Method Of Postoperative Pain Control Research Articles

The Cost-effectiveness of Enhanced Recovery after Surgery Protocols in Abdominally Based Autologous Breast Reconstruction.

The purpose of this study was to conduct a systematic review on the cost-effectiveness of enhanced recovery after surgery (ERAS) protocols in abdominally based autologous breast reconstruction. Further, we reviewed the use of liposomal bupivacaine transversus abdominis plane (TAP) blocks in abdominal autologous reconstruction. PubMed, Embase, Cochrane, and Scopus were used for literature review, and PRISMA guidelines were followed. Included articles had full-text available, included cost data, and involved use of TAP block. Reviews, case reports, or comparisons between immediate and delayed breast reconstruction were excluded. Included articles were reviewed for data highlighting treatment cost and associated length of stay (LOS). Cost and LOS were further stratified by treatment group (ERAS versus non-ERAS) and method of postoperative pain control (TAP versus non-TAP). Incremental cost-effectiveness ratio (ICER) was used to compare the impact of the above treatments on cost and LOS. Of the 381 initial articles, 11 were included. These contained 919 patients, of whom 421 participated in an ERAS pathway. The average ICER for ERAS pathways was $1664.45 per day (range, $952.70-$2860). Average LOS of ERAS pathways was 3.12 days versus 4.57 days for non-ERAS pathways. The average ICER of TAP blocks was $909.19 (range, $89.64-$1728.73) with an average LOS of 3.70 days for TAP blocks versus 4.09 days in controls. The use of ERAS pathways and postoperative pain control with liposomal bupivacaine TAP block during breast reconstruction is cost-effective. These interventions should be included in comprehensive perioperative plans aimed at positive outcomes with reduced costs.

Comparing the Analgesic Effects Between the Pre- and Post-costal Cartilage Harvest Cohorts Using Ultrasound-Guided Deep Serratus Anterior Plane Block in Children with Microtia Undergoing Auricular Reconstruction: A Randomized Clinical Trial.

Pain following costal cartilage harvest surgery is the most common complaint of auricular reconstruction (AR). Anesthesiologists are continuously searching for an effective postoperative pain control method. This study was conducted from 10 April 2022 to 10 June 2022. Sixty children undergoing AR using costal cartilage were randomly assigned to either a serratus anterior plane block performed before costal cartilage harvest (SAPB-pre-cohort; n=30) or the SAPB-post-cohort (Post-costal cartilage Harvest Cohort: n=30). The primary endpoint measures were the Numerical Rating Scale (NRS) scores of the chest and ear pain degrees recorded at 1-, 6-, 12-, 24-, and 48-h after surgery. Intraoperative anesthetic and analgesic dosages, sufentanil consumption and rescue analgesia consumption during the first 24h post-operation, cough score during extubation, extubation agitation score, length of stay, the extubation time, first ambulatory time, analgesia duration, and opioid-related adverse effects and SAPB-related adverse effects were the secondary endpoints. The rest and coughing NRS scores were significantly reduced in the SAPB-pre-cohort 6 and 12h post-operation in comparison with the SAPB-post-cohort (rest 6h p=0.002, others p<0.001). No significant difference in the NRS ear scores existed between the two cohorts (p>0.05). The use of propofol and remifentanil for general anesthesia during the SAPB-pre-procedure was significantly reduced compared to the SAPB-post-group, with statistical significance (p<0.001). Sufentanil consumption and rescue analgesia consumption were significantly reduced in the SAPB-pre-cohort (p=0.001, p=0.033). The extubation time and first ambulatory time were markedly shorter in the SAPB-pre-cohort (all p<0.001). Analgesia duration was markedly longer in the SAPB-pre-cohort (p<0.001). No significant differences were noted in the cough score during extubation, extubation agitation score, length of stay between the two cohorts (all p>0.05). Opioid-related adverse effects occurred more in the SAPB-post-cohort, while there was no statistical significance (16.7 vs. 36.7%; p=0.082). There were no blockade-related complications observed in either cohort. The analgesic effect of the SAPB-pre-cohort was better than the SAPB-post-cohort suggesting both efficacy and feasibility of preemptive analgesia. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Pharmacological and Non-Pharmacological Methods of Postoperative Pain Control Following Oral and Maxillofacial Surgery: A Systematic Review

Pharmacological and Non-Pharmacological Methods of Postoperative Pain Control Following Oral and Maxillofacial Surgery: A Systematic Review

Pharmacological and Non-Pharmacological Methods of Postoperative Pain Control Following Oral and Maxillofacial Surgery: A Systematic Review.

