Method Of Pain Control Research Articles

Pericapsular nerve group block for a child with spina malformation for hip surgery

Postoperative pain management after surgery for developmental dysplasia of the hip is a challenge for older children and pediatric patients with epidural block contraindications. Pericapsular nerve group (PENG) block is an innovative technique reported for pain control around the hip joint. We report the application of a PENG block in a child with spina malformation who underwent open hip surgery. A 7-year-old girl with spina bifida and myelomeningocele was scheduled for open left hip surgery. After general anesthesia, the PENG block was performed for perioperative analgesia. No remifentanil was required during the operation. There was no hemodynamic instability during the operation. The patient did not cry awake or report pain, and the numeric rating scale (NRS) score was 1/10 after extubation. No pain, vomiting or nausea was reported in the postoperative recovery area. Up to 24 h after surgery, the pain level was 2/10 with sustained PCIA. In this case, the PENG technique seems to be a safe and satisfying perioperative pain control method for a child with sacrum malformation who underwent unilateral open hip operation. This initial experience encourages the use of the PENG block in hip surgery or other conditions in this specific demographic.

TRANSCUTANEOUS ELECTRIC NERVE STIMULATION THERAPY IN TEMPOROMANDIBULAR DISORDERS- A SYSTEMATIC REVIEW

Temporomandibulardisordercharacterizes a varied group of pathologies affecting temporomandibularjoints, masticatory muscles, or both.The treatment of temporomandibular disorders is a major challenge because of its varied causes and structures involved and also because the functioning of one joint is always dependent on the other. Transcutaneous electric nerve stimulation is a non-pharmacological method of pain control and recently it is gaining importance in treatment of temporomandibulardisorders. Hence this study was undertaken to analyze the effect of transcutaneous electric nerve stimulation on pain due to temporomandibular disorders and to compare the efficacy of transcutaneous electric nerve stimulation treatment over other treatments available for the same.Electronic search for articles published in various journals were undertaken through various search engines from 2020-2022. 9 randomized control trials of transcutaneous electric nerve stimulation therapy performed on temporomandibular disorder patients were selected for analysis. The efficacy of transcutaneous electric nerve stimulation therapy was compared with conventional therapy [muscle relaxant+ analgesic], low level laser therapy,Microcurrent Nerve Stimulation therapy, Physiotherapy, and Placebo therapy.Results of selected study conclude that transcutaneous electric nerve stimulation therapy is superior to all other treatment modalities included in the study in the treatment of pain due to temporomandibular disorders. Maximum reduction in pain was obtained in combination therapy of transcutaneous electric nerve stimulation with muscle relaxant, hot fermentation, and soft diet.Transcutaneous electric nerve stimulation along with medication proved to be highly effective in treating pain due to temporomandibular disorders.

Liposomal bupivacaine reduces opioid requirements following Ravitch repair for pectus excavatum.

The management of post-operative pain after surgical repair of pectus excavatum with the Ravitch procedure is challenging. Although previous studies have compared various methods of pain control in these patients, few have compared different local anesthetics. This retrospective analysis compares the use of bupivacaine to its longer-acting form, liposomal bupivacaine, in patients who had undergone pectus excavatum repair with the Ravitch method. Eleven patients who received local infiltration with liposomal bupivacaine were matched to 11 patients who received local infiltration utilizing bupivacaine with epinephrine. The primary outcome was total morphine milligram equivalents per kilogram body weight (MME/kg) over the complete length of hospital stay. Secondary outcomes included total cumulative diazepam, acetaminophen, ondansetron, and NSAID dose per kilogram body weight (mg/kg) over the course of the hospital stay, chest tube drainage (ml/kg body weight), number of post-operative hours until the first bowel movement, Haller Index, patient request for magnesium hydroxide, average pain scores from post-operative day 1 to post-operative day 5, and length of hospital stay. Continuous variables were reported as medians with inter-quartile ranges, and categorical values were reported as percentages and frequencies. The total MME/kg [1.7 (1.2-2.4) vs 2.9 (2.0-3.9), P = 0.007] and hydromorphone (mg/kg) [0.1 (0.0-0.2) vs 0.3 (0.1-0.4), P = 0.006] use in the liposomal bupivacaine group versus bupivacaine with epinephrine was significantly reduced over total length of hospital stay. Similarly, there was a reduction in diazepam use in the liposomal bupivacaine group versus the bupivacaine group [0.4 (0.1-0.8) vs 0.6 (0.4-0.7), P = 0.249], but this did not reach statistical significance. The total dose of ondansetron (mg/kg) was not statistically different when comparing the liposomal bupivacaine group to the bupivacaine group [0.3 (0.0-0.5) vs 0.3 (0.2-0.6), P = 0.332]. Interestingly, the total dose of acetaminophen (mg/kg) was statistically increased in the liposomal bupivacaine group compared to the bupivacaine with epinephrine group [172 (138-183) vs 74 (55-111), P = 0.007]. Additionally, the total chest tube drainage (ml/kg) was significantly reduced in the liposomal bupivacaine group [9.3 (7.5-10.6) vs 12.8 (11.3-18.5), P = 0.027]. Finally, the percentage of patients without requests for magnesium hydroxide to promote laxation was significantly higher in the liposomal bupivacaine group than in the bupivacaine group (63.6% vs 18.2%, P = 0.027). The use of liposomal bupivacaine for local infiltration in patients who undergo the Ravitch procedure for pectus repair offers advantages over plain bupivacaine, including reduced opioid consumption and opioid-related side effects. However, more data are needed to understand the significance of these findings.

