Postoperative Pain In Patients Research Articles

Effect of estazolam plus remimazolam on attenuating preoperative anxiety and remifentanil-induced postoperative hyperalgesia in elective gynecological laparoscopic surgery: a randomized clinical trial.

Preoperative anxiety is closely related to opioid-induced hyperalgesia, and high levels of preoperative anxiety have the potential to aggravate opioid-induced hyperalgesia. We aimed to estimate the effect of estazolam, remimazolam, and their combination on preoperative anxiety and opioid-induced hyperalgesia in patients undergoing elective gynecological laparoscopic surgery. We carried out a randomized, double-blind, placebo-controlled experiment between October 2020 and April 2021. Starting on 9, October 2020,a total of 108 patients were split into four groups: (1 mg estazolam or starch was taken orally on the evening before surgery; 0.1 mg/kg remimazolam or normal saline was administered intravenously after entering the operating room) Group E received estazolam and normal saline; Group R received starch and remimazolam; participants in Group ER were given not only estazolam but also remimazolam; participants in Group C were given starch and normal saline. We recorded pain intensity at rest at 24 hours postoperatively as the primary outcome and measured pain intensity, sufentanil consumption, and adverse events within 72 hours postoperatively. The mean anxiety scores were significantly lower in Groups E, R, and ER than in Group C before surgery. Compared with Group C, mean pain scores were significantly lower in Group ER at 0.5, 1, 4, 8, 24, 48, and 72 hours after surgery and lower in Groups R or E at 4, 8, and 24 hours after surgery. The mean pain scores in Group E (at 8 and 24 hours postoperatively) and Group R (at 8 hours postoperatively) were both significantly higher than those in Group ER. Moreover, the mean cumulative sufentanil consumption was significantly lower in Group ER at 0.5, 1, 4, 8, 24, 48, and 72 hours after surgery and lower in Groups E or R at 0.5 hours after surgery, compared with Group C. The preoperative application of estazolam, remimazolam, and their combination can relieve preoperative anxiety and postoperative pain for patients undergoing gynecological laparoscopic surgery. Moreover, the preoperative combination can also significantly reduce postoperative sufentanil consumption.

Effect of intervertebral foramen area and width on postoperative pain relief in patients with cervical spondylotic radiculopathy

ObjectiveThis study aims to investigate the relationship between preoperative cervical intervertebral foramen width and area and the persistence of postoperative pain in patients diagnosed with cervical spondylotic radiculopathy (CSR).MethodsPatients were divided into two groups, based on their pain relief at the 6-month postoperative follow-up: the pain relief group and the persistent pain group. We compared various parameters, including age, sex, body mass index (BMI), duration of symptoms, preoperative Japanese Orthopedic Association (JOA) score, Neck Disability Index (NDI) score, postoperative ratio of disc space distraction, preoperative width of the intervertebral foramen (WIVF), and area of the intervertebral foramen (AIVF) between the two groups. Binomial logistic regression analysis was conducted to identify the factors affecting pain relief.ResultsSignificant differences were observed in preoperative WIVF, AIVF, duration of symptoms, preoperative NDI scores, and the ratio of disc space distraction between the two groups (all P < 0.05). Regression models indicated that symptom duration, preoperative NDI score and ratio of disc space distraction were negatively associated with pain relief, whereas preoperative WIVF and AIVF were positively associated with pain relief.ConclusionPreoperative WIVF and AIVF may be linked to persistent postoperative pain in patients with CSR.

Effect of virtual reality intervention on hospitalized patients with acute pain after thoracoscopic surgery: a pilot randomized clinical trial.

