Incidence Of Pain Research Articles

Clinical Analysis of Different Anesthesia and Analgesia Methods for Patients Undergoing Uniportal Video-assisted Lung Surgery

PurposeA comparison of three intra-op modalities to determine a best and convenient pain control for uniportal lung surgery. This study compared general anesthesia with serratus plane block, general anesthesia with epidural and general anesthesia alone to look at post-operative pain scores in patients. Methods80 patients were enrolled and statistically analyzed. There were three interventions studied: Group S: General Anesthesia with Serratus Plane Block, Group E: General Anesthesia with thoracic epidural, Group G: General Anesthesia only. Outcome measures compared among 3 groups included demographic characters; surgical types; anesthesia and operative time; postoperative pain scores; vitals sign; morphine consumption at 0, 2, 6 hours, day1 and day2 postoperative; incidence of opioid-related adverse events and chronic pain; LOS hospital and overall expenses.The numerical rating scale was used to assess the degree of pain on the first and second postoperative days. Postoperative morphine consumption, incidence of opioid-related side effects, LOS(length of stay) hospital and overall hospital expenses were documented, as well as incidence of chronic postoperative pain. FindingsThere was no difference in incidence of opioid-related adverse events and chronic pain, LOS hospital and overall expenses among 3 groups. After investigating factors that may influence LOS hospital and overall expenses, the multivariable analysis indicated only longer operative time was associated with longer hospital stay and more hospital expenses. ImplicationsThis prospective study demonstrates that general anesthesia alone offers an easy and efficient approach resulting in similar postoperative pain scores and morphine consumption compared with nerve block and epidural. Longer operative time was associated with longer hospital stay and more hospital expenses.

Preoperative nebulization with dexamethasone or magnesium sulfate for prevention of incidence and severity of postoperative sore throat – A prospective randomized comparative study

Introduction: Postoperative sore throat (POST) is a common cause of distress and dissatisfaction after general anesthesia. POST is one of the most distressing symptoms after general anesthesia. Incidence of POST ranges from 14.4% to 90% following laryngoscopy and tracheal intubation. Various drugs with different routes are examined to prevent POST. We intended to compare the effectiveness of nebulized dexamethasone and magnesium sulfate (MgSO4) in decreasing the incidence and severity of POST. Materials and Methods: In this prospective double-blind study, adult patients with either sex undergoing laryngoscopy and intubation for surgery were randomly assigned into dexamethasone (Group D) and MgSO4 (Group M). The primary outcome was to assess incidence and severity of POST, and secondary outcome was to assess the incidence of hoarseness and cough. Continuous variables were presented as mean ± standard deviation, and t-test was applied for comparing the difference of means between the two groups. P ≤0.05 was considered statistically significant. Results: The incidence of POST in Group D was much lower as compared to Group M at 0 h (P = 0.0262), but after that, there was no significant difference between groups. Severity of POST was compared between Group D and Group M at 0, 4, 8, 12, and 24 h postoperatively. At 0 h, Group D had 22 patients with no pain at rest (Grade 0) whereas Group M had 12 patients. The secondary outcomes (pain at deglutition, hoarseness, and cough) at 0, 4, 8, 12, and 24 h were not statistically significant (P > 0.05). Conclusions: Preoperative MgSO4 nebulization is as effective as dexamethasone nebulization in decreasing the incidence and severity of POST without causing any adverse effect. Incidence of pain on deglutition, hoarseness, and cough are also reduced effectively by both drugs.

Clinical, Laboratory, and Imaging Characteristics of Tropheryma Whipplei Detection in Bronchoalveolar Lavage Fluid Using Next-Generation Sequencing: A Case-Control Study.