Data on ultrasound therapy as an adjuvant pain control method among Indian TMDS patients.

It is of interest to evaluate the efficacy of ultrasound therapy as an adjuvant pain control modality in dysfunctions of the temporomandibular joint. The study comprised 20 patients with TMJ issues who had received a clinical diagnosis of temporomandibular disorders (TMDS). These patients underwent independent VAS evaluations for the intensity of pain, opening and closing of the mouth, and soreness of the muscles of mastication, including the masseter muscle, medial pterygoid muscle, lateral pterygoid muscle, and temporalis muscle, as well as additional auxiliary muscles. The chosen patients received ultrasonic treatment. The mean value of mouth opening before therapy was 39.51cm, with SD values of 7.61 cm. The mean value of mouth opening after therapy was 42.91 cm with SD values of 6.08.The findings were statistically significant, with a p-valueof0.021. The mean value of VAS in the TMJ area before therapy was 8.41 with SD values of 2.11.There was a reduction in the mean values of VAS after therapy, which was 3.11 with SD values of 1.12. The findings were significant statistically, with a p-value equal to 0.001. Thus, ultrasonographic therapy for temporomandibular joint pain demonstrated a considerable improvement in pain reduction and mouth opening. It is possible to view this therapy as the adjuvant methodology to control pain in disorders of TMJ.

Acupuncture for pain control after degenerative lumbar spine surgery

BackgroundWound pain after surgery for lumbar spine disease may interfere with patients’ recovery. Acupuncture is commonly used for pain management, but its efficacy for postoperative pain control is unclear. This study aimed to evaluate the effectiveness of acupuncture for adjuvant pain control after surgery for degenerative lumbar spine disease.MethodsWe retrospectively reviewed the records of consecutive patients who received surgery for degenerative lumbar spine disease at our institution from 2013 to 2014. Surgical procedures included open laminectomy, discectomy, and trans-pedicle screw instrumentation with posterior-lateral fusion. Patients were grouped by pain control methods, including routine analgesia, patient-controlled analgesia (PCA), and acupuncture. The routine analgesia group received oral acetaminophen/non-steroidal anti-inflammatory drugs with meperidine as needed for immediate pain control. The PCA group received a basal dose of morphine and subsequent user-demand doses. The acupuncture group received acupuncture every other day after surgery.ResultsNinety-six patients were included, of whom 37 received acupuncture, 27 received PCA, and 32 received routine analgesics for pain control. Visual analog scale (VAS) pain scores in all 3 groups decreased significantly, and to the same degree, from the first postoperative day to the second day. No significant differences were found in VAS scores over the next 6 postoperative days; however, the scores of patients treated with PCA were slightly but still significantly higher (p = 0.026) on postoperative day 4 than scores of patients treated with acupuncture and traditional analgesia, a difference likely due to PCA being discontinued on postoperative day 3. No major complications were noted in the acupuncture group, but 2 patients dropped out because of fear of needle insertion.ConclusionsAcupuncture may be as effective as traditional analgesia and PCA for adjuvant pain control after surgery for degenerative lumbar spine disease.

Multidisciplinary Approach to Treating Chronic Pain in Patients with Ehlers-Danlos Syndrome: Critically Appraised Topic.