The study investigates the effectiveness of immersive virtual reality (VR) as a nonpharmaceutical approach to manage postoperative pain in patients following thoracoscopic surgery. In this single-center, triple-arm pilot randomized controlled trial (RCT), 61 postsurgical patients with a postoperative pain numerical rating scale (NRS) score ≥4 after receiving standard analgesia were included and assigned to either a quantum clinics-VR (QTC-VR) group, a Placebo-VR group, or a control group. The QTC-VR group engaged in a daily 10-minute interactive pain relief 3D-VR program, while the Placebo-VR group watched a daily 10-minute relaxation-based 2D film through VR headsets for three days following surgery. 61 postsurgical patients were randomized and allocated (21 in the QTC-VR group, 20 in the Placebo-VR group, and 20 in the control group) in the final intention-to-treat (ITT) analyses. Compared with patients receiving Placebo-VR intervention, patients reported significantly lower pain scores following the daily QTC-VR intervention on postoperative days 1 (mean difference,-0.889; 95% CI,-1.464 to -0.314; P < 0.001), 2 (mean difference,-0.631; 95% CI,-1.211 to -0.051; P =0.014), and 3 (mean difference,-0.798; 95% CI,-1.345 to -0.251; P < 0.001), respectively. Additionally, patients receiving QTC-VR intervention also reported high satisfaction and tolerable adverse events with their treatment. In conclusion, this pilot RCT demonstrates that QTC-VR might be a promising intervention for pain management post-thoracoscopic surgery, warranting further validation in ongoing phase III trials.

Analysis of feasibility, effectiveness and safety of transvaginal natural orifice transluminal endoscopic surgery(vNOTES) of ectopic pregnancy: a retrospective study

BackgroundvNOTES has been documented as a viable approach for conducting benign gynecologic surgery; however, its application in ectopic pregnancy cases remains relatively scarce. The principal objective of this investigation was to assess the practicability, effectiveness, and safety of vNOTES in surgical procedures related to ectopic pregnancy.MethodsClinical data pertaining to patients diagnosed with ectopic pregnancy at Beijing Hospital between January 2018 and August 2023 were retrospectively collected (This study retrospectively registered with the China Clinical Trial Registry with the registration number ChiCTR2100052223 in September 22, 2021.). Based on the surgical technique employed, participants were categorized into two groups: the vNOTES group (29 cases) and the conventional laparoscopy (CL) group (34 cases). The baseline data, including age, body mass index (BMI), parity, and maximum diameter of pregnancy objects, were collected and analyzed, along with intraoperative indicators such as operation time and intraoperative blood loss, and postoperative indicators including postoperative exhaust time, hospital stays after surgery, and postoperative pain score at 24 h.ResultsA total of 73 patients were included in this study, and all surgeries in both groups were performed according to the assigned procedures. There were no statistically significant differences observed in operation time, intraoperative blood loss, and hospital stays between the vNOTES group and the CL group (P > 0.05). However, the vNOTES group exhibited significantly lower postoperative exhaust time and 24-hour VAS scores compared to the CL group (P < 0.05).ConclusionsvNOTES proves to be a safe and effective approach for performing conservative tubal festration or salpingectomy in cases of tubal pregnancy. Furthermore, vNOTES offers a more minimally invasive surgical technique, resulting in reduced postoperative pain in patients.

Multimodal Pain Recognition in Postoperative Patients: Machine Learning Approach.

