data were collected from medical records, focusing on analgesic therapy, opioid types, dosages, and patient demographics. Statistical analyses were performed using JAMOVI software.ResultsOpioid consumption was prevalent among the cohort, with 89.6% of patients receiving opioids postoperatively. Tramadol was the most frequently administered opioid, followed by nalbuphine and morphine. Patients treated with morphine had a significantly extended median hospital stay (15.5 days) compared to those receiving tramadol or nalbuphine (2 days). Morphine use was also associated with a higher mortality rate, with these patients being 16 times more likely to die compared to those on weaker opioids. Older age and extended hospital stays were additional risk factors for increased mortality.ConclusionOpioids were used extensively in this cohort as the main analgesic drug for postoperative pain management after abdominal surgeries. Use was associated with prolonged hospital stay and higher probability of death.

Efficacy of Erector Spinae Plane Block on Postoperative Analgesia for Patients Undergoing Metabolic Bariatric Surgery: A Randomized Controlled Trial.

Metabolic bariatric surgery (MBS) advocates multimodal analgesia, discouraging opioid use to minimize side effects, such as nausea and vomiting, during postoperative pain management for quicker recovery. Combining erector spinae plane block (ESPB) with multimodal analgesia aims to reduce opioid consumption, improving postoperative recovery. This study aimed to compare morphine consumption between patients with severe obesity undergoing laparoscopic MBS with and without ESPB. This study enrolled 91 patients with severe obesity who underwent laparoscopic MBS involving either sleeve gastrectomy or Roux-en-Y gastric bypass. Of these, 63 patients were included in this study. The participants were randomly allocated to either the intervention group, which received an ESPB before the standard anesthesia protocol, or the control group, which did not receive pre-anesthesia block. The primary outcome measured was 24-h morphine consumption via a patient-controlled analgesia machine. Secondary outcomes included patients' satisfaction, postoperative numerical rating score, changes over time, and quality of recovery (QoR) using the Thai QoR-35 score. We found no statistically significant difference in morphine consumption between the intervention group and the control group. Furthermore, our analysis revealed no significant between-group differences in patient satisfaction, postoperative numeric rating score, or QoR across all five aspects evaluated using the Thai QoR-35 score. ESPB did not reduce morphine consumption or QoR following laparoscopic MBS. Further studies are required to confirm and identify the reasons for the ineffectiveness of ESPB.

A Clinical Prospective Randomised Comparative Study Of Ultrasound Guided Bilateral Subcostal Transversus Abdominis Plane Block And Port Site Infiltration With Bupivacaine For Post-Operative Analgesia In Patients Undergoing Laparoscopic Cholecystectomy.

Background: Post-operative pain management is critical in laparoscopic cholecystectomy to enhance patient recovery and satisfaction. This study compares the efficacy of ultrasound-guided bilateral subcostal transversus abdominis plane (TAP) block and port site infiltration with bupivacaine for post-operative analgesia. Methods: In this prospective, randomized, comparative study, 60(30/30) patients undergoing elective laparoscopic cholecystectomy were randomly assigned to one of two groups: Group A received an ultrasound-guided bilateral subcostal TAP block with 0.25% bupivacaine (20 ml on each side), while Group B received port site infiltration with 0.25% bupivacaine (5 ml per port). The primary outcome was the duration of post-operative analgesia, assessed by the time to first rescue analgesic request. Secondary outcomes included total analgesic consumption in the first 24 hours post-operatively, pain intensity measured by the Visual Analog Scale (VAS) at 1, 4, 8, 12, and 24 hours, and any complications related to the procedures. Results: The TAP block group (Group A) demonstrated a significantly longer duration of analgesia compared to the port site infiltration group (Group B) (p < 0.05). Group A also exhibited lower total analgesic consumption and lower VAS scores at all time points. No significant complications were observed in either group. Conclusion: Ultrasound-guided bilateral subcostal TAP block with bupivacaine provides superior post-operative analgesia compared to port site infiltration in patients undergoing laparoscopic cholecystectomy, with a longer duration of pain relief and reduced analgesic requirements. This technique should be considered a viable option for enhancing post-operative recovery in these patients.

Can a Continuous Wound Infiltration System Replace Intravenous Patient-Controlled Analgesia for Postoperative Pain Management after a Single-Port Access Laparoscopy?

Background: The aim of this study was to determine whether continuous wound infiltration (CWI) can replace intravenous patient-controlled analgesia (IV PCA) and to investigate effective pain control strategies after a single-port access (SPA) laparoscopy for adnexal disease. Methods: A total of 470 patients (the CWI group [n = 109], the IV PCA group [n = 198], and the combined group [n = 163]) who underwent an SPA adnexal laparoscopy and who received CWI or IV PCA for postoperative pain management were retrospectively reviewed. The numeric rating scale (NRS) pain score at 6, 12, 24, and 48 h (h) after surgery and the total amount of fentanyl administered via IV PCA were collected. The incidence of postoperative nausea and vomiting (PONV) and the total amount of rescue antiemetic drugs administered were also evaluated. Results: The mean NRS pain scores at 6 h (combined vs. PCA vs. CWI, 3.08 vs. 3.44 vs. 3.96, p < 0.001), 12 h (2.10 vs. 2.65 vs. 2.82, p < 0.001), and 24 h (1.71 vs. 2.01 vs. 2.12, p < 0.001) after surgery were significantly lower in the combined group. CWI showed a similar pain-reduction effect after surgery compared to IV PCA, except for the acute phase (within 6 h after surgery). The incidence of PONV during the entire hospitalization period was significantly lower in the CWI group compared to the groups using IV PCA (p < 0.05). The combined group had a significantly lower incidence of PONV and use of rescue antiemetics than the IV PCA group (p < 0.05). The combined group required significantly less total PCA fentanyl compared to the IV PCA group (combined vs. PCA, 622.1 μg vs. 703.1 μg, p < 0.001). Conclusions: CWI is an effective alternative to IV PCA and has fewer side effects. Combined use of CWI and IV PCA may be an ideal pain management strategy, offering a strong pain-reduction effect and only moderate side effects.

Preparation and characterization of intramuscularly long-acting celecoxib nanosuspensions for postoperative pain management

Preparation and characterization of intramuscularly long-acting celecoxib nanosuspensions for postoperative pain management