The aim of this study was to assess the prevalence of Tropheryma whipplei (TW) infection in the population and to investigate the clinical symptoms, as well as the laboratory and imaging characteristics of patients testing positive for TW using next-generation sequencing (NGS). A retrospective review was conducted on 1346 bronchoalveolar lavage fluid (BALF) samples collected between January 2021 and September 2023. The case group comprised patients with TW detected using NGS while the control group included 65 randomly chosen Gram-positive bacterial infection patients without TW. Comparative analyses were carried out on the basic demographics, laboratory parameters, and imaging findings between the two groups. Additionally, the case group underwent an in-depth examination of underlying diseases, pathogens, final diagnoses, treatment strategies. The case group comprised of 51 patients with TW, constituting 3.8% of the total. There was no significant difference in gender and age between the case and control groups (P = 0.84, P = 0.07). Symptoms such as coughing, expectoration, wheezing, fever, and hemoptysis are less commonly detected in the case group with a higher incidence of chest pain when compared to the control group (P >0.05). The case group exhibited decreased albumin levels and increased C-reactive protein and D-dimer levels compared to normal levels. Imaging findings in the case group commonly included nodules, patchy images, and interstitial changes, the most common underlying disease is cardiovascular disease, and the most frequently co-occurring pathogen is the human herpesvirus. Among the case group, 27 patients received a final diagnosis of pneumonia, and 3 patients clinically diagnosed with Whipple's disease demonstrated improvement in both symptoms and imaging after treatment. NGS revealed a relatively low overall detection rate of TW-positive patients using BALF. TW was more prevalent in middle-aged and elderly male patients characterized by symptoms such as cough, expectoration, shortness of breath, and fever. Chest imaging in these cases typically showed nodules and interstitial changes.

Comparison of Clinical Presentations and Disease Severity of Children Hospitalized with Influenza A and B.

This study compared the clinical presentations and disease severity between influenza A and B (FLUA and FLUB). The study included children hospitalized with virologically confirmed influenza between 2010 and 2020. The severity of the disease was evaluated based on admission to the pediatric intensive care unit (PICU), mechanical ventilation requirement, length of hospital stay, length of stay in the PICU, and death. Influenza viruses were compared within predefined age groups (0-2, 3-9, and 10-18 years) and in all age groups. Of 343 patients, FLUA and FLUB were detected in 75.8% and 24.2% of children, respectively. FLUB was associated with a higher incidence of headache and abdominal pain (P < .001 and P = .01). Children with FLUB were prescribed antibiotics and antivirals 0.56 and 0.58- fold fewer than those with FLUA. Headache and abdominal pain rates were higher in patients between 3 and 9 years with FLUB. Children between 0 and 2 years with FLUA were more frequently admitted to the PICU than those with FLUB (23.6% vs. 4.0%; P < .004). Eight patients with FLUA died, while only 1 with FLUB died (P = .69). The clinical presentation of FLUA and FLUB appeared similar, except for headache and abdominal pain, which were more prevalent in older patients with FLUB. Our study revealed that children between 0 and 2 years with FLUA were at a significantly higher risk for admission to the PICU. As a result, greater attention and awareness should be paid to children under 2 years old with FLUA.

Single-shot interscalene block with liposomal bupivacaine vs. non-liposomal bupivacaine in shoulder arthroplasty

Regional anesthesia is a valuable component of multimodal pain control in total shoulder arthroplasty (TSA), and multiple interscalene block anesthetic options exist, including nonliposomal interscalene bupivacaine (NLIB) and liposomal interscalene bupivacaine (LIB). The purpose of this study was to compare pain control and opioid consumption within 48 hours postoperation in those undergoing TSA with either LIB or NLIB. This was a retrospective cohort study at a single academic medical center including consecutive patients undergoing inpatient (>23-hour hospitalization) primary anatomic or reverse TSA from 2016 to 2020 who received either LIB or an NLIB for perioperative pain control. Perioperative patient outcomes were collected including pain levels and opioid usage, as well as 30- and 90-day emergency department (ED) visits or readmissions. The primary outcome was postoperative pain and opioid use. Overall, 489 patients were included in this study (316 LIB and 173 NLIB). Pain scores at 3, 6, 12, and 48 hours postoperatively were not statistically significantly different (P>.05 for all). However, the LIB group had improved pain scores at 24 and 36 hours postoperation (P<.05 all). There was no difference in the incidence of severe postoperative pain, defined as a 9 or 10 numeric rating scale-11 score, between the 2 anesthesia groups after adjusting for preoperative pain and baseline opioid use (odds ratio 1.25, 95% confidence interval 0.57-2.74; P=.57). Overall, 99 of 316 patients receiving LIB (31.3%) did not require any postoperative opioids compared with 38 of 173 receiving NLIB (22.0%); however, this difference was not statistically significant after adjusting for prior opioid use and preoperative pain (P=.33). No statistically significant differences in postoperative total morphine equivalents or mean daily morphine equivalents consumed between the groups were found during their hospital stays (P>.05 for both). Finally, no significant differences were found in 30- and 90-day ED visits or readmission rates (all P>.05). LIB and NLIB demonstrated differences in patient-reported pain scores at 24 and 36 hours postoperation, although these did not reach clinical significance. There were no statistically significant differences in opioid consumption during the hospital stay, including opioid use, total morphine equivalents, and daily mean morphine equivalents consumed during the hospital stay. Additionally, no differences were observed in 30- and 90-day ED visits or readmission rates.

