Postoperative Pain Research Articles

Methadone or buprenorphine: which is the better analgesic for feline ovariohysterectomy?

Question In female cats undergoing routine ovariohysterectomy, is using methadone in the anaesthetic protocol associated with lower post-operative pain scores, compared to buprenorphine? Clinical bottom line The category of research question was: Treatment. The number and type of study designs that were critically appraised were: Four assessor-blinded randomised controlled trials. Critical appraisal of the selected papers meeting the inclusion criteria collectively provide zero/weak/moderate/strong evidence in terms of their experimental design and implementation: Moderate. The outcomes reported are summarised as follows… Two studies found methadone to be associated with significantly lower postoperative pain scores than buprenorphine; one showed significantly different pain scores over the entire 8-hour postoperative period and one only at 10 minutes postextubation. One study found buprenorphine to be associated with lower postoperative pain scores at some time points postsurgery. One study found no significant difference in pain scores between methadone and buprenorphine. In view of the strength of evidence and the outcomes from the studies the following conclusion is made… It can be concluded that using methadone in the anaesthetic protocol may provide better analgesia for cats undergoing ovariohysterectomy compared to buprenorphine. The two papers that used validated pain scoring both concluded that methadone was associated with lower pain scores at some points postoperatively. Although one of the studies concluded that buprenorphine is associated with lower postoperative pain scores, this paper provides only very weak evidence because an unvalidated pain scoring method was used. More evidence is needed to confidently recommend using one opioid over another.

Abstract 4145819: Reducing the Burden of the Opioid Epidemic by Adopting a Novel Pain Control Strategy Utilizing Pectoral Nerve Block in Adults Undergoing Transvenous Cardiac Device Implants

Introduction: Despite early mitigation efforts, the opioid pandemic in the United States has persisted and affected many Americans. A public health emergency was declared urging all prescribers to use caution in prescribing opioids. Alternative approaches to postoperative pain management during transvenous cardiac device implants (TCDI) in adults have not been described. Methods: We report a single-center retrospective analysis of 612 consecutive patients that underwent TCDI between January 2021 and January 2024 with ultrasound guided pectoral nerve block (PNB) using liposomal bupivacaine prior to implant for postoperative pain management. Pain scores (0-10) were recorded systematically in the postoperative period, at discharge, and at wound check follow-up. Any need for opioid use in the postoperative period was recorded as well. Results: A total of 612 patients were evaluated, 50% female with a mean age of 71.2 years. All patients received PNB successfully with no device site infection or hematomas. The mean Visualized Analog Scale (VAS) pain scores at 1, 3, and 5 hours after the procedure, at discharge, and at the follow-up visit were 1.93, 1.22, 1.10, 1.05, and 0.13 respectively. During follow-up, no patients required opioids for pain control throughout the entire postoperative period of 14 days. Conclusion: Pectoral nerve block with liposomal bupivacaine can be performed safely preoperatively during TCDI and provides adequate pain control without need for opioid use postoperatively. Further research is needed to assess broad scale implications of this approach to larger patient populations.

Abstract 4136561: Music therapy for postprocedural pain in patients undergoing cardiac surgery: a meta-analysis of randomized controlled trials