We aimed to investigate the pharmacological and non-pharmacological interventions used for mitigating pain. We integrated randomized controlled trials (RCTs) chosen from PubMed, Google scholar, and Scopus and aimed at assessing the effectiveness of one or multiple variants of Non-steroidal anti-inflammatory drugs (NSAIDs), as well as Narcotic analgesics, compared to corticosteroids, curcumin, hyaluronic acid, and antibiotics. In addition, trials utilizing NSAIDs, including Rofecoxib, which have been withdrawn from market circulation, were deemed ineligible for inclusion. A total of 9 RCTs were evaluated in this study, and the patients' postoperative pain was assessed using the visual analog scale (VAS) and the time measurement. Moreover, there were various approaches to alleviating pain and discomfort. The administration of ibuprofen prior to surgery leads to a marked reduction in pain. Pharmacological interventions, such as the administration of dexamethasone and oxycodone, alongside non-pharmacological interventions, such as laser therapy, have been shown to effectively alleviate the discomfort resulting from surgical procedures on the jaw and face.

Combined femoral and popliteal nerve block is superior to local periarticular infiltration anaesthesia for postoperative pain control after total knee arthroplasty

IntroductionAfter primary total knee arthroplasty (TKA), local periarticular infiltration anaesthesia (LIA) is a fast and safe method for postoperative pain control. Moreover, ultrasound-guided regional anaesthesia (USRA) with femoral and popliteal block is a standard procedure in perioperative care. Two analgesic regimens for TKA—LIA versus URSA with dexmedetomidine—were compared as an additive to ropivacaine. We hypothesised that the use of URSA provides a superior opioid sparing effect for TKA compared with LIA.MethodsFifty patients (planned 188 participants; safety analysis was performed after examining the first 50 participants) were randomised. These patients received LIA into the knee capsule during surgery with 60 ml of ropivacaine 0.5% and 1 ml of dexmedetomidine (100 µg ml−1) or two single-shot URSA blocks (femoral and popliteal block) before surgery with 15 ml of ropivacaine 0.5% and 0.5 ml of dexmedetomidine for each block. Postoperative opioid consumption in the first 48 h, pain assessment and complications were analysed.ResultsIn the safety analysis, there was a significantly higher need for opioids in the LIA group, with a median oral morphine equivalent of 42.0 [interquartile range (IQR) 23.5–57.0] mg versus 27.0 [IQR 0.0–33.5] mg (P = 0.022). Due to this finding, the study was terminated for ethical considerations according to the protocol.ConclusionThis is the first study presenting data on LIA application in combination with dexmedetomidine. A superior opioid-sparing effect of URSA was observed when compared with LIA in TKA when dexmedetomidine is added to local anaesthetics. Also, a longer lasting opioid-sparing effect in the LIA group was observed when compared with the recently published literature; this difference could be attributed to the addition of dexmedetomidine. Therefore, multimodal analgesia regimens could be further improved when LIA or USRA techniques are combined with dexmedetomidine.