The Ehlers–Danlos syndromes (EDS) are a group of 13 related connective tissue disorders with a combined prevalence of 1 in 5000 people, with the most common noted as hypermobile EDS (hEDS). The EDS genetic condition is thought to affect both males and females equally, although most symptomatic patients are female. EDS causes a myriad of symptoms, including skin hyperextensibility and fragility, easy bruising and bleeding, joint hypermobility, subluxation, dislocation, and chronic pain. Pain is one of the most common symptoms of EDS, leading to disability and decreased quality of life. Current guidelines for treating chronic pain in EDS are lacking. Clinicians focus on a conservative multidisciplinary approach in patients with EDS, which avoids surgical interventions and its accompanying risks of morbidity and mortality. The multidisciplinary approach includes physiotherapy, occupational therapy, cognitive behavioral therapy, and pharmacologic interventions to decrease pain. This review identifies literature examining the components of this conservative multidisciplinary approach and their effectiveness across the PubMed, EMBASE, CINAHL, Web of Science, and Trip databases, using the terms “Ehlers-Danlos Syndrome AND Pain Management” that was then subsequently evaluated. The evaluation of this current literature provides weak evidence to support the efficacy of the individual components of the conservative multidisciplinary approach. Lack of alternative approaches leaves medical providers with little choice but to suggest these pain control methods, despite low-grade evidence of weak evidence of their efficacy. More research into the pathophysiology of chronic pain in EDS could help identify additional modes and rationales for therapy.

Scalp Nerve Block, Local Anesthetic Infiltration, and Postoperative Pain After Craniotomy: A Systematic Review and Network Meta-analysis of Randomized Trials.

The most efficacious methods for controlling postoperative pain in craniotomy remain unknown. A systematic review and network meta-analysis were performed to compare the efficacies of different strategies of scalp nerve block (SNB), scalp infiltration (SI), and control in patients undergoing craniotomy. MEDLINE, Embase, and CENTRAL databases were searched for randomized controlled trials. The primary outcome was postoperative 24-hour pain score, and the secondary outcome was opioid consumption within the first 24hour after surgery. The effect was estimated using the between-group mean difference and ranked using the surface under the cumulative ranking curve (SUCRA) score. Twenty-four randomized trials were identified for inclusion. SNB using ropivacaine reduced postoperative 24-hour pain score when compared with control (mean difference [95% credible interval], -2.04 [-3.13, -0.94]; low quality), and when compared with SI using ropivacaine (-1.77 [-3.04, -0.51]; low quality) or bupivacaine (-1.96 [-3.65, -0.22]; low quality). SNB using ropivacaine was likely the most efficacious method for pain control (SUCRA, 91%), and also reduced opioid consumption within the first postoperative 24 hours as compared with control (mean difference [95% credible interval], -11.91 [-22.42, -1.4]; low quality). SNB using bupivacaine, lidocaine, and epinephrine combined, and SNB using ropivacaine, were likely the most efficacious methods for opioid consumption reduction (SUCRA, 88% and 80%, respectively). In summary, different methods of SNB / SI seem to have different efficacies after craniotomy. SNB using ropivacaine may be superior to other methods for postcraniotomy pain control; however, the overall quality of evidence was low.

The Effects of Additional Intraoperative Epidural Morphine Bolus Followed by Postoperative Thoracic Epidural Analgesia in Patients Underwent Liver Resection: A Retrospective Study

Background: Liver resection is a major surgery that usually causes immense postoperative pain. Thoracic epidural analgesia is one of the effective methods for postoperative pain control. However, inadequate epidural analgesia in liver resection is still high. Objective: To compare the effectiveness of adding a bolus dose of morphine to epidural analgesia with the epidural analgesia alone in patients that underwent liver resection. Materials and Methods: A retrospective study collected the data from medical records of patients aged 18 to 80 who underwent liver resection between October 2018 and March 2021. Patients were divided into two groups, the conventional group and the epidural morphine bolus group that received additional epidural morphine bolus intraoperatively followed by continuous epidural analgesia. The numeric pain rating scale and the requirement for breakthrough pain were collected either at the post-anesthetic care unit (PACU) or on the first postoperative day (POD1) at the ward. The epidural morphine-related side effects were reviewed. Results: One hundred sixty-two patients that underwent liver resection and received thoracic epidural analgesia were reviewed. The eighty-four patients (51.8%) were in the epidural morphine bolus group. The median pain scores at PACU and POD1 in the epidural morphine bolus group and the conventional group were 2.5 (0 to 7) and 6 (1 to 8) (p=0.025), and 1 (1 to 6) and 6 (6 to 7) (p<0.001), respectively. Moreover, the requirement for rescue treatment of the epidural morphine bolus group at both PACU and POD1 was significantly lower than that of the conventional group. However, the incidence of pruritus in the epidural morphine bolus group was significantly higher. Conclusion: Additional epidural morphine bolus into epidural analgesia provided better postoperative pain control and decreased the need for rescue treatment of breakthrough pain compared with the conventional technique. At the same time, the incidence of pruritus was significantly higher in the epidural morphine bolus group. Keywords: Epidural analgesia; Epidural morphine; Hepatectomy; Morphine side effects; Postoperative pain