Background: Patients undergoing cardiac surgeries often experience significant levels of pain and anxiety, which can impair effective recovery. Music therapy has been proposed as a non-pharmacological intervention to alleviate these symptoms. This meta-analysis aimed to evaluate the effectiveness of music therapy in patients undergoing cardiac surgeries. Methods: We systematically searched PubMed, Embase, and Cochrane databases for randomized controlled trials (RCTs) analyzing music therapy in patients undergoing cardiac surgeries. We pooled mean differences (MD), and standardized mean differences (SMD) for continuous outcomes with 95% confidence intervals (CI) with a random-effects model. We performed a trial sequential analysis (TSA) to assess the random risk of pain, and conducted a subgroup analysis to compare heart and respiratory rate between children and adults. We used R version 4.3.2 and TSA version 0.9.5.10 for statistical analyses. Results: Our meta-analysis included 20 RCTs comprising 1379 patients, of whom 715 (51.9%) were randomized to music therapy. Compared with control, music significantly reduced postoperative pain (SMD -0.59; 95% CI: -0.76 to -0.41; p<0.05; Figure A), and anxiety (SMD -0.59; 95% CI: -0.74 to -0.44; p<0.05; Figure B). There was a significant difference between groups in heart rate (MD -5.68 bpm; 95% CI: -9.73 to -1.63; p<0.05), overall there was an important subgroup interaction between children and adults (p=0.01). In children, music therapy reduced the respiratory rate (MD -5.98 ipm; 95% CI: -6.71 to -5.25) compared to control, whereas in adults, no significant differences were observed among these groups, overall, there was a significant subgroup interaction (p<0.01). For the primary endpoint, TSA suggested a low risk of type 1 error, therefore these results may be conclusive. Conclusion: In patients undergoing cardiac surgery, music therapy reduced postoperative pain, anxiety, heart rate, and respiratory rate.

Urgent focus on enhanced recovery after surgery of AIDS patients with limb fractures

AimsThe incidence of limb fractures in patients living with HIV (PLWH) is increasing. However, due to their immunodeficiency status, the operation and rehabilitation of these patients present unique challenges. Currently, it is urgent to establish a standardized perioperative rehabilitation plan based on the concept of enhanced recovery after surgery (ERAS). This study aimed to validate the effectiveness of ERAS in the perioperative period of PLWH with limb fractures.MethodsA total of 120 PLWH with limb fractures, between January 2015 and December 2023, were included in this study. We established a multidisciplinary team to design and implement a standardized ERAS protocol. The demographic, surgical, clinical, and follow-up information of the patients were collected and analyzed retrospectively.ResultsCompared with the control group, the ERAS group had a shorter operating time, hospital stay, preoperative waiting time, postoperative discharge time, less intraoperative blood loss, and higher albumin and haemoglobin on the first postoperative day. The time to removal of the urinary catheter/drainage tube was shortened, and the drainage volume was also significantly reduced in the ERAS group. There was no significant difference in the visual analogue scale (VAS) scores on postoperative return to the ward, but the ERAS group had lower scores on the first, second, and third postoperative days. There were no significant differences in the incidence of complications, other than 10% more nausea and vomiting in the control group. The limb function scores at one-year follow-up were similar between the two groups, but time to radiological fracture union and time to return to physical work and sports were significantly reduced in the ERAS group.ConclusionThe implementation of a series of perioperative nursing measures based on the concept of ERAS in PLWH with limb fracture can significantly reduce the operating time and intraoperative blood loss, reduce the occurrence of postoperative pain and complications, and accelerate the improvement of the functional status of the affected limb in the early stage, which is worthy of applying in more medical institutions.Cite this article: Bone Joint Res 2024;13(11):647–658.

Comparative clinical efficacy of single-incision thoracoscopic bullectomy combined with C-shaped electrocautery pleurodesis vs. chemical pleurodesis in the management of spontaneous pneumothorax

ObjectiveThis study aims to observe the clinical efficacy of single-incision thoracoscopic bullectomy combined with C-shaped electrocautery pleurodesis compared to traditional iodine chemical pleurodesis in the treatment of patients with spontaneous pneumothorax.MethodsA total of 128 patients with spontaneous pneumothorax who underwent surgical treatment at our institution from January 2021 to December 2022 were selected. Patients were categorized into the study group (n = 65) and the control group (n = 63) based on the surgical method used. The study group received C-shaped pleura cautery for pleurodesis, while the control group underwent traditional iodine chemical pleurodesis. Surgical and clinical outcomes were evaluated, and recurrence rates within one year postoperatively were compared. Serum C-reactive protein (CRP) levels and visual analog scale (VAS) scores were measured at different time points.ResultsNo significant differences were observed between the two groups regarding surgical duration, intraoperative blood loss, or postoperative hospital stay (p > 0.05). However, the study group demonstrated significantly lower serum CRP levels and VAS scores on postoperative days 1 and 2, as well as reduced drainage volumes compared to the control group (p < 0.05). The recurrence rates of pneumothorax within one year postoperatively did not differ significantly between the groups (p > 0.05).ConclusionSingle-incision thoracoscopic bullectomy combined with C-shaped electrocautery pleurodesis is an effective treatment for spontaneous pneumothorax. Compared to traditional iodine chemical pleurodesis, this method causes less pleural irritation, results in lower postoperative pain and drainage, and facilitates patient recovery, making it a safe and reliable option for the management of spontaneous pneumothorax.