Effect of Short-term Deep Breathing Exercises on Perioperative Anxiety and Pain in Pediatric Orthopedic Patients: A Randomized Controlled Trial

PurposeThere are currently no pediatric studies examining the effects of deep breathing on perioperative pain and anxiety. This study sought to determine the effect of short-term deep breathing exercises on perioperative anxiety and pain in pediatric patients and their parents. DesignA randomized controlled trial was conducted in the Department of Orthopaedic Surgery where pediatric patients about to undergo surgery were allocated to a control group or a deep breathing group. In the intervention group, patients and their main guardian were guided to practice 10 minutes of deep breathing exercises twice a day for 3 to 4 days prior to surgery. Perioperative anxiety and pain were measured for both the children and parents as outcome indicators. MethodsPerioperative anxiety was measured using the modified Yale Preoperative Anxiety Scale-Short Form (mYPAS-SF) and state anxiety was measured using the State-Trait Anxiety Inventory (STAI). Patients reported their pain levels daily using the Wong-Baker FACES Pain Rating Scale. The following cutoffs were determined as high levels of anxiety: STAI (adult) > 44, STAI (child) > 36, and mYPAS-SF ≥ 30. FindingsNo significant differences were found in the STAI, mYPAS-SF, and Wong-Baker FACES Pain Rating Scale scores of the patients between the intervention and control group. Overall statistics showed that parents had significantly higher postoperative state anxiety levels toward female children (44.93 ± 9.01) compared to male children (40.18 ± 9.89). Preoperative and postoperative parental state anxiety levels were correlated with the child’s postoperative anxiety. Furthermore, children’s postoperative state anxiety was slightly correlated with postoperative pain. ConclusionsShort-term use of our deep breathing exercises was ineffective in reducing incidences of perioperative pain and anxiety in pediatric orthopedic patients. A longer period of deep breathing administration may be required for the intervention to be effective. Parental anxiety may have an effect on anxiety levels in children, and postoperative parental anxiety may be affected by the gender of the child.

Poster 131: Loop 'N' Tack Tenodesis: A Multi-Center Retrospective Case Series of Clinical and Patient Reported Outcomes of a Novel Suture Technique for Proximal Biceps Tenodesis