Limited cryoablation reduces hospital stay and opioid consumption compared to thoracic epidural analgesia after minimally invasive repair of pectus excavatum.

pain following minimally invasive repair of pectus excavatum (MIRPE) is a critical concern that leads to a prolonged hospital stay and high doses of opiates administered to the patients. This study aimed to evaluate the efficacy of intraoperative cryoanalgesia (cryoablation of the intercostal nerves) during MIRPE. We retrospectively analyzed the data of 64 patients who underwent MIRPE and received cryoanalgesia or epidural analgesia between January 2019 and January 2021. The oral morphine milligram equivalent (MME) was used to calculate the dosage of opioid agents. The median age was 15 years (range, 4–33 years). The median postoperative hospital stay was 4 days (range, 2–6 days), with a median oral MME consumption of 45 mg (ranging from 0 to 1360 mg). Cryoanalgesia was performed in 38 patients, and epidural analgesia was administered to the remaining 26 patients. The cryoanalgesia group had a significantly lesser pain score, shorter postoperative hospital stay and lower oral MME consumption than the epidural analgesia group (5 vs 2; P < .001, 3 days vs 5 days; P < .001, 19 mg vs 634 mg; P < .001). Cryoanalgesia appears to reduce postoperative hospital stay and opioid consumption compared with epidural analgesia. The outcomes of this study indicate that cryoanalgesia might be a safe and effective method for pain control following MIRPE.

Chronic pelvic pain — current search for truth

Chronic pelvic pain (HTB) remains a relevant multidisciplinary problem. Its symptoms are the result of interaction between psychological factors and dysfunction of the immune, neurological and endocrine systems. HTB is a serious problem for women. Approximately 14% of women experienced HTB at least once in their lives. HTB is grueling and related to significant costs and incidence, and its etiology is multifactorial, which often complicates medical treatment and treatment of associated symptoms. Best practice guidelines recommend an interdisciplinary and biopsychosocial approach to treatment. However, the problem of HTB requires further comprehensive study and expanding possible methods of effective pain control and improving the quality of life of the female population.&#x0D; The article systematizes literary sources on the genesis of pain, the principles of classification, diagnostics and management.

Narcotic waste in the operating room and immediately post operatively in gynecologic oncology surgery (118)

Narcotic waste in the operating room and immediately post operatively in gynecologic oncology surgery (118)

Opioid for in-hospital admitted patient analgesics; which demographics and psychiatric profiles need more pain drugs?

Introduction: The prevalence of substance use disorders is higher in patients receiving opioid analgesics, and pain management in these patients is more challenging. This study aimed to investigate the pattern of analgesic drug administration and evaluate the associated factors. Method: The cross-sectional study was performed on 230 patients admitted to General Hospital ( internal medicine, surgery, and cancer wards). Result: The most used analgesic drug was morphine (59.4%), and a mean dose of 27 mg, then pethidine and methadone. Most pain control methods were intravenous (68.1%) and PRN pattern (61.1%). Using analgesics in patients who do not have risk factors for drug abuse, or addiction, can be considered safe. In our subjects, 95.6% of analgesic users did not become addicted or had any misuse. Discussion and Conclusion: For effective and low-risk treatment of these patients, there is a need for clinical skills, knowledge of opioid administration, assessment, and risk management of substance abuse and addiction. In patients with substance abuse, analgesics should be prescribed in a particular setting, under supervision, and with careful monitoring. Structured and planned administration of opioid agonists (such as methadone or buprenorphine) seems appropriate according to a structured schedule. These plans are recommended: · Increasing the awareness of clinicians about prescribing narcotic analgesics. · Prescribing narcotic analgesics with a regular pattern against PRN. · Evaluating patients for a history of substance abuse. · Closely monitoring them, and if necessary. · Counseling. Identifying high-risk groups such as women, youth, and psychiatric patients are also recommended, and performing early interventions.