Acute pain management is critical in postoperative care, especially in vulnerable patient populations that may be unable to self-report pain levels effectively. Current methods of pain assessment often rely on subjective patient reports or behavioral pain observation tools, which can lead to inconsistencies in pain management. Multimodal pain assessment, integrating physiological and behavioral data, presents an opportunity to create more objective and accurate pain measurement systems. However, most previous work has focused on healthy subjects in controlled environments, with limited attention to real-world postoperative pain scenarios. This gap necessitates the development of robust, multimodal approaches capable of addressing the unique challenges associated with assessing pain in clinical settings, where factors like motion artifacts, imbalanced label distribution, and sparse data further complicate pain monitoring. This study aimed to develop and evaluate a multimodal machine learning-based framework for the objective assessment of pain in postoperative patients in real clinical settings using biosignals such as electrocardiogram, electromyogram, electrodermal activity, and respiration rate (RR) signals. The iHurt study was conducted on 25 postoperative patients at the University of California, Irvine Medical Center. The study captured multimodal biosignals during light physical activities, with concurrent self-reported pain levels using the Numerical Rating Scale. Data preprocessing involved noise filtering, feature extraction, and combining handcrafted and automatic features through convolutional and long-short-term memory autoencoders. Machine learning classifiers, including support vector machine, random forest, adaptive boosting, and k-nearest neighbors, were trained using weak supervision and minority oversampling to handle sparse and imbalanced pain labels. Pain levels were categorized into baseline and 3 levels of pain intensity (1-3). The multimodal pain recognition models achieved an average balanced accuracy of over 80% across the different pain levels. RR models consistently outperformed other single modalities, particularly for lower pain intensities, while facial muscle activity (electromyogram) was most effective for distinguishing higher pain intensities. Although single-modality models, especially RR, generally provided higher performance compared to multimodal approaches, our multimodal framework still delivered results that surpassed most previous works in terms of overall accuracy. This study presents a novel, multimodal machine learning framework for objective pain recognition in postoperative patients. The results highlight the potential of integrating multiple biosignal modalities for more accurate pain assessment, with particular value in real-world clinical settings.

Postoperative pain in primary root canal treatments after Er: YAG laser-activated irrigation: a systematic review and meta-analysis.

This systematic review aimed to compare postoperative pain in endodontic treatments using PIPS Er: YAG laser-activated irrigation (LAI) versus conventional needle irrigation. An electronic search was conducted to identify randomized clinical trials (RCT) investigating postoperative pain in patients who underwent root canal treatments in permanent teeth using PIPS Er: YAG laser-activated irrigation or conventional needle irrigation. Two reviewers performed study selection, data extraction, risk of bias assessment (RoB 2.0 tool), and the certainty of evidence (GRADE). The meta-analyses were conducted using Review Manager software (p ≤ 0.05). The mean difference (MD) was chosen as the effect measure, and a random-effect model was employed, along with a 95% confidence interval (CI). The search identified 2864 records, and after selecting, three RCTs were included in the quantitative analysis. The meta-analysis showed a difference in postoperative pain according to the evaluation time. The subgroup meta-analysis revealed that the PIPS Er:YAG showed a significant reduction in the postoperative pain in the 48 hours (MD = -0.78; 95% CI [-1.39, -0.17]; p = 0.01; I² = 69%) compared to the control group. However, no statiscally significant results were found when assessing postoperative pain after 1, 3 and 7 days (95% CI; p > 0.05). The PIPS Er: YAG laser-activated irrigation reduced postoperative pain at 2 days following primary endodontic treatment. However, the certainty of the evidence is low and further RCTs are needed to confirm these results and avoid bias and confounding factors. Registration: PROSPERO registration number: CRD42023432499.

The influence of high doses of vitamin C on functional recovery and postoperative pain in patients with trochanteric fracture after intramedullary nailing during a three-month follow-up: a pilot study

&amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Aim&amp;lt;/strong&amp;gt; To determine the effects of high peri- and postoperative doses of vitamin C administration on severity of pain in postoperative period and functional outcome of the patients with trochanteric fracture treated with intramedullary nailing during a three-month follow-up.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Methods&amp;lt;/strong&amp;gt; A prospective, randomized, pilot study included 56 patients who were randomly divided into vitamin C (intervention) and control groups. In the intervention group, patients received vitamin C perioperatively by an intravenous route for 2 days, and oral vitamin C for 38 days postoperatively. Baseline characteristics, postoperative metamizole consumption, Visual Analogue Scale (VAS) score, Harris Hip Score (HHS) value, and the prevalence of complications were evaluated in both groups.&amp;amp;nbsp;&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Results&amp;lt;/strong&amp;gt; No significant differences were noted between the groups regarding age, gender, length of hospitalization, and distribution in fracture type. Postoperative metamizole consumption was notably higher in the control group compared to the vitamin C group (p=0.006). Postoperative VAS score was higher in the control group (p&amp;amp;lt;0.05). No significant differences in HHS values were detected between the groups at 6 and 12 weeks postoperatively (p=0.655 and p=0.755, respectively). The group variable significantly contributed to VAS score, and age and gender variables significantly contributed to HHS value.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Conclusion&amp;lt;/strong&amp;gt; A significant reduction of subjective pain levels and lower analgesic consumption was found in patients who received vitamin C, suggesting that it should be considered as an adjuvant agent for analgesia in patients with hip fracture.&amp;lt;/p&amp;gt;