Objectives: Tenodesis and tenotomy of the long head of the biceps are treatment options for a wide range of pathologies without clear superior technique or site of fixation. Tenotomy may result in a cosmetic “Popeye” deformity and fatigue pain. The Loop ‘N’ Tack technique is a quick, simple, and knotless technique for tenodesis of the long head of the biceps that can be completed entirely arthroscopically. The tensionless repair allows the biceps to scar within the biceps groove, thereby reducing subsidence and formation of a “Popeye" deformity and fatigue pain in the biceps seen with tenotomy alone while eliminating the ability to overtension. The primary objective will be to retrospectively report the clinical outcomes and associated complications of patients undergoing biceps tenodesis utilizing the Loop ‘N’ Tack technique at multiple institutions from 1/1/2015 – 7/25/2021. Methods: CPT procedure codes (29827,29823, 29826) were used to identify participants in the EHR (i.e., Epic) who underwent the Loop ‘N’ Tack biceps tenodesis technique by each author at 9 separate institutions. Patient reported outcomes (PRO) including Visual Analog Scale (VAS), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), Single Assessment Numeric Evaluation (SANE), UCLA Shoulder Rating Scale (UCLA), and Simple Shoulder Test (SST) were recorded at multiple time points throughout the patient’s preoperative and postoperative course. Scores were compared to the established minimal clinically important difference (MCID) for each PRO to assess the viability of this tenodesis technique. Additional metrics including bicipital groove pain, Popeye deformity, and need for revision surgery were also recorded. Results: 1,473 patients were initially screened who underwent the Loop ‘N’ Tack biceps tenodesis technique. 82 patients were excluded secondary to limited follow up or lack of PRO data within the EHR. The average patient age was 64.7 years old with average follow up of 8.11 months. Mean preoperative PRO scores were 5.64 (2.13), 43.31 (20.38), 15.14 (3.52), 5.81 (1.92), and 49.24 (15.06) for the VAS, SANE, UCLA, SST, and ASES scores, respectively. Postoperative PRO scores at most recent follow up respectively measured 1.05 (1.66), 89.56 (17.06), 31.50 (4.01), 10.69 (1.92), and 89.48 (13.81). MCID was reached for each PRO at the 1-2 month mark postoperatively. 36 patients (2.6%) underwent revision surgery for biceps related pathology, while 40 patients (2.9%) required revision shoulder surgery for a separate pathology. Postoperative Popeye deformity was noted in 15 patients (1.08%). Conclusions: The Loop ‘N’ Tack technique results in high rates of patient satisfaction with improvement in shoulder related patient reported outcomes, low incidence of postoperative pain, and low rates of Popeye deformity. This case series establishes the Loop ‘N’ Tack technique as a viable tenodesis approach during shoulder arthroscopy for biceps related pathology.

Postoperative Pain of Endodontic Re-treatment in Single and Multiple Visits: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Abstract Aim: This systematic review aimed to evaluate the influence of single-visit and multi-visit non-surgical endodontic re-treatments on the incidence, intensity, and duration of postoperative pain and adverse effects. Materials and Methods: A search of the literature was conducted after registration of the study protocols in PROSPERO to find randomized clinical studies assessing postoperative pain in non-surgical endodontic re-treatment conducted during one or more visits in PubMed, Cochrane library, and Scopus databases and EBSCO using a definitive search strategy based on inclusion and exclusion criteria. Using the Cochrane risk of bias method, two independent reviewers determined the studies that were eligible for inclusion, extracted data, and evaluated the quality. Meta-analysis was carried out at wherever appropriate. Results: A total of 827 citations were found by the database search and 16 citations from other sources. Eleven full-text articles were obtained after duplicates were eliminated. Three clinical trials were deemed eligible for inclusion; on qualitative evaluation, two studies showed an unclear risk and one was graded as having a significant high risk of bias. The sample size was significant in only one study, and the other two studies had a smaller sample size. Meta-analysis was performed at 24 h, 48 h, and 7 days. The random-effects model at 24 and 48 h and fixed-effects model after 7 days indicated that there is no significant difference in pain intensity between single-visit and multi-visit re-treatments. Conclusion: The significance of the number of visits on the subsequent pain following the re-treatment procedure was underlined by this current systematic review and meta-analysis. The single visit re-treatment caused less postoperative pain and can be considered based on the clinical scenario.