Nurses' Influenza Vaccination and Hesitancy: A Systematic Review of Qualitative Literature.

Vaccine hesitancy (VH) is defined as “delaying or refusing a secure vaccine despite its availability”. This hesitancy affects caregivers and more specifically nurses. The purpose of this study is to assess determinants of influenza VH in the nurse’s community. We conducted a systematic review of qualitative literature according to criteria of Preferred Reporting Items for Systematic Review and Meta-Analysis and Enhancing Transparency in Reporting the synthesis of Qualitative Research from 2009 until October 2020. Eleven qualitative studies analysed (ten thematic content analyses and one grounded theory method) found three main factors in VH. The first determinant was the benefit–risk equation considered as unfavourable due to an ineffective vaccine and fears about adverse effects as the pain of the injection. Wrong immunological beliefs brought into hesitancy. Disease barriers (hand washing and masks) and personal immunity were regarded as more effective than the vaccine. Lastly, dehumanised vaccination and the difficulties of access to healthcare were institutional determinants. Nurses ask for a vaccine promotion by hierarchy and doctors with transparent information and respect for autonomy. The availability of vaccines and methods of pain control seem to be some tracks to reduce nurses’ VH.

Clinical Evaluation for Effectiveness and Safety of Lidocaine and Bupivacaine Combination Epidural Infusion for the Management of Post-Total Hip Replacement Pain

Background&#x0D; The management of post-operative pain is critical for both the patient and the surgical outcome. Although epidural analgesia is valuable method, optimal local anesthetic selection and combination could improve its effectiveness. To determine the effectiveness and safety of bupivacaine and lidocaine bolus epidural analgesia in the management of post-total hip arthroplasty.&#x0D; Methods &#x0D; 65 Records of patients who underwent total hip arthroplasty and received bolus epidural analgesia with bupivacaine and lidocaine were evaluated retrospectively. The numerical pain score for 48 hours, drug adverse effects, hospital stay, and opioid intake were analyzed statistically to determine the effectiveness and safety of epidural analgesia.&#x0D; Results&#x0D; The numerical pain score showed mild pain perception through the first 48 hours post operatively. There was no significant difference (p≥ 0.005) between the first score data collected at 6 hours and the last score at 48 hours. Post-operatively, patients had lower incidence of hypotension and headache with acceptable mobility. Opioid rescue analgesia was used for 11(16.9%) of patients.&#x0D; Conclusions&#x0D; For patients who have undergone total hip replacement surgery, epidural analgesia with a bolus epidural infusion of lidocaine and bupivacaine delivers an effective and safe pain control method for 48 hours. This method was effective in opioid sparing.&#x0D;

Preparation and evaluation of liposome with ropivacaine ion-pairing in local pain management

Local analgesia is one of the most desirable methods for postoperative pain control, while the existing local anesthetics have a short duration of analgesic effect. Nano-drug carriers have been widely used in various fields and provide an excellent strategy for traditional drugs. Although the existing liposomes for local anesthetics have certain advantages, their instability and complexity of the preparation process still cannot be ignored. Here, we developed novel ropivacaine hydrochloride liposomes with improved stability and sustained release performance by combining ropivacaine hydrochloride with sodium oleate in liposomes via hydrophobic ion-pairing (HIP). The liposomes are easy to prepare, inexpensive, and suitable for mass production. The infrared (IR), particle size, and Zeta potential measurements adequately characterized the complex, which showed a diameter of 81.09 nm and a zeta potential of −83.3 mV. Animal behavioral experiments, including the hot plate test and von Frey fiber test, demonstrated that the liposome system had a prolonged analgesic effect of 2 h versus conventional liposome preparations, consistent with the results of in vitro release experiments. In addition, in vitro cytotoxicity evaluations in RAW264.7 cells and in vivo evaluations revealed the biocompatibility and safety of the ropivacaine-sodium oleate ion-paired liposome (Rop-Ole-Lipo) system as a suitable local anesthetic for local pain management. Our findings provide a new idea for the preparation of local anesthetics.