Comparative Efficacy of Postoperative Pain Management Techniques Following Costal Cartilage Harvest: A Systematic Review and Network Meta-analysis

Abstract Background Efficient pain control is essential in reconstructive surgeries, particularly in procedures involving the harvest of costal cartilage. This study examines and compares different pain relief treatments using a network meta-analysis (NMA) to determine the most effective techniques for managing pain. Methods We performed a systematic review and network meta-analysis (NMA) by scanning several databases such as PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), China National Knowledge Infrastructure (CNKI), Wanfang, and Weipu till March 18, 2024. The review analyzed randomized controlled trials and observational studies that evaluated the effectiveness of local anesthetics and multimodal analgesia techniques in treating postoperative pain following costal cartilage harvest. Primary outcomes were pain scores at 6-, 12-, 24-, and 48-h post-surgery, while secondary outcomes included the need for rescue analgesia and opioid-related adverse effects. Results Fourteen studies involving 935 participants were included. The analysis revealed that multimodal strategies, particularly ‘Methylene Blue and Ropivacaine Intercostal Nerve Block (MB & Ropivacaine ICNB) combined with Patient-Controlled Analgesia (PCA),’ were the most effective techniques to reduce pain scores across 6, 24, and 48-h time points. “Pre-operation SAPB & PSB + PCA” was most effective in reducing pain score at 12h and significantly decreased the need for rescue analgesia and opioid-related adverse effects. In contrast, traditional ICNB with single drug consistently showed the least efficacy. Conclusion The results of our study strongly support the use of multimodal analgesic techniques instead of typical single medication ICNB for managing postoperative pain after costal cartilage harvest. These strategies not only provide superior pain control but also contribute to reducing the dependency on opioids, aligning with current clinical priorities to enhance recovery and minimize opioid-related risks. No Level Assigned This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Effect of intravenous lidocaine on catheter‑related bladder discomfort, postoperative pain and opioid requirement in complex fusion lumbar spinal surgery: a randomized, double blind, controlled trial

Effect of intravenous lidocaine on catheter‑related bladder discomfort, postoperative pain and opioid requirement in complex fusion lumbar spinal surgery: a randomized, double blind, controlled trial

Continuation versus Interruption of Buprenorphine/Naloxone in Adult Veterans Undergoing Surgery: Examination of Postoperative Pain and Opioid Utilization in a National Retrospective Cohort Study

Background Prescription rates for buprenorphine in opioid use disorder are increasing, and recent guidelines recommend its continuation during and after surgery; however, evidence from clinical outcome studies is limited. We tested the hypotheses that 1) perioperative continuation of buprenorphine does not result in higher pain scores and 2) that this approach does not result in higher supplemental postoperative opioid requirements. Methods The Veterans Affairs Corporate Data Warehouse was queried for patients who underwent surgery while being prescribed buprenorphine/naloxone for opioid use disorder between 2010 and 2020. Analysis of the prescription record was used to infer buprenorphine management, and a 3:1 matched control set of patients without buprenorphine prescriptions was generated. We examined patients who continued buprenorphine, patients who had buprenorphine interrupted, and control patients. The primary outcome was time-weighted average postoperative pain scores from inpatient and outpatient sources within 72 hours of surgery. The secondary outcome was postoperative average daily morphine equivalent opioid requirements within two weeks of surgery. Results A total of 1,881 surgical procedures in 1,673 patients taking buprenorphine for opioid use disorder were included; these procedures were matched to 5,748 control patients (5,775 procedures) without a buprenorphine prescription. Among the 1,881 procedures, 1,186 (63%) continued buprenorphine through the perioperative period while 695 (37%) interrupted buprenorphine. Pain scores were clinically similar for all three groups (4.1 ± 1.9 control [n = 3284], 4.9 ± 2.0 continued buprenorphine [n = 662], and 5.5 ± 1.7 interrupted buprenorphine [n = 419]; P < 0.001).Patients who continued buprenorphine did not require significantly more supplemental opioids as compared to controls (39.7 mg morphine equivalents/day ± 1.9 versus 36.5 ± 0.7, P = 0.23), and patients who interrupted buprenorphine received more supplemental opioids than those who continued it (74.2 ± 4.5 mg morphine equivalents/day versus 39.7 ± 1.9,respectively; P < 0.001). Conclusions Continuation of buprenorphine is not associated with higher average pain scores or postoperative opioid requirements, supporting recently published guidelines.