EVALUATION OF VITAMIN B12 LEVELS WITH NEUROPATHIC PAIN IN HEMODIALYSIS PATIENTS: A SINGLE CENTER OBSERVATIONAL STUDY

Background: Uremic syndrome in chronic kidney disease (CKD), particularly in hemodialysis (HD) patients, is a growing global health problem. The majority of patients with this condition experience one or more neurological disorders, such as neuropathic pain. One of the adjuvant therapies in the treatment of neuropathic pain is vitamin B12, which is important for the regeneration and myelination of peripheral nerves and also plays an important role in the restoration of functional nerves. Objective: The aim of this research is to evaluate the role of vitamin B12 in the relief of pain symptoms Method: This research was conducted at General Hospital in Bali use a case-control design and consecutive sampling. This was carried use 21 patients with CKD on regular hemodialysis with neuropathic pain, while 22 patients without neuropathic pain were used as the control group. All patients were tested for serum vitamin B12 levels. Neuropathic pain was assessed using the DN4. Results: The data values of total vitamin B12 levels in blood serum were obtained within a range of 81.72 pmol/L to 2337.5 pmol/L, and a median value of 1306.25 pmol/L. A cut-off value of 1509.375 pmol/L was obtained with 76.2% sensitivity and 59.1% specificity. Furthermore, an odd ratio between low serum vitamin B12 and the incidence of neuropathic pain was also obtained, namely OR= 3.611 (95% CI= 1.012-12.9; p=0.044). Conclusion: It was found that low serum vitamin B12 in CKD patients on hemodialysis increased the risk of experiencing neuropathic pain by 3.611 times compared to those with normal serum vitamin B12.

Does Patellar Denervation with Electrocautery Benefits for Total Knee Arthroplasty without Patellar Resurfacing: A Meta-analysis of Randomized Controlled Trails.

To investigate the effects of patellar denervation (PD) and non-patellar denervation (NPD) after primary total knee arthroplasty (TKA) without patellar resurfacing, this study conducted systematic electronic searches in November 2023 using PubMed, Embase, Web of Science, Cochrane, and Scopus, adhering to Cochrane Collaboration recommendations. Only randomized controlled trials (RCTs) were included. Additionally, a manual search was performed to identify potentially eligible studies from the reference lists of review articles. Two researchers independently conducted literature reviews, data extraction, and risk of bias assessments. The outcome analysis encompassed the incidence of anterior knee pain (AKP), visual analogue scale (VAS), range of motion (ROM), American Knee Society Score (KSS), Oxford Knee Score (OKS), patellar score (PS), complications, and reoperations. Meta-analysis was executed using RevMan 5.3 software. To enhance the credibility of the study, TSA v0.9 software was utilized to perform power analysis on the overall efficacy of primary and secondary outcomes. Twelve studies involving 1745 patients (1587 knees) were included, with 852 undergoing PD and 893 undergoing NPD. Results indicated a superior reduction in AKP incidence in the PD group compared to the NPD group. Statistically significant differences were observed between PD and NPD in KSS, OKS, and PS. However, the upper limit of the 95% confidence interval for each outcome fell below the minimal clinically important difference (MCID). No significant differences were found in VAS and ROM between PD and NPD. Additionally, PD was not associated with an increased incidence of complications or reoperations. Within 12 months and beyond, PD was proven to be a beneficial intervention in reducing AKP following TKA without patellar resurfacing, achieved without an increase in complications or reoperations. Regarding KSS, OKS, and PS, the minimal advantage achievable through PD may not be clinically significant.

A Cross-sectional Study on Association of Iliopsoas Muscle Length with Lumbar Lordosis Among Desk Job Workers

Background: Prolonged hours of sitting in sustained posture is a common job requirement of desk job workers. Potential risk of iliopsoas muscle shortening leading to lumbar hyperlordosis, which in turn may cause low-back pain was identified. Thus, this study determined association between iliopsoas muscle length and lumbar lordosis in desk job workers. Methods and Material: This cross-sectional study was conducted on forty-six desk job workers working for 5 hrs/day for at least 5 years. Workers were assessed for iliopsoas muscle length using Modified Thomas test and flexi-ruler was used to measure lumbar lordosis. Pearson’s correlation was operated for association of iliopsoas length with lumbar lordosis. Results: Lumbar lordosis demonstrated moderate positive correlation with both right (r = 0.628) and left Iliopsoas muscle length (r = 0.647). Conclusion: This study concluded workers with higher degree of lumbar lordosis presented with shorter iliopsoas length. Timely intervention to maintain the length of this muscle will ensure low incidence of low-back pain among desk job workers thereby safeguarding their spine due to cumulative trauma.

Discovery and Hit to Lead Optimization of Macrocyclic Peptides as Novel Tropomyosin Receptor Kinase A Antagonists.