Laparoscopic Transverse Abdominis Plane Block

<h3>Study Objective</h3> To describe a technique for laparoscopic application of a transverse abdominis plane (TAP) block. <h3>Design</h3> Video description of a laparoscopic technique in a single patient. <h3>Setting</h3> Standard operating room equipped for laparoscopic procedures. <h3>Patients or Participants</h3> Single patient undergoing total laparoscopic hysterectomy for uterine fibroids and abnormal uterine bleeding. <h3>Interventions</h3> The patient was positioned in lithotomy in Trendelenburg position to allow adequate visualization of pelvic organs. After completion of surgery, a transverse abdominis plane block was performed using 30 ml of a 1:1 mixed solution of 0.25% bupivacaine hydrochloride and 1.3% liposomal bupivacaine injected with a 22-gauge spinal needle in a space between the internal oblique and transversus abdominis muscles. The following landmarks were used to identify the insertion site externally: anterior superior iliac spine and the inferior costal margin at the level of the anterior axillary line. Direct laparoscopic visualization of the injection site was obtained to monitor development of a bulge underneath the peritoneum and transverse abdominis muscle, first by creating a peritoneal blister, followed by a bulge (Doyles bulge). The procedure was repeated in the contralateral side by the assisting surgeon. The total time of procedure is usually 1 minute or less on each side. <h3>Measurements and Main Results</h3> The patient required no opiate analgesia in the immediate postoperative period. Her pain was adequately managed with non-steroidal anti-inflammatory medication. The patient was discharged home the same day of the procedure. During a telephonic follow-up two days after the surgery, patient reported no use of opiates for pain control. <h3>Conclusion</h3> Laparoscopic transverse abdominis plane block is a quick and effective method of postoperative pain control, consistent with ERAS protocols. Further, studies have shown TAP block to provide superior pain relief and reduced opiate use in the postoperative period.^{1, 2.}

Use of Erector Spinae Fascial Plane Blocks in Enhanced Recovery for Open Abdominal Surgery

Bilateral erector spinae fascial plane blocks (ESPB) offers a novel, alternative method of regional post-operative pain control to thoracic epidural analgesia (TEA). The aim of this study was to compare rates of postoperative hypotension, and other standard enhanced recovery after surgery (ERAS) endpoints, in patients receiving ESPB versus TEA for open hepatopancreaticobiliary (HPB) surgery. This retrospective analysis compared historical controls of ERAS patients undergoing open HPB surgery with TEA versus ESPB. The incidence of postoperative hypotension and clinical outcomes, including opioid requirements, were compared. Forty patients receiving TEA were compared to 27 ESPB patients. Return of bowel function and length of stay (mean 7.2 versus7.4 days; P=0.83) were similar. ESPB patients received less intraoperative colloid (142cc versus 340cc; P=0.01) and had less postoperative hypotension versus TEA (22% versus 55%; P=0.03). No ESPB patient required patient-controlled analgesia (versus 32.5% TEA; P< 0.001). ESPB MME requirements decreased over time, while TEA MME requirements increased over 72 hours (P=0.019). ESPB is a novel method that shows promising outcomes in improving enhanced recovery parameters and minimizing opioid administration in open HPB surgery.

CHOICE OF THE OPTIMAL METHOD OF PERIOPERATIVE ANESTHESIA AT THORACOTOMIA

Introduction. Lung cancer occupy an advanced place among malignant neoplasms. It is more common in men aged 30 to 74 years. Almost all lung cancer patients need surgical treatment. Pulmonary dysfunction is caused by impaired evacuation of bronchial secretions, and the diaphragm dysfunction due to the pain. Postoperative pain is one of the main reasons for the development of complications. There are many methods of postoperative pain control, but the search for a better method is still ongoing.Objective. Improve results of perioperative analgesia in patients undergoing thoracotomy by choosing the optimal method of analgesia.Маterials and methods. 45 patients with lung cancer who underwent thoracotomy. Patients were randomized into 4 groups. Group A: according to the concept of pre-emptive analgesia, patients received 1000 mg of paracetamol intravenously 1 hour before incision, 50 mg of dexketoprofen intravenously and epidural analgesia: 40 mg of 2% lidocaine solution when placing a venous catheter, in the postoperative period - 2 mg / ml (3-7 ml / h) of ropivacaine. Group B: epidural analgesia: 40 mg of 2% lidocaine solution when placing a venous catheter, in the postoperative - 2 mg / ml (3-7 ml / h) ropivacaine. Group C: according to the concept of pre-emptive analgesia, patients received 1000 mg of paracetamol intravenously 1 hour before incision and of 50 mg of dexketoprofen intravenously. Group D: Without pre-emptive analgesia and epidural analgesia. The severity of the pain syndrome was assessed using a numerical rating scale (NRS) after 3, 6, 12, 24 and 32 hours.Results and discussion. No statistically significant differences were observed in the subgroups by age, body weight, duration of surgery and blood loss (p&gt; 0.05). Patients in group A did not require additional morphine analgesia and reported lower pain intensity using NRS. After 32 hours, the data were significantly different from groups B, C, and D (p &lt;0.05). There was no significant difference between groups B and C in the assessment of the NRS (p &lt;0.05), but in the group C only one patient required additional morphine analgesia.Conclusion. The effectiveness of the combination of pre-emptive analgesia and epidural analgesia indicates sufficient level of analgesia in patients after lung surgery. A multimodal approach to perioperative analgesia for patients undergoing thoracic surgery without epidural analgesia reduces opioid use compared to epidural analgesia alone.