Pain Control and Opioid Consumption in Patients Undergoing Total Hip or Knee Arthroplasty Receiving a Preoperative Low Dose of Gabapentin

Background: Meta-analyses and randomized controlled trials were inconclusive regarding the role of gabapentinoids in patients undergoing joint arthroplasties. The aim of the present study was to investigate the effect of a preoperative low dose of gabapentin in patients undergoing total hip (THA) and knee arthroplasties (TKA). Methods: A retrospective observational study was conducted on 135 patients undergoing THA and TKA at the National Orthopedic Hospital Cappagh, Dublin, from July to December 2022. The primary outcome was the assessment of numerical rating scores (NRS) for postoperative pain at various time intervals. Results: During the observation period, 55 patients received a preoperative dose of gabapentin, while 80 patients did not. Statistically significant differences in numerical rating scores (NRS) were found at 6 (3 vs. 0, p < 0.001), 12 (4 vs. 2, p < 0.001), 18 (4 vs. 3, p < 0.001), and 24 h (4 vs. 3, p = 0.010) after surgery, in favor of the group receiving gabapentin. A reduction in opioid consumption, measured as morphine equivalents, was also noted in the gabapentin group (40 vs. 30 mg, p = 0.040). Conclusions: A low preoperative dose of gabapentin was associated with reduced postoperative pain and opioid consumption in patients undergoing TKA and THA, without impacting hospital stay. Prospectively designed trials are encouraged to assess the safety and effect on pain control of a preoperative low dose of gabapentin.

QOL-27. PATIENT REPORTED OUTCOME AND PREFERENCE AFTER CRANIOTOMY AND LASER THERMAL ABLATION: A PILOT STUDY

Abstract BACKGROUND Laser interstitial thermal therapy (LITT) is a minimally invasive procedure that allows cytoreduction in the treatment of brain tumors and can be considered by both surgeons and patients as an alternative to craniotomy. OBJECTIVE We surveyed 27 patients who underwent both craniotomy and LITT during distinct stages of their oncology journey to assess patient reported outcomes comparing both procedures. METHODS A nine question survey was developed and validated to assess patient reported post-operative recovery, pain level, narcotic use, and procedure preference. The survey was administered to patients with WHO II-IV gliomas who underwent both craniotomy and LITT. RESULTS The survey was reviewed by independent surgeons, patient advocates, and patients in terms of face validity and showed >90% correlation in test-retest reliability. Our cohort had a mean age of 57 (+/- 12 years), 78% had glioblastoma. There was no significant difference in symptomatic improvement post-craniotomy or post-LITT (30% versus 4%, p=0.17). Similarly, no significance was detected in patient-reported recovery time from craniotomy (time required to return to pre-operative state, 4.3 +/- 9.1 weeks, median 2 weeks) or LITT (2 ± 2.3 weeks, median 1 week)(p=0.21). Notably, post-surgical pain (1-10 pain scale) and need for narcotic use in the first week (yes/no) after the procedure were significantly lower post-LITT (average pain score 1.7 versus 5 points, narcotic use 4% versus 81%, p<0.0005 for both comparisons). When asked which procedure they would choose – having experienced both craniotomy and LITT, surveyed patients overwhelmingly chose LITT over craniotomy (89% versus 11%, p<0.0005). Of note, the patients who preferred craniotomy experienced improved neurologic function post-craniotomy or suffered new deficits post-LITT. CONCLUSION In this pilot study, patients reported less pain and narcotic use post-LITT relative to craniotomy and generally preferred the former procedure if given the choice. Validation of these results in future studies can help inform decision making in clinical scenarios where there is equipoise between LITT and craniotomy.