Pain Management in Geriatric Hip Fracture Patients - Are There Barriers to Performing Ultrasound Guided Femoral Nerve Blocks?

Ultrasound-guided femoral nerve blocks (UGfNB) are an effective alternative to opiates for hip fractures, yet few are performed in the Emergency Department (ED). To augment implementation of UGfNB at our institution, we used convergent, parallel mixed-methods approach to explore barriers to closing this evidence-to-practice gap. Considering all the stakeholders for UGfNB, we started by recruiting emergency medicine physicians and residents practicing in a large academic medical center to discuss barriers and facilitators to UGfNB adoption. Guided by the Consolidated Framework for Implementation Research, we developed an interview guide for our qualitative (focus group) and quantitative approach (survey). To develop comprehensive understanding, we distributed the quantitative survey to focus group participants regarding current practice, knowledge, and attitudes regarding UGfNB. This data was entered into Redcap®, anonymized, and collated for thematic analysis to supplement our focus group data. Twenty-two physicians participated in the quantitative survey. All participants reported weekly or monthly exposure to geriatric hip fractures yet only 27% (N=6) ever performed UGfNB. The most difficult aspect of controlling pain in geriatric hip fractures was that "typical IV/PO medicines have a lot of negative side effects" and that "the effects of pain control methods do not last long enough" thus requiring "frequent reassessments". Strong influencers of UGfNB included supportive hospital policy and multi-specialty agreement. Most (64%) reported that UGfNB offers "superior pain control, are safe, and have fewer side effects". Respondents were least comfortable with ultrasound anatomy, including identifying the femoral nerve and fascia iliaca. The most cited barriers to performing UGfNB in the ED were "too much time to perform" and "lack of procedural comfort". Though advantages for UGfNB exist in the ED, only a minority of physicians perform them in geriatric hip fractures. We identified barriers and facilitators towards implementation that serve as context for more in-depth focus group discussion.

Ultrasound-guided versus laparoscopic-guided subcostal transversus abdominis plane (TAP) block versus No TAP block in laparoscopic cholecystectomy; a randomized double-blind controlled trial

BackgroundTransversus abdominis plane (TAP) block is an effective modality for the control of immediate postoperative pain. The present randomized trial aimed to assess the efficacy of ultrasound-guided subcostal TAP (USTAP) and laparoscopic subcostal TAP (LSTAP) block as compared to standard care without TAP block after laparoscopic cholecystectomy. MethodsThis was a prospective, randomized, controlled trial on patients who underwent laparoscopic cholecystectomy. Patients were equally randomized to one of three groups: USTAP, LSTAP, and control group (no TAP block). The main outcome measures were pain scores and analgesic consumption within the first 24 h postoperatively, postoperative nausea and vomiting (PONV), time to ambulation, time to first flatus, and adverse effects of TAP block. ResultsThe trial included 110 patients (90% females) with a mean age of 40.9 ± 11.7 years. Both USTAP and LSTAP block groups were associated with significantly lower pain scores at 2, 6, 12, and 24 h postoperatively, lower cumulative dose of paracetamol, less PONV, and shorter time to flatus than the control group. USTAP and LSTAP block were associated with similar pain scores at all time points, similar analgesic requirements, a similar incidence of PONV, and comparable time to first ambulation and time to first flatus. No adverse effects related to TAP block were recorded. ConclusionsTAP block is a safe and effective method for pain control and improving recovery after laparoscopic cholecystectomy. Both USTAP and LSTAP blocks were equally effective in terms of pain relief, analgesic requirements, PONV, return of bowel function, and time to ambulation.

A Practical Guide to Lower Extremity Nerve Blocks for the Sports Medicine Surgeon