Comparison of effect of perioperative infusion of lidocaine vs dexmedetomidine on post-operative pain in patients undergoing laparoscopic cholecystectomy

Comparison of effect of perioperative infusion of lidocaine vs dexmedetomidine on post-operative pain in patients undergoing laparoscopic cholecystectomy

Pain management in percutaneous nephrolithotomy - an approach rooted in pathophysiology.

Pain related to percutaneous nephrolithotomy (PCNL) is multifactorial and poorly elucidated. However, understanding the pathophysiology of pain can enable a practical approach to pain management, which can be tailored to each patient. A number of potential mechanisms underlie pain perception in PCNL, and these mechanisms can be leveraged at various points on the perioperative care pathway. These interventions provide opportunities for modulation of pain associated with PCNL but must take into account various technical, pharmacological and patient-related considerations. Technical considerations include the influence of percutaneous access, stone removal and drainage techniques. Pharmacological aspects include the use of various analgesics and anaesthesia approaches. Patient factors include consideration of the biopsychosocial model in pain experience to understand each individual's response to pain. By understanding the contemporary evidence surrounding the physiology of postoperative pain and identifying tangible intervention points, we can seek to mitigate postoperative pain in patients undergoing PCNL.

The Effects of Magnesium Sulfate on Postoperative Pain in Patients Undergoing Lumbar Spinal Surgery: A Systematic Review of Randomized Controlled Trials

The Effects of Magnesium Sulfate on Postoperative Pain in Patients Undergoing Lumbar Spinal Surgery: A Systematic Review of Randomized Controlled Trials

An observational study to evaluate the utility of surgical plethysmographic index as a tool to predict postoperative pain in patients receiving oral calcium channel blocker therapy

Abstract Background and Aims: Surgical plethysmographic index (SPI) is a monitoring parameter used to predict postoperative pain. Our primary objective was to determine whether the value of SPI obtained 10 min before expected completion of surgery can be used as a reliable tool to predict postoperative pain in patients receiving oral calcium channel blocker (CCB) therapy for hypertension. Our secondary objective was to determine if SPI can be used as a tool to predict awakening of the patient from anesthesia. Materials and Methods: Seventy patients on CCB were enrolled. SPI values at 10 min before the anticipated end of the surgical procedure were recorded. The mean value of 10 readings was calculated and used as the SPI score for the patient. The time that anesthetic was cut off till the time of extubation was taken as the time of awakening. Numerical rating pain scale assessed the patient’s level of postoperative pain 15 min after extubation. Thirty-five patients not on CCB were studied similarly to serve as controls. Data obtained were analyzed using Statistical Package for the Social Sciences version 28 for Windows through the Department of Medical Statistics. P value less than 0.05 was considered significant. Results: In patients on CCB, based on the r value, a positive correlation was noted between the mean SPI and NRS values on scatterplot (P = 0.009). In patients not on CCB, a positive correlation was noted between mean SPI and NRS. In both groups, a negative correlation was noted between mean SPI and awakening time, which was not significant. Conclusions: In patients receiving oral CCB, SPI values obtained 10 min before expected completion of surgery can be a reliable tool to predict postoperative pain, but not to predict awakening from anesthesia.