Analgesic Efficacy of Transversus Abdominis Plane block vs Local Infiltration of Lignocaine and Bupivacaine in Post-operative Patients

Objective: To compare the effectiveness of Transversus Abdominis Plane (TAP) block vs Local Infiltration for pain management techniques in patients undergoing laparoscopic lower abdominal surgeries. Methodology: This cross-sectional study was conducted at the Department of Surgery, Lahore General Hospital, from March to May, 2024. It involved a total of 110 patients, divided into two groups of 55 each, between the ages of 20 to 60 years, diagnosed with indirect inguinal hernia by ultrasound. Chronic smokers, drug addicts, intravenous drug abusers, patients with a history of previous surgeries, with known drug allergies and with complicated hernia were excluded from this cross-sectional study. The Numerical Rating Scale (NRS) was used to see the pain variation and effectiveness of both techniques at 6, 12, 18 and 24 hours. Results: The mean age in the TAP Block Group was 32.0 ± 9.92 years, and the mean age in the Local Wound Infiltration Group was 34.21 ± 10.01 years. There were 108 (98.18%) male and 2(1.81%) female cases with a higher male-to-female ratio. The results indicated that the TAP Block group consistently required fewer rescue analgesic doses than the local wound Infiltration group at all postoperative time points. At 6 hours, 23.63% of patients in the TAP Block group needed additional analgesia, compared to 38.18% in the Wound Infiltration group, though this difference was not statistically significant. However, at 12, 18, and 24 hours, the TAP Block group showed a significantly lower need for rescue analgesia, with p-values of 0.002, and 0.008, respectively. Conclusion: In managing postoperative pain of Inguinal Hernia Repair, TAP Block is superior to Wound Infiltration of local anesthetic agent. After TAP Block NRS remains fewer and a smaller number of rescue doses are needed as compared to Wound infiltration.

Effectiveness of laser tonsillectomy compared to conventional cold steel tonsillectomy in children

Background: The Effectiveness of CO2 laser tonsillectomy is not conclusively known. The current study aimed to determine its effectiveness compared to the cold steel dissection for tonsillectomy in children. Methods: This interventional study was done in the Department of Otolaryngology of AL-Yarmouk Teaching Hospital, Baghdad, Iraq. It was done in 80 children eligible for tonsillectomy, evenly divided into cold steel dissection tonsillectomy (group A) and CO2 laser tonsillectomy (group B). The surgical outcomes of the two groups were analysed for operative time, intra-operative blood loss, post-operative pain, bleeding, tonsillar fossae sloughing, and the time taken to return to daily activity. Results: The CO2 tonsillectomy group showed better effectiveness in terms of operative time (37.6 versus 19.5 min), intra-operative blood loss (42.7 versus 15.8 mL), postoperative pain at days 1, 7 and 14), and tonsillar bed sloughing (25.0% versus 32.5%). However, primary and secondary postoperative haemorrhages were similar between the groups. Conclusions: Although the results are not generalisable, the CO2 laser tonsillectomy was more effective than the cold steel dissection tonsillectomy.

Liposomal Bupivacaine Versus Plain Bupivacaine for Pain Control Following Congenital Cardiac Surgery