Pain management practice patterns after hip arthroscopy: an international survey.

Several post-operative pain control methods have been described for hip arthroscopy including systemic medications, intra-articular or peri-portal injection of local anesthetics and peripheral nerve blocks. The diversity of modalities used may reflect a lack of consensus regarding an optimal approach. The purpose of this investigation was to conduct an international survey to assess pain management patterns after hip arthroscopy. It was hypothesized that a lack of agreement would be present in the majority of the surgeons’ responses. A 25-question multiple-choice survey was designed and distributed to members of multiple orthopedic professional organizations related to sports medicine and hip arthroscopy. Clinical agreement was defined as > 80% of respondents selecting a single answer choice, while general agreement was defined as >60% of a given answer choice. Two hundred and fifteen surgeons completed the survey. Clinical agreement was only evident in the use of oral non-steroidal anti-inflammatory drugs (NSAIDs) for pain management after hip arthroscopy. A significant number of respondents (15.8%) had to readmit a patient to the hospital for pain control in the first 30 days after hip arthroscopy in the past year. There is significant variability in pain management practice after hip arthroscopy. The use of oral NSAIDs in the post-operative period was the only practice that reached a clinical agreement. As the field of hip preservation surgery continues to evolve and expand rapidly, further research on pain management after hip arthroscopy is clearly needed to establish evidence-based guidelines and improve clinical practice.

Comparison of bupivacaine alone and in a combination with lidocaine for caudal block in patients undergoing circumcision: A historical cohort study.

Optimal analgesia following ambulatory surgery is an important matter in patient satisfaction, and it reduces unnecessary hospital admissions. This study investigated whether a caudal block with bupivacaine alone or in a combination with lidocaine can alter postoperative pain scores, complications, and peroperative and postoperative analgesic consumption. This is a retrospective study that included children who underwent elective circumcision surgery under general anesthesia and caudal analgesia between January and June 2018. Among the 103 children, 17 cases were not analyzed due to an unsuccessful caudal block and procedures simultaneously underwent another operation unrelated to circumcision. We divided the study participants into two groups according to the type of local anesthetic applied: 0.5 mL/kg 0.25% bupivacaine (Group B) and 0.5 mL/kg 0.25% bupivacaine + 3 mg/kg 1% lidocaine (Group BL) caudally. Pain scores were similar between these groups and remained in the mild-to-moderate range throughout the hospitalization (p>0.05). There were significant differences regarding the rescue analgesic use, first micturition, and mobilization times (p<0.001). In addition, we applied the multivariable logistic regression for fentanyl consumption adjusted for first mobilization and micturition time, unlike mobilization, a significantly increased risk for postoperative delayed micturition (OR, 1.06; 95% CI, 1.0-1.12; p=0.038) was found with intra-operative intravenous fentanyl use. Our results suggest that the caudal block with a lidocaine+bupivacaine combination decreases rescue analgesic consumption at day-case surgery. In circumcision procedures, the caudal block is an effective and safe analgesic method for intraoperative and postoperative pain control with no side effects. This trial was registered at Clinicaltrals.gov, NCT03911648.