The efficacy of acupuncture in relieving postoperative pain in patients with low simple anal fistula: Protocol of a prospective, randomised, controlled trial.

Anal fistula surgery often leads to postoperative pain, which can hinder recovery and negatively impact patients' quality of life. This prospective, randomised, controlled trial (RCT) aims to investigate the efficacy of acupuncture in alleviating postoperative pain and reducing the usage of analgesic medications following anal fistula surgery. This single-centre, patient-blinded, assessor-blinded, placebo-controlled randomised controlled trial (RCT) will be conducted at a tertiary referral hospital. A total of 66 patients with low simple anal fistula will be randomised at a 1:1 ratio to receive either acupuncture or sham acupuncture. The primary outcome is the difference in the numerical rating scale (NRS) pain score before and after acupuncture at 6 hours post surgery. The secondary outcomes include postoperative analgesic usage (Day 0 to Day 7), complications (including infection, urinary retention, and bleeding from Day 0 to Day 7, as well as delayed wound healing and recurrence within 3 months post surgery), sleep quality (PSQI from Day 0 to Day 7), psychological state (SDS and SAS on Day 0, Day 1, and Day 7), and overall recovery quality (QoR-15 on Day 1, Day 3, and Day 7). The statistical analysis of this trial will be conducted using SPSS software, validating the normality of data and the homogeneity of variance, and employing t-tests, Mann-Whitney U tests, chi-square tests, and repeated measures ANOVA to analyze baseline data, primary and secondary outcome indicators. This study aims to contribute to the expanding evidence base regarding the role of acupuncture in postoperative pain management. Through a comprehensive assessment of pain relief, analgesic usage, and other recovery-related outcomes, our findings will establish a foundation for standardizing acupuncture protocols specifically tailored for anal fistula surgery patients. The strengths of this trial are rooted in its rigorous randomised controlled trial (RCT) design, comprehensive outcome measures, and focused examination of a clinically significant issue. Ultimately, the findings of this trial have the potential to offer valuable insights into the utility of acupuncture as an adjunctive therapy for postoperative pain management among anal fistula patients, thereby informing future clinical practice and research directions. This study was registered in the China Clinical Trial Registry on June 1, 2024, with registration number: ChiCTR2400085178.

Liver Bed Infiltration With Isobaric Levobupivacaine Versus Intravenous Paracetamol Analgesia for Postoperative Pain Management in Patients Undergoing Laparoscopic Cholecystectomy.

Objectives The study aimed to compare the use of isobaric levobupivacaine for liver bed infiltration and intravenous analgesia with paracetamol (acetaminophen) in managing postoperative pain in patients undergoing laparoscopic cholecystectomy. Methods An observational study was conducted on 80 patients scheduled for elective laparoscopic cholecystectomy. Inclusion criteria comprised adults of American Society of Anesthesiologists grade I, aged 18-65, undergoing elective surgeries. Exclusion criteria were contraindications to local anesthetics, history of chronic pain disorders, or ongoing opioid therapy. Participants were divided into two groups: Group LBreceiving 30-40 ml 0.5% isobaric levobupivacaine for liver bed infiltration, and Group Preceiving paracetamol 1 g intravenous during surgeryjust after removing the gallbladder out of the laparoscopic port. Primary outcomes included pain scores assessed using the visual analog scale (VAS) at one hour, six hours, 12 hours, 18 hours, and 24 hours postoperatively. Secondary outcomes included the total analgesic consumption, patient satisfaction scores, and any adverse effects experienced. Results In Group LB, the VAS scores showed a declining trend, starting at 6.4 ± 0.8 at one hour and decreasing to 4.5 ± 1.5 at six hours, 4.1 ± 1.7 at 12 hours, 2.6 ± 1.3 at 18 hours, and 1.3 ± 0.6 at 24 hours. In Group P, the VAS scores alsodecreased, beginning at 7.2 ± 1.1 at one hour, then dropping to 5.2 ± 1.2 at six hours, 4.8 ± 1.1 at 12 hours, 3.2 ± 0.9 at 18 hours, and 1.8 ± 0.5 at 24 hours. However, statistically, VAS scores were significantly lower in Group LB as compared to Group P at all time points: one hour, six hours, 12 hours, 18 hours, and 24 hours (p<0.05). Group LB demonstrated significantly better outcomes compared to Group P, including a longer time to first rescue analgesia (12 vs. five hours, p<0.0001), a reduced dose of additional analgesic requirement (3 ± 1 vs. 6 ± 2 µg/kg, p<0.0001), and higher patient satisfaction (38 (95%) vs. 23 (57.5%), p=0.0001). The incidence of nausea (3 (7.5%) vs. 6 (15%), P=0.481) and vomiting (5 (12.5%) vs. 8 (20%), p=0.363) was comparable between Group LB and Group P. Conclusion The use of levobupivacaine for liver bed infiltration provided adequate pain relief following laparoscopic cholecystectomy in comparison to paracetamol intravenous analgesia. Side effects like nausea and vomiting were statistically comparable in both groups. Overall, levobupivacaine for liver bed infiltration is a safe and effective option for controlling painand increasing satisfaction among patients undergoing laparoscopic cholecystectomy.