Background Pain control following cardiac surgery can be challenging, and inadequate pain control is associated with postoperative complications. Liposomal bupivacaine can improve postoperative pain control due to its prolonged duration compared with plain bupivacaine. However, there is a paucity of data regarding its efficacy in congenital cardiac surgery. The primary outcome was to compare opioid requirements between liposomal bupivacaine and plain bupivacaine for local infiltration in pediatric patients undergoing cardiac surgical procedures via a median sternotomy approach. Secondary outcomes included antiemetic use, adjunct pain medication use, length of stay, and pain scores. Methods This single center retrospective study analyzed data from 2017 to 2022 involving patients who underwent congenital cardiac surgery via median sternotomy. Sixty-three patients who received liposomal bupivacaine were matched with 33 patients who received plain bupivacaine. Patient data were extracted from the electronic medical record and underwent statistical analysis using Wilcoxon, χ2, and Fisher exact tests. Results There were no demographic differences between the two groups. Postoperative opioid use did not differ significantly between the liposomal bupivacaine and plain bupivacaine groups. The liposomal bupivacaine group had increased acetaminophen and antiemetic use, while the plain bupivacaine group had increased ketorolac use. Otherwise, there were no significant differences in secondary outcomes, including length of stay. Conclusion Liposomal bupivacaine may not offer any advantage over plain bupivacaine in congenital cardiac postoperative pain control.

Advantages of the split-leg supine position single-port plus one laparoscopic surgery approach

The goal of this study was to compare the advantages of conventional laparoscopic surgery (CLS) and the split-leg supine position single-port plus one laparoscopic surgery (SSP SILS + 1) in esophageal surgery. This study enrolled 73 patients who previously underwent radical esophagectomy for esophageal cancer from August 2021 to February 2023. Among them, 36 patients underwent SSP SILS + 1, whereas the remaining 37 patients underwentCLS. Surgical time, bleeding volume, number of dissected lymph nodes, incision length, and postoperative abdominal pain score between the two groups of patients were compared using either the Student’s t-test or chi-square test. Time of abdominal incision (1.4 ± 0.2 min vs. 5.2 ± 0.7 min, p < 0.001) was shorter in patients in the SSP SILS + 1 group compared with those in the CLS group. However, the average incision length was shorter in the SSP SILS + 1 group compared with that in the CLS group (35.4 ± 4.0 cm vs. 4.6 ± 4.1 cm, p < 0.001). Notably, the pain score on postoperative day (POD) 1 was lower in the SSP SILS + 1 group compared with that in the CLS group (5.7 ± 0.7 vs.6.3 ± 0.7, p = 0.001). The SCAR score was also lower in the SSP SILS + 1 group compared with that in the CLS group (3.5 ± 0.9 vs. 8.3 ± 1.4, p = 0.019). There was no significant difference in the number of dissected abdominal lymph nodes and positive lymph nodes (p > 0.01) between the two groups. The SSP SILS + 1 intervention offers multiple benefits over conventional surgical procedures, encompassing shorter incision length and pain scores on POD 1. In accelerated rehabilitation surgery for esophageal cancer, this surgical procedure demonstrated high safety, feasibility.

Plasma Rich in Growth Factors Compared to Xenogenic Bone Graft in Treatment of Periodontal Intra-Osseous Defects—A Prospective, Comparative Clinical Study

Background: Periodontal intra-bony defects are challenging conditions in dental practice, often requiring regenerative approaches for successful treatment. This clinical study aimed to compare the effectiveness of plasma rich in growth factors (PRGF) versus xenogenic bone graft (BXG) in addressing intra-bony defects. Methods: Forty patients aged between 30 and 50 years presenting with generalized periodontitis were included. The study assessed various parameters, including relative attachment level (RAL); probing pocket depth (PPD); gingival marginal level (GML); intra-bony defect depth (IBDD) at baseline, 3, and 6 months; and level of pain, post-operative bleeding, and swelling, as patient-reported outcomes during the first seven days post operation. Results: The results revealed that both PRGF and BXG treatments led to significant reductions in IBDD over the 6-month study period. PRGF demonstrated significant advantages in GML enhancement and post-operative pain management during the initial post-treatment days. However, BXG showed a significantly greater reduction in IBDD compared to PRGF. Post-operative bleeding and swelling levels were comparable between the two treatments. Conclusions: These findings underscore the efficacy of both PRGF and BXG in periodontal regeneration, with treatment decisions guided by patient-specific factors and clinical goals.

Transrectus Extraperitoneal Versus Minimally Invasive Inguinal Hernia Repair: A Systematic Review and Meta-Analysis.