Tropomyosin receptor kinases (Trks) are receptor tyrosine kinases activated by neurotrophic factors, called neurotrophins. Among them, TrkA interacts with the nerve growth factor (NGF), which leads to pain induction. mRNA-display screening was carried out to discover a hit compound 2, which inhibits protein-protein interactions between TrkA and NGF. Subsequent structure optimization improving phosphorylation inhibitory activity and serum stability was pursued using a unique process that took advantage of the peptide being synthesized by translation from mRNA. This gave peptide 19, which showed an analgesic effect in a rat incisional pain model. The peptides described here can serve as a new class of analgesics, and the structure optimization methods reported provide a strategy for discovering new peptide drugs.

Influence of Work Posture and Work Duration on the Incidence of Low Back Pain Among Batik Artisans: a Cross-sectional Study

Background: Batik artisans, particularly those involved in the "nyanting" process, are susceptible to lower back pain due to non-ergonomic working postures. These craftsmen sit for long durations as they meticulously apply wax to fabric. They utilize dingklik, which compels them to sit in a slightly hunched position. The repeated adoption of such postures can heighten the risk of lower back pain. This research aims to investigate the relationship between work posture, years of service, and the incidence of low back pain among "nyanting" batik artisans in Pulorejo Village Methods: This observational analytical research employed a cross-sectional approach with 42 "nyanting" batik artisans chosen through a total sampling technique. Conducted in Pulorejo Village in January 2024, the research assessed work posture using the Rapid Entire Body Assessment (REBA) instrument, while the occurrence of low back pain was evaluated through history taking and physical examination. Statistical analysis was performed using IBM SPSS version 25.0 software. Results: A significant positive correlation was found between years of service and the occurrence of low back pain (LBP) (p=0.002; r=0.471). The risk of LBP increases with the length of service. Additionally, there was a significant positive correlation between working posture, as indicated by the REBA score, and the occurrence of LBP (p=0.010; r=0.395). A higher REBA score corresponds to a greater risk of LBP. Conclusions: the Years of service and the working posture were associated to the incidence of low back pain (LBP) among "nyanting" batik artisans in Pulorejo Village.

Analgesic Requirements and Incidence of Neuropathic Pain after Erector Spinae Plane Block in Different Patient Positions: A Retrospective Comparative Study.

Analgesic Requirements and Incidence of Neuropathic Pain after Erector Spinae Plane Block in Different Patient Positions: A Retrospective Comparative Study.

Comparing outcomes of prepectoral, partial muscle-splitting subpectoral, and dual-plane subpectoral direct-to-implant reconstruction: implant upward migration and the pectoralis muscle.

Although dual-plane subpectoral breast reconstruction has been widely implemented in implant-based breast reconstruction, animation deformities remain an issue. Recent advances in skin flap circulation detection have increased the use of prepectoral reconstruction. A partial muscle-splitting subpectoral plane was introduced to decrease the visibility of the implant edge. However, there is yet to be a direct comparison of these methods for optimal results, including changes in implant position after reconstruction. This study aims to compare the incidence of complications such as rippling, animation deformity, implant upward migration between the dual-plane, the partial muscle splitting subpectoral and the prepectoral reconstruction group. In addition, multivariate analysis was conducted to identify the risk factors of complications. We retrospectively investigated 349 patients who underwent unilateral direct-to-implant breast reconstruction from January 2017 to October 2020. Implants were inserted into the dual-plane subpectoral (P2) or partial muscle-splitting subpectoral (P1, the muscle slightly covering the upper edge of the implant) or the prepectoral pocket (P0). Postoperative outcomes and at least 2 years of follow-up complications were compared. There was no significant difference in rippling (P=0.62) or visible implant edges on the upper pole (P=0.62) among the three groups. In contrast, the P0 group had a lower incidence of seroma (P=0.008), animation deformity (P<0.001), breast pain (P=0.002), and upward implant migration (P0: 1.09%, P1: 4.68%, P2: 38.37%, P<0.001). According to the multivariate analysis, P2 resulted in a greater risk of seroma (odds ratio: 4.223, P=0.002) and implant upward migration (odds ratio: 74.292, P<0.001) than did P0. P0 and P1 showed better postoperative outcomes than P2. Additionally, P0 had less implant migration than P1. Even though P1 minimally dissects the muscle, the location of the implant may change. Considering that muscle contraction can deteriorate symmetry and aesthetic results, the P0 method may be the most favorable.