Effects of a Very Low Dose Naloxone Addition to Intraoperative Remifentanil Infusion on Postoperative Pain in Patients Undergoing Total Hip Replacement Surgery: A Randomized Clinical Trial

Background: The objective of this study was to assess the effect of adding a very low dose of naloxone to a remifentanil infusion on postoperative pain in patients undergoing hip replacement surgery in the lateral position. Methods: This randomized clinical trial involved 80 patients who underwent hip replacement surgery under general anesthesia and were randomly assigned into two groups through block randomization: group 1 received remifentanil at a dose of 0.3 μg/kg/minute, while group 2 received remifentanil at a dose of 0.3 μg/kg/minute with a very low dose of naloxone administered at 0.05 μg/kg/hour following injection. Postoperative pain [measured using the visual analog scale (VAS)], drowsiness caused by narcotics and analgesics in recovery, and the duration of getting out of bed were all monitored and recorded in the ward. Results: The median [interquartile range (IQR)] of time to administration of the first sedative drug was 0 (0, 4) hours in the control group and 4 (0, 4) hours in the intervention group. The difference between the groups was statistically significant (P &lt; 0.0001). The frequency of pain after surgery at 0, 4, and 8 hours was significantly different between the control and intervention groups (P = 0.003, P &lt; 0.0001, and P = 0.021, respectively). Conclusion: Based on the results, we recommend using a very low dose of naloxone along with remifentanil infusion in patients undergoing complete hip replacement surgery to reduce their pain and the need for painkillers

Impact of Demographics and Psychological Factors on Three-Day Postoperative Pain Perception Following Hand Surgery

Background: Effective pain management is crucial for both comfort and outcomes, yet predicting and managing this pain is difficult. This study aimed to analyze postoperative pain in patients undergoing hand surgery at the Mayo Clinic Florida, examining how patient characteristics and anxiety affect pain outcomes. Methods: We conducted a single-arm clinical trial at Mayo Clinic Florida, recruiting patients undergoing hand surgery. Preoperative pain and anxiety were assessed using the Pain Catastrophizing Scale (PCS) and State-Trait Anxiety Inventory (STAI). Postoperatively, patients used an iPhone app to record pain levels and medication use every four hours. Devices were collected three days after surgery. We analyzed the relationship between demographics, PCS, STAI scores, and pain levels using linear and logistic regression models. All statistical tests were two-sided with significance set at p &lt; 0.05, analyzed with R4.2.2. Results: Data were collected from 62 patients (62.9% women, 37.1% men) undergoing hand surgery. Participants were mainly White (90.3%), with 50% being in the middle-aged adult group. Most had low anxiety levels (80.6% STAI-S, 82.3% STAI-T) and low catastrophizing (61.3% PCS). Postoperative pain was low, with median scores between 1.0 and 2.0 over three days. Demographics, anxiety, and catastrophizing were not significant predictors of pain levels. Logistic regression showed time as a significant factor, with pain levels peaking on Day 3. Conclusions: Postoperative pain after hand surgery was generally low, with time being a significant predictor of increased pain. Demographic factors, anxiety, and catastrophizing did not significantly affect pain levels. Pain management should emphasize time-sensitive interventions and ongoing monitoring.