Background: Peripheral nerve blocks (PNBs) are vital in the administration of surgical analgesia and have grown in popularity for use in lower extremity arthroscopic procedures because of their capacity to safely and effectively control pain. The number and specificity of PNBs, however, have made choosing the best option for a procedure nebulous for orthopaedic surgeons. Purpose: To present a narrative literature review of the PNBs available for arthroscopic hip and knee procedures that is adapted to an audience of orthopaedic surgeons. Study Design: Narrative literature review. Methods: A combination of the names of various lower extremity PNBs AND “hip arthroscopy” OR “knee arthroscopy” was used to search the English medical literature including PubMed, Cochrane Library, ScienceDirect, Embase, and Scopus. Placement technique, specificity of blockade, efficacy, and complications were assessed. Searches were performed through May 2, 2021. Results: A total of 157 studies were included in this review of lower extremity PNBs. Femoral nerve, lumbar plexus, sciatic nerve, and fascia iliaca compartment blocks were most commonly used in arthroscopic hip surgery, while femoral nerve, 3-in-1, and adductor canal blocks were preferred for arthroscopic knee surgery. Each block demonstrated a significant benefit (P > .05) in ≥1 of the following outcomes: intraoperative morphine, pain scores, nausea, and/or opioid consumption. Combination blocks including the lateral femoral cutaneous nerve block, obturator nerve block, quadratus lumborum block, and L1 and L2 paravertebral block have also been described. Complication rates ranged from 0% to 4.8% in those administered with ultrasound guidance. The most commonly reported complications included muscular weakness, postoperative falls, neuropathy, intravascular and intraneural injections, and hematomas. Conclusion: When administered properly, PNBs were a safe and effective adjuvant method of pain control with a significant potential to limit postoperative narcotic use. While blockade choice varies by surgeon preference and procedure, all PNBs should be administered with ultrasound guidance, and vigilant protocols for the risk of postoperative falls should be exercised in patients who receive them.

Early Postoperative Opioid Requirement Is Associated With Later Pain Control Needs After Supratentorial Craniotomies.

Despite a renewed focus in recent years on pain management in the inpatient hospital setting, postoperative pain after elective craniotomy remains under investigated. This study aims to identify which perioperative factors associate most strongly with postoperative pain and opioid medication requirements after inpatient craniotomy. Using an existing dataset, we selected a restricted cohort of patients who underwent elective craniotomy surgery requiring an inpatient postoperative stay during a 7-year period at our institution (n=1832). We examined pain scores and opioid medication usage and analyzed the relative contribution of specific perioperative risk factors to postoperative pain and opioid medication intake (morphine milligram equivalents). Postoperative pain was found to be highest on postoperative day 1 and decreased thereafter (up to day 5). Factors associated with greater postoperative opioid medication requirement were preoperative opioid medication use, duration of anesthesia, degree of pain in the preoperative setting, and patient age. Notably, the most significant factor associated with a higher postoperative pain score and Morphine milligram equivalents requirement was the time elapsed between the end of general anesthesia and a patient's first intravenous opioid medication. Postcraniotomy patients are at higher risk for requiring opioid pain medications if they have a history of preoperative opioid use, are of younger age, or undergo a longer surgery. Moreover, early requirement of intravenous opioid medications in the postoperative period should alert treating physicians that a patient's pain may require additional or alternative methods of pain control than routinely administered, to avoid over-reliance on opioid medications.

Parecoxib Reduced Postsurgical Pain and Facilitated Movement More Than Patient Controlled Analgesia.

BackgroundPostoperative pain management is an imperative issue for patients undergoing lumbar spinal fusion surgery. Delayed pain relief is associated with poor clinical outcomes. This study compared the effects of intravenously administered patient-controlled analgesia (PCA) with intravenous parecoxib, both commonly used methods for analgesic pain control after surgery.MethodsA non-randomized study was used to recruit 68 patients who were scheduled to receive lumbar spinal fusion surgery at a hospital in Taiwan from April through December of 2020. The group treated with parecoxib received an initial perioperative dose of parecoxib 40 mg during a 30-min period and then postoperative intravenous parecoxib at 40 mg per 12-h period, for 72 h. Those with PCA received morphine (0.4 mg/ml), droperidol (0.02 mg/ml), diphenhydramine (0.48 mg/ml), midazolam (0.02 mg/ml) and saline solution during the 3-day study course. Major outcomes, including visual scale pain score and Barthel index of activities of daily living, were collected via review of medical records at 4 times: 12, 24, 48 and 72 h after surgery. Comparative effects between two groups were assessed by the generalized estimating equations.ResultsAfter adjusting for potential confounders, the administration of parecoxib was associated with a significant decrease in pain scores and an increase in the Barthel Index, when compared with the PCA group (all p < 0.05). Notably, both effects would maintain for 72 h after surgery.DiscussionThis is the first trial of which the authors are aware, that supports intravenous parecoxib as significantly enhancing patient mobility, in addition to having pain control efficacy, when compared with PCA. This study could be used as a reference when instituting interventions to improve the adaptation process and clinical prognoses after lumbar spinal fusion surgery.