Possibilities of using short stems of hip endoprosthesis: meta-analysis

Short femoral stems of the hip endoprosthesis with femoral neck preservation facilitate the restoration of the anatomy of the proximal femur and the physiological biomechanics of the hip joint. The design of the stem is of particular interest as it allows for the creation of a hip joint with higher functional characteristics and increased service life of implants that are easier to replace. Neck-sparing short femoral stems achieve excellent early and mid-term results in both clinical and radiographic parameters that are functionally equivalent to conventional femoral stems. To date, the results of this meta-analysis indicate that neck-sparing stems may provide better bone mineral density maintenance than their conventional counterparts, in addition to lower incidence of hip pain.

Внутрішньовенна інфузія лідокаїну для попередження хронічного післяопераційного болю в дітей після різних видів оперативних втручань

Chronic postoperative pain is a serious postoperative complication. Inadequate pain management in the early postoperative period can contribute to the development of hyperalgesia. Aim - to evaluate the effectiveness of intravenous infusion of lidocaine in the prevention of chronic postoperative pain after various types of surgical intervention in children and adolescents. Materials and methods. 150 children who underwent under general multicomponent anesthesia surgical interventions due to traumatic pathology (I group, n=40), abdominal (II group, n=48) and urological (III group, n=62) surgical interventions were examined. Each of these groups was divided into two subgroups: in the subgroups Ib (n=17), IIb (n=19) and IIIb (n=24) children received intravenous lidocaine (according to the instructions) as a component of multimodal analgesia in the perioperative period, in the control subgroups Ia (n=23), IIa (n=29) and IIIa (n=38) children did not receive lidocaine. The presence of chronic postoperative pain 6 and 12 months after the operation, its frequency, localization, intensity according, the impact on the child’s daily activity were analyzed. Data analysis was performed using the statistical package «SPSS 20» (SPSS Inc.) version 21.0.0. Results. Perioperative use of intravenous lidocaine infusion inpediatric patients was associated with a lower incidence of chronic pain 6 and 12 months after trauma surgery (odds ratio (OR): 5.13; 95% confidence interval (95% CI): 1.13-23.3 and OR: 4.24; 95% CI: 1.01-93.48, respectively) and after abdominal surgery (OR: 5.19; 95% CI: 1.02-26.94), as well as a higher level of functional activity after trauma (OR: 5.52; 95% CI: 1.08-28.2; p=0.028) and abdominal surgery (OR: 8.1; 95% CI: 1.01-70.36; p=0.032), but not after urological operations. Conclusions. This study demonstrated the efficacy of intravenous infusion of lidocaine to prevent of chronic pain after trauma and abdominal surgery in pediatric patients. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

From Rib Hump to Baby Hump-Common Questions of Patients Suffering from and Undergoing Treatment for Scoliosis-A Comprehensive Literature Review.

Background: Scoliosis, the most prevalent spinal deformity in children, is often associated with adolescent idiopathic scoliosis (AIS). Curves surpassing 50 degrees can deteriorate, especially thoracic curves, leading to pulmonary limitations. Surgical intervention is usually advised for curvatures exceeding 50 degrees to halt further progression. Severe AIS is notably more frequent in females, yet knowledge regarding subsequent pregnancies and associated risks is scarce. Female patients often inquire about conception, pregnancy, labor, and future back pain (BP) concerns. Reports on the long-term outcomes after pediatric AIS treatment and pregnancy consequences remain limited. Uncertainty looms over the likelihood of increased back pain (BP), cesarean sections (CSs), or other pregnancy-related issues following surgical AIS management. In this investigation, an attempt was made to scrutinize the existing research on individuals afflicted with scoliosis who received either conservative or surgical treatment, with the aim of delineating crucial and pragmatic findings that can serve as a compass for spine surgeons when counseling young patients with adolescent idiopathic scoliosis regarding the ailment, its repercussions, the available treatment modalities, and the associated outcomes. A comprehensive analysis pinpointed the optimal data at hand. Consequently, the primary objective of this investigation was to assess the patient-reported and clinical consequences in scoliosis patients who have undergone segmental posterior fusion and subsequently conceived. Conclusions: While the majority of individuals with AIS are capable of conceiving and bearing children, they may encounter greater challenges in fertility than healthy women unaffected by AIS. Pregnant women with a prior history of spinal fusion for AIS can undergo pregnancy and childbirth with no significant escalation in perinatal complications. Women who have undergone surgical procedures for AIS have been observed to exhibit a prevalence of back pain comparable with that of healthy pregnant women; however, a higher incidence of low back pain is evident when spinal fusion is extended to the L3 or L4 vertebra. Although back pain is a common occurrence in pregnant women with AIS, the spinal alterations induced by pregnancy are typically minor and transient. In comparison with healthy women, individuals with a history of spinal fusion necessitate cesarean sections more frequently. The degree of correction loss during pregnancy is lower in previous reports involving pedicle screw instrumentation than in previous reports involving Harrington or hybrid segmental instrumentation.