Medial meniscus posterior root tears with advanced osteoarthritis or subchondral insufficiency fracture are good indications for unicompartmental knee arthroplasty at a minimum 2-year follow-up

IntroductionThe outcomes of unicompartmental knee arthroplasty (UKA) in the presence and absence of medial meniscus posterior root tears (MMPRTs) have not been compared. This study compared the characteristics and clinical outcomes of patients undergoing UKA with and without MMPRTs.Materials and methodsThis study analyzed 68 patients. The presence or absence of MMPRTs was evaluated using preoperative magnetic resonance imaging. Patient characteristics, clinical scores before surgery and at the final evaluation, and imaging findings were compared between patients with and without MMPRTs. Multiple regression analysis was conducted on postoperative visual analog scale (VAS)-pain scores.ResultsMMPRTs were present in 64.7% (44/68) of patients. Patients with MMPRTs were significantly younger (67.8 ± 8.2 vs. 75.0 ± 7.1 years, p < 0.001) and had a shorter duration from the development of symptoms to the time of surgery than those without (6.8 ± 8.4 vs. 36.1 ± 38.9 months, p < 0.001). Component placement or lower-limb alignment did not significantly differ between the groups. Preoperative clinical scores were not significantly different between the groups; however, patients with MMPRTs showed significantly better postoperative VAS-pain scores than those without (10.0 ± 9.0 vs. 28.2 ± 26.0 points, p = 0.026). Multiple regression analysis of postoperative VAS-pain scores revealed the significant effect of duration from the development of symptoms to the time of surgery (p = 0.038).ConclusionsPatients undergoing UKA with MMPRTs were younger with less radiographic osteoarthritic changes compared to those without MMPRTs, and their postoperative VAS-pain scores were significantly superior. The duration from the development of symptoms to the time of surgery significantly influenced postoperative pain in patients undergoing UKA.

Effectiveness of Lidocaine with Epinephrine Irrigation in Reducing Acute Pain from Surgical Removal of Mesioangular-Impacted Third Molars.

Anesthetic irrigation is an effective treatment for postoperative pain suppression in patients after molar extraction, but exerts a short period of extraction. The study aimed to evaluate the effect of lidocaine with epinephrine irrigation on acute pain relief in healthy volunteers with inferior alveolar nerve block (IANB) injection for the surgical removal of mesioangular (MA)-impacted third molars. A total of 28 patients (56 samples) with bilateral MA-impacted third molars were recruited. This study was a split-mouth, double-blind, randomized clinical trial. Surgical procedures were conducted over two separate appointments. Each patient randomly received 2% lidocaine with 1:100,000 epinephrine for the irrigation of the extraction site after surgery on one side of the mouth and normal saline solution on the other side. The postoperative visual analog scale (VAS) as a pain indicator was recorded and statistically analyzed for both treatments. The VAS levels at 3 and 4 h after surgery in the lidocaine group were significantly lower than those of the normal saline group. Increases in pain scores were recorded five hours after surgery in both groups. No complications were recorded during this study. Continuous local anesthetic irrigation appears to be effective in reducing acute postoperative pain in patients with IANB for MA-impacted third molar surgery. Reference number ISRCTN13866362, Date: 1 October 2024.

Analgesic effect of external oblique intercostal block in laparoscopic cholecystectomy: A retrospective study.