Purpose: Recent guidelines have recommended minimally invasive surgery (MIS) for unilateral inguinal hernia due to reduced chronic pain. The most performed approaches consist of posterior mesh placement by the transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) techniques. However, it remains debatable whether the advantage of those techniques stems from the MIS approach or posterior mesh placement or both. As the transrectus preperitoneal (TREPP) technique is an open option for posterior mesh placement, we conducted a systematic review and meta-analysis comparing TREPP and MIS techniques for groin hernia repair. Material and Methods: Cochrane, Embase, Scopus, Scielo, and PubMed were systematically searched for studies comparing TREPP and MIS techniques for groin hernia repair. Outcomes assessed were recurrence, cumulative surgical site occurrences (SSO), surgical site infection (SSI), and postoperative pain. Results: Twenty-nine studies were screened, and eight were thoroughly reviewed. Three studies were included, of which two compared TREPP with the TEP technique, and one compared TREPP with both TEP and TAPP techniques. We found lower SSI rates for the MIS approaches (0.61% versus 0.33%; risk ratios (RRs) 3.96; 95% confidence interval (CI): 1.04-15.16; P = .04). We did not find statistically significant differences regarding recurrence (2.42% versus 2.51%; RR 1.01; P = .98), postoperative pain (4.2% versus 6.4%; RR 0.61; P = .4), and SSO (4.2% versus 4.0%; RR 0.6; P = .43) between TREPP and MIS techniques. Conclusion: Our systematic review and meta-analysis found a lower SSI for the MIS repair but did not find differences regarding recurrence, SSO, and postoperative pain. More studies are required to provide a more accurate conclusion about this topic.

Ultrasound-guided anterior iliopsoas muscle space block compared with fascia iliaca compartment block in elderly hip surgery: A randomized controlled trial

Background: Elderly hip fracture patients experience severe pain. Surgical stress and pain during position changes for spinal anesthesia puncture can adversely affect hemodynamics. The objective of this study was to compare the perioperative analgesic efficacy of anterior iliopsoas muscle space block with supra-inguinal fascia iliaca compartment block (S-FICB) in elderly patients undergoing hip surgery. Method: In this randomized control trial, 66 patients were randomly assigned to either the iliopsoas space or the S-FICB group. Each patient received 30 mL of ropivacaine 0.375%. Perioperative pain scores were assessed and compared in both groups. The primary outcome was pain scores during changes in position for neuraxial anesthesia. Secondary outcomes included postoperative pain intensity, inflammatory markers for 12 to 24 hours, and perioperative adverse reactions. Results: The iliopsoas space group demonstrated a faster median block onset of 7 [6–8] minutes compared to S-FICB 14.50 [13–16] minutes (P &lt; .001). Neuraxial anesthesia position changes resulted in lower pain scores for iliopsoas 2 [1–2] versus S-FICB 3 [3–4] (P &lt; .001). Resting pain scores were similar at 12 hours post-surgery, but during exercise, the iliopsoas group had significantly lower scores [1–2] compared to S-FICB 4 [2–4] (P &lt; .001). After 24 hours, C-RP levels were lower in the iliopsoas group (14.86 ± 1.23 mg/L) than S-FICB (17.90 ± 1.25 mg/L) (P &lt; .001). The 2 groups differed from one another (P &lt; .001). These findings suggest that iliopsoas space block may offer faster, superior dynamic pain control, and potentially reduced inflammation compared to FICB block for postoperative pain management. Conclusion: In elderly hip fracture patients, the anterior iliopsoas space block works slightly better than S-FICB at providing effective perioperative analgesia.