Prevention and management of rebound pain after resolution of regional block: a systematic review.

An extreme pain known as rebound pain develops after regional blockage wears off. Patient, surgical, and anesthesia-related factors influence the occurrence and intensity of rebound pain. Prior to the peripheral nerve block (PNB) being resolved, multimodal therapy should use. The objective of this review was to explore rebound pain prevention and management following PNB resolution. We conducted a thorough search across Pub Med, Hinari, Google Scholar, and Cochrane review databases, utilizing relevant keywords and search parameters to identify studies meeting our inclusion criteria. These studies aimed to provide sufficient evidence regarding the prevention and management of rebound pain following the resolution of regional blocks. Duplicate entries were removed using Endnote software. Screening of the literature was performed using a rigorous appraisal checklist. The findings of this review are reported in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. Using an electronic search, 3526 items were found from databases and websites. After removing duplicates (n=500), 3026 articles remained. Of these, 2813 were excluded after going through their titles and abstracts. Of the 213 articles screened, 126 were removed for such reasons as ineligibility or similarity in objectives. Of the remaining 87 studies, 37 were excluded for such reasons as the inaccessibility of free full texts. Finally, 50 studies were included for review. Proper patient education about rebound pain, combined with the utilization of multimodal systemic analgesia before the resolution of PNBs, perineural dexamethasone, and employing a combination of nerve blocks, has been demonstrated to decrease the incidence of rebound pain. Therefore, clinicians should aim to prevent and manage rebound pain by implementing perioperative multimodal strategies before the resolution of regional blocks.

Effect of proton pump inhibitors compared to histamine-2 receptor antagonists on bleeding management and wound healing after endoscopic mucosal resection or endoscopic submucosal dissection: A meta-analysis of randomized clinical trials.

Proton pump inhibitors (PPIs) and histamine type-2 receptor antagonists (H2RAs) are generally effective in preventing delayed bleeding and healing artificial wounds after endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD). This study aimed to review the therapeutic effects of PPIs and H2RAs on damage caused by EMR and ESD. Thirteen articles were collected between 2002 and 2022 by searching Medlib, ScienceDirect, PubMed, International Scientific Indexing (ISI), Embase, and Scopus databases using valid keywords. The main inclusion criteria were delayed wound healing, bleeding, epigastric pain, intraoperative bleeding, and perforation. The odds ratio (OR) and 95% confidence interval (95% CI) were evaluated using a random or fixed effects model. Data analysis was performed using Stata v. 14.2. A total of 13 articles including 1,483 patients were analyzed. The results showed that delayed bleeding was significantly less frequent in the PPI group than in the H2RA group (OR = 0.6; 95% CI: 0.39-0.92). Subgroup analysis showed that PPI was more effective in preventing delayed bleeding than H2RA for ESD wounds (OR = 0.65; 95% CI: 0.44-1.08). There was no statistically significant difference between both groups regarding the incidence of epigastric pain, intraoperative bleeding, wound healing, and perforation after endoscopic treatments. The meta-analysis results reveal that PPI is more effective than H2RA in preventing delayed bleeding after endoscopic treatment, particularly in patients treated with ESD. However, there was no significant difference between PPI and H2RA in terms of intraoperative bleeding, epigastric pain, wound healing, and perforation from endoscopic therapy.