The aim of this study was to assess the impact of the external oblique intercostal block (EOIB) on early postoperative pain in patients who underwent laparoscopic cholecystectomy. 120 patients were divided into two groups: the EOIB group (Group E) and the control group (Group C). The assessed variables were mainly intraoperative remifentanil usage, numerical rating scale (NRS) pain scores at 0, 1, 2, 4, 6, 12, and 24 h postoperatively, cumulative fentanyl consumption within 24 h postoperatively and within the first-hour post-anesthesia care unit. Remifentanil consumption during surgery was significantly reduced in Group E compared to Group C. Postoperative fentanyl requirements were also lower in Group E at 1 and 24 h after surgery. Furthermore, Group E demonstrated significantly lower NRS scores at 0, 1, 2, 4, and 6 h postoperatively and a reduced need for rescue analgesia compared to Group C. However, at 12 h post-surgery, Group E's NRS scores were slightly higher than Group C's. The EOIB is associated with reduced pain within the first 24 postoperative hours following laparoscopic cholecystectomy.

Postoperative pain management in patients with preexisting opioid dependence-A scoping review protocol.

Opioid-dependent patients with chronic pain conditions present a significant challenge for anesthesiologists when managing acute postsurgical pain. Opioid-dependent patients can experience tolerance, physical dependence, and hyperalgesia. These patients have an increased risk of poorly managed acute postoperative pain, which can ultimately lead to suffering and potentially an overall increase in length of hospitalization and healthcare cost. However, this is an under-researched field. This scoping review aims to investigate effective strategies in managing postoperative pain in patients with preexisting opioid dependence. A scoping review will be conducted on postoperative pain management in patients with preexisting opioid dependence. This review will be prepared according to the JBI methodology for scoping reviews and to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). We will conduct a comprehensive search across multiple databases. Backward citation searching of the final included articles will also be conducted. Data extraction will include trial and participant characteristics, intervention details, and reported outcomes. In the final review the results will be presented as a descriptive summary with supplementary tables, figures, and graphs where applicable. The planned scoping review will map out the current evidence about effective strategies to manage postoperative pain in patients with preexisting opioid dependence. We will aim to identify research gaps that can be used as support in the development of further research.

Preemptive Analgesic Efficacy of Parecoxib for Reducing Postoperative Pain in Patients Undergoing Gynecological Surgery

Objective: This study aimed to evaluate the effectiveness of preemptive parecoxib in reducing postoperative pain following gynecological surgery. Materials and Methods: A double-blind, randomized study involved 168 patients undergoing laparotomy gynecological procedures, including total hysterectomy, adnexal surgery, and surgical staging, between November2023 and July 2024. Patients were randomly assigned to receive either intravenous parecoxib (n = 82) or normal saline (n = 86) 15 minutes before surgery. Postoperative pain was measured using a visual analog scale at 2, 6, 12, and 24 hours. Morphine consumption within the first 24 hours post-surgery was recorded, along with any adverse events related to parecoxib and the length of hospital stay. Results: Mean pain scores at 2, 6, 12, and 24 hours postoperatively were lower in the treatment group compared to the control group (5.3 vs. 5.7, p = 0.261; 3.7 vs. 5.0, p &lt; 0.001; 3.3 vs. 5.1, p &lt; 0.001; 3.5 vs. 4.0, p = 0.164, respectively). The mean 24-hour postoperative morphine consumption was significantly lower in the treatment group (4 ± 8 mg vs. 8 ± 5 mg, p &lt; 0.001). No significant adverse events occurred between the groups. The total length of hospital stay was similar between the two groups (3.4 ± 1.8 vs. 3.5 ± 1.4 days, p = 0.698). Conclusion: Preemptive parecoxib significantly reduced pain at 6 and 12 hours post-surgery and reduced morphine use within 24 hours, with no significant effect on hospital stay duration in gynecological surgery.