Postoperative pain control following minimally invasive correction of pectus excavatum in pediatric patients: A systematic review

PurposeSurgery for pectus excavatum is associated with significant postoperative pain. The aim of this study was to summarize the current literature regarding postoperative pain control for pediatric patients undergoing minimally invasive repair of pectus excavatum (MIRPE). MethodsA systematic search of Medline, Embase, PubMed, CINAHL, Web of Science, and the Cochrane Library for randomized controlled trials (RCT) comparing methods of pain control in pediatric patients undergoing MIRPE was conducted. Studies were restricted to the English language. ResultsAfter screening 1304 references, 9 randomized control trials (RCTs) enrolling 485 patients were included. The average age was 11.9 years (±3.1). Pain scores were decreased with ropivacaine compared to bupivacaine-based epidurals. In studies comparing ketamine to opioid based patient-controlled anesthesia (PCA) pumps, the results were variable. Intercostal and paravertebral nerve blocks had decreased pain scores in 75% of the studies compared to opioid-based PCA. Opioid consumption was decreased in 50% of the trials assessing ketamine-based infusions and 75% of the studies comparing intercostal and paravertebral nerve blocks. Nausea was decreased in several of the ketamine-based infusion and intercostal and paravertebral nerve block studies. ConclusionKetamine-including infusions or paravertebral and intercostal nerve blocks may represent superior methods of postoperative pain control for MIRPE. Further work is needed to confirm results. Level of evidence2A [1].

Can Combination of Peripheral Nerve Block and Non-opioidal Patient Controlled Analgesia Be an Effective Postoperative Pain Control Method?

Category:Ankle, Pain medicineIntroduction/Purpose:Even though bone surgery is very painful after operation, there is no established method to control postoperative pain due to efficacy and side effects. Ultrasound-guided peripheral nerve block (PNB) and nonsteroidal anti- inflammatory drugs (NSAIDs) patient controlled analgesia (PCA) can effectively control pain and reduce side effects.Methods:We conducted a prospective study of 150 patients over 18 years of age who underwent bone surgery from June 2018 to December 2018. All operations were performed under anesthetic ultrasound-guided PNB and additional PNB was performed to control postoperative pain. Among the 120 patients who participated in the final study, NSAIDs PCA was used in group A (65 patients) and NSAIDs PCA was not used in group B (55 patients) for pain control. Postoperative management except PCA was same in both groups. Pain scores are measured at 6, 12, 18, 24, 36, 48, and 72 hours after the operation and they were compared using visual analogue scale (VAS) pain scores. Survey was done on satisfaction of patients, and their willingness to reconsider same method of pain control when they undergo same surgery next time. Also, we evaluated possible side effects that might happen during process of controlling pain.Results:VAS pain score were significantly different only at 24 h postoperatively (p=0.004). In Group A, three patients were prescribed 3 amples of pethidine intramuscular injection as rescue analgesic. In group B, 35 patients were prescribed 50 amples of pethidine and 12 patients of them were received additional 18 amples of ketorolac intramuscular injection as rescue analgesic(p=0.000). In group A, all patients were satisfied with the pain control method, but 5 of the group B patients were dissatisfied (p=0.001). 3 patients responded to severe pain after operation and 2 of them due to postoperative nausea and vomiting (PONV). In group A, there were no patients complaining of PONV, but in group B, 5 patients complained of symptoms (p=0.018), and 3 of them were prescribed additional antiemetics (p=0.093).Conclusion:Combined use of ultrasound-guided PNB and NSAIDs PCA seems to be an effective postoperative pain control method in foot and ankle surgery. Because, pain can be effectively controlled and PONV can be reduced.

Effect of fentanyl nasal packing treatment on patients with acute postoperative pain after closed reduction of nasal bone fracture: a randomized double-blind controlled trial

Purpose: Nasal bone fracture reduction surgery is normally followed by nasal packing to control bleeding. Yet, patients suffer from pain and require further analgesic treatments following nasal packing and removal. This study aimed to evaluate the effect of fentanyl-soaked packing as a method of controlling pain after nasal surgeries in a prospective, randomized, double-blind controlled trial.Methods: Sixty-five patients that have undergone closed nasal bone fracture reduction surgery were included in this study. Thirty-two patients were treated postoperatively with 50 mcg fentanyl-soaked Merocel®, a biodegradable synthetic polyurethane foams packing, and the other 33 patients were treated with saline-soaked packings. To analyze the relative nasal pain control effect of fentanyl, Numeric Rating Scale, patient satisfaction and Ramsay Sedation Scale were used. Patients were closely monitored to record relevant cardiopulmonary indicators and degree of adverse symptoms such as headache or sore throat.Results: Fentanyl group had a significantly lower Numeric Rating Scale and higher patient satisfaction for most of the time periods after operation (p < .05). Symptoms of headache and sore throat were also significantly reduced. Ramsay Sedation Scale scores improved compared to the control group (p < .05). No significant differences in cardiopulmonary relevant indicators between the two experimental groups were observed (p > .05).Conclusion: Fentanyl-soaked packing significantly decreased postoperative pain with no observable adverse effects. Our results demonstrate that topical fentanyl application to nasal packing is an effective method of postoperative pain control after closed nasal bone fracture reduction surgery.