Supporting prescriber progression: a group concept mapping study

Abstract Introduction Education reforms allow pharmacists to become prescribers earlier in their career and from 2026, new registrants will be independent prescribers.1 In NHS Scotland, an operational framework supports the development of pharmacist independent prescribing.2 We wanted to supplement the operational framework by identifying our core areas of prescribing to articulate prescribing progression and inform education and training provision. Aim To develop a core prescribing framework to support safe prescribing and a spiral approach to expanding scope of practice. Methods We conducted a participatory mixed-method approach using group concept mapping methodology.3 Phase 1 (brainstorming): all hospital pharmacists working in a patient-facing clinical role were invited to enter statements on a cloud-based platform (Padlet®) using the prompt ‘In my day-to-day practice I prescribe and/or make prescribing recommendations about the following medicines / conditions …’. The statements were triangulated with electronic inpatient pharmacist prescribing data over the previous three months. Phase 2 (sorting and rating): a project group comprised of pharmacists with different levels of practice and areas of clinical expertise, individually sorted the statements into groups based on the statements’ conceptual similarity and rated each statement by level of practice (post-registration foundation, advancing, advanced) and importance for including in a core framework (5-point Likert scale). R software applied multidimensional scaling to sorting data to create a similarity matrix, cluster map and Go-Zones. ChatGPT generated cluster titles. The project group discussed the results and following a few revisions, consensus was achieved on the content of the prescribing framework. This study was not considered research and was approved by the pharmacy quality improvement team in line with local governance process. Results Forty-three pharmacists participated in the brainstorming phase and generated 158 statements. Fourteen pharmacists participated in the sorting and rating phase. Multidimensional scaling analysis identified three clusters of prescribing activities: initiating, adjusting and deprescribing. The data identified activities involving initiating medicines and autonomous decision making rated at advancing/advanced level practice while adjusting/deprescribing medicines (often with the caveat of within guidelines, protocols or team decisions) was rated at post-registration foundation level. The prescribing framework includes the activities considered important and is organised by cluster and level of practice. Discussion / Conclusion This study provides a structured conceptualisation of prescribing across the levels of practice. The prescribing framework reflects the needs of our patients and hospital inpatient service and provides a scaffolded approach to progressing from inexperienced to more advanced prescribing roles. Post-registration foundation prescribing activities focus on processes or types of prescribing, whilst advanced are more autonomous and complex. Limitations we didn’t collect clinical area of practice as part of the demographic information for the brainstorming phase and some specialities may not be represented. Further work includes a training needs analysis and developing entrustable professional activities for core and higher risk areas of prescribing (e.g. post-operative pain).

Patient Experiences of Long-term Pain and Pain Management Following Pelvic Exenteration for Locally Recurrent Rectal Cancer: A Qualitative Study.

Although pain may persist for patients who undergo pelvic exenteration for treatment of locally recurrent rectal cancer, studies exploring patient experience of postoperative pain and its management remains limited. This study aimed to explore patient experiences of postoperative chronic pain and management following pelvic exenteration. Qualitative cohort study of patients who have undergone pelvic exenteration for locally recurrent rectal cancer. The study was conducted through one-on-one semi-structured telephone interviews. Seventeen patients with locally recurrent rectal cancer who underwent pelvic exenteration between January 2018 and December 2020 were included. Semi-structured interviews explored participants' experiences of pain including its impact on life and management strategies at six and twelve months following exenteration. Interview transcripts were analyzed by two researchers using inductive thematic analysis. Participant experiences of pain following exenteration are reflected by three themes identified: 1) adapting to long-term consequences of pelvic exenteration including pain, 2) reluctance to take pain medications, 3) engaging multidisciplinary care team is essential to post-pelvic exenteration chronic pain management. Several participants reported ongoing intermittent pain following surgery that significantly affected various aspects of their lives. This prompted participants to adapt their lifestyle and explore alternative pain relief methods as some were hesitant to rely on analgesics. The small sample size from a single center whereby all patients underwent curative pelvic exenteration for lower recurrent rectal cancer with none undergoing the procedure for palliation limits the generalizability of the results of this study. While chronic pain following pelvic exenteration for locally recurrent rectal cancer interferes with patient's postoperative quality of life, analgesia use was influenced by pain habituation and fear of dependence on pain medications. Our findings emphasize the further need to investigate a multidisciplinary approach, including non-pharmacological methods, for optimization of pain outcomes following pelvic exenteration. See Video Abstract.

Erratum to: Can preoperative quantitative sensory testing predict persistent post-operative knee pain following total knee replacement? A systematic review

Erratum to: Can preoperative quantitative sensory testing predict persistent post-operative knee pain following total knee replacement? A systematic review