Popliteal Versus Local Field Block for Pain-Related Postoperative Unplanned Emergency Room Visits After Foot and Ankle Surgery.

Ultrasound-guided popliteal blocks for postoperative pain management have grown in popularity within foot and ankle surgery. The purpose of this study was to evaluate the efficacy of popliteal block in preventing postoperative emergency department visits after foot and ankle surgery. We compared rates of presentation to the emergency department for pain following foot and ankle surgery between surgeries with a popliteal block and those with local field block alone. We identified 101 charts, of which 26 presented to the emergency department for postoperative pain following popliteal block. Our results demonstrated that popliteal blocks did not perform better than local blocks, and that there is no statistically significant difference between the 2 methods of postoperative pain control in terms of rates of presentation to the emergency department for pain. Levels of Evidence: Level III, All statistical analyses were carried out using the R statistical package by the primary author (NS) (R Developmental, Core Team. R: A Language and Environment for Statistical Computing, 2012. http://www.R-project.org ).

Acute Benefits After Liposomal Bupivacaine Abdominal Wall Blockade for Living Liver Donation: A Retrospective Review.

ObjectiveTo investigate whether the addition of liposomal bupivacaine abdominal wall blocks to a multimodal analgesic regimen improves postoperative numeric rating scale pain scores and reduces opioid consumption in patients undergoing living liver donation.Patients and MethodsWe conducted a single-center, retrospective review of patients who underwent living liver donation from January 1, 2011, through February 19, 2016, and received multimodal analgesia with (block group) or without (control group) abdominal wall blockade. The block solution consisted of liposomal bupivacaine (266 mg) mixed with 30 mL of 0.25% bupivacaine. Both groups received intrathecal hydromorphone. Main outcome measures were pain scores, opioid requirements, time to full diet, and bowel activity.ResultsPostoperative day 0 pain scores were significantly better in the block group (n=29) than in the control group (n=48) (2.4 vs 3.5; P=.002) but were not significantly different on subsequent days. Opioid requirements were significantly decreased for the block group in the postanesthesia care unit (0 vs 9 mg oral morphine equivalents; P=.002) and on postoperative day 0 (7 vs 18 mg oral morphine equivalents; P=.004). Median (interquartile range) time to full diet was 23 hours (14-30 hours) in the block group and 38 hours (24-53 hours) in the control group (P=.001); time to bowel activity was also shorter in the block group (45 hours [38-73 hours] vs 67 hours [51-77 hours]; P=.01).ConclusionAbdominal wall blockade with liposomal bupivacaine after donor hepatectomy provides an effective method of postoperative pain control and decreases time to full diet and bowel activity.

Research on the efficacy of the rectus sheath block method.

We aimed to retrospectively investigate the efficacy of ultrasound guided rectus sheath block (RSB) method in our study. We scanned 235 patient files operated for abdominal pathology. Patients meeting the criteria were evaluated for intra-operative rectus sheath block and two different groups were formed. In these two groups of patients visual analogue scale (VAS) values recorded from the postoperative pain follow-up form and analgesic delivery (DEL) and analgesic demand (DEM) values recorded from patient controlled analgesia (PCA) device were compared. In addition, complaints of nausea, vomiting and constipation were evaluated. Postoperative VAS values (Postoperative 1, 12 and 24 hours p<0.001), DEM values (Postoperative 1, 12 and 24 hours p<0.001) and total amount of morphine consumed (Postoperative 1, 12 and 24 hours p<0.001) were lower in patients with RSB. Also, in patients with RSB nausea (p=0.014) and vomiting was less seen postoperatively (p=0.007). In the first 24 hours after surgery, constipation was seen in 8 patients with RSB and constipation was seen in 30 patients without RSB (p=0.00). Ultrasound guided rectus sheath block is an effective method for postoperative pain control.

Comparison of Postoperative Pain Control Methods in Patients with Spinal Stenosis after Posterior Spinal Decompression

Comparison of Postoperative Pain Control Methods in Patients with Spinal Stenosis after Posterior Spinal Decompression

Comparison of Postoperative Pain Control Methods in Patients with Spinal Stenosis after Posterior Spinal Decompression

Comparison of Postoperative Pain Control Methods in Patients with Spinal Stenosis after Posterior Spinal Decompression

Pain Management After Hip Arthroscopy: Systematic Review of Randomized Controlled Trials and Cohort Studies

Background: Hip arthroscopy is often associated with significant postoperative pain and opioid-associated side effects. Effective pain management after hip arthroscopy improves patient recovery and satisfaction and decreases opioid-related complications. Purpose: To collect, examine, and provide a comprehensive review of the available evidence from randomized controlled trials and comparative studies on pain control after hip arthroscopy. Study Design: Systematic review. Methods: Using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a systematic review of the literature for postoperative pain control after hip arthroscopy was performed using electronic databases. Only comparative clinical studies with level 1 to 3 evidence comparing a method of postoperative pain control with other modalities or placebo were included in this review. Case series and studies without a comparative cohort were excluded. Results: Several methods of pain management have been described for hip arthroscopy. A total of 14 studies met our inclusion criteria: 3 on femoral nerve block, 3 on lumbar plexus block, 3 on fascia iliaca block, 4 on intra-articular injections, 2 on soft tissue surrounding surgical site injection, and 2 on celecoxib (4 studies compared 2 or more methods of analgesia). The heterogeneity of the studies did not allow for pooling of data. Single-injection femoral nerve blocks and lumbar plexus blocks provided improved analgesia, but increased fall rates were observed. Fascia iliaca blocks do not provide adequate pain relief when compared with surgical site infiltration with local anesthetic and are associated with increased risk of cutaneous nerve deficits. Patients receiving lumbar plexus block experienced significantly decreased pain compared with fascia iliaca block. Portal site and periacetabular injections provide superior analgesia compared with intra-articular injections alone. Preoperative oral celecoxib, compared with placebo, resulted in earlier time to discharge and provided significant pain relief up to 24 hours. Conclusion: Perioperative nerve blocks provide effective pain management after hip arthroscopy but must be used with caution to decrease risk of falls. Intra-articular and portal site injections with local anesthetics and preoperative celecoxib can decrease opioid consumption. There is a lack of high-quality evidence on this topic, and further research is needed to determine the best approach to manage postoperative pain and optimize patient satisfaction.

Comparison of Postoperative Pain Control Methods after Bony Surgery of the Foot and Ankle

Category: Ankle, Pain Introduction/Purpose: We performed a prospective study to evaluate and compare the effectiveness of postoperative pain control methods after bone surgery of the foot and ankle. Methods: Among the patients who underwent foot and ankle surgery from June 2014 to September 2015 with an ultrasound- guided nerve block, 84 patients who fully completed a postoperative pain survey were enrolled. An opioid patch (fentanyl patch, 25 mg) was applied in group A (30 patients), diluted anesthetic (0.2% ropivacaine, 30 ml) was injected into the sciatic nerve once, about 12 hours after the pre-operative nerve block in group B (27 patients), and periodic analgesic intramuscular injection (ketorolac (Tarasyn? R), 30 mg) was performed in group C (27 patients). Visual analog scale (VAS) pain scores at 6, 12, 18, 24, and 48 hours after surgery were checked, and complications of all methods were surveyed. Results: The mean VAS pain score was lower in group B, with a statistically significantly difference (p &lt; .05) between groups A, B, and C at 12 and 18 hours after surgery. Four patients in group A suffered from nausea and vomiting, whereas no other patients complained of any complications or side effects. Conclusion: The ultrasound-guided injection of diluted anesthetic into the sciatic nerve seemed to be the most useful method for controlling pain in the acute phase following foot and ankle bone surgery. By injecting the diluted anesthetic once on the evening of the day of surgery, patients suffered less postoperative pain.