Postoperative Pain Assessment Research Articles

Psychometric properties of the Bovine Pain Scale developed for postoperative pain assessment in the hospital setting

Psychometric properties of the Bovine Pain Scale developed for postoperative pain assessment in the hospital setting

Nonpharmacological interventions for managing postoperative pain and anxiety in children: A randomized controlled trial.

Hospitalizations and surgical procedures are unpleasant for both children and their parents. Therefore, postoperative pain assessments and management are less commonly performed in younger children than in adults. To evaluate the effects of nonpharmacological interventions on postoperative pain and anxiety in children. In this randomized controlled trial, 160 children were randomly allocated to experimental (n=80) and control (n=80) groups. The children in the experimental group received age-appropriate distraction interventions for 3 postoperative days along with usual care. Children in the control group received standard care only. Each patient's pain was assessed using the EVENDOL pain scale, while their anxiety was measured using the modified Yale Preoperative Anxiety Scale. The data were analyzed using SPSS 23.0. Descriptive statistics (frequency, percentage, mean, and standard deviation) and repeated-measures analysis of variance were used to analyze the data. The children in the experimental group showed significantly decreased pain, anxiety, and physiological parameters (heart rate, respiratory rate, and oxygen saturation) compared to those in the control group. Significant intergroup differences were noted in the mean and standard deviation values of the pain, anxiety, and physiological parameters. The distraction interventions provided by nurses reduced the pain and anxiety levels and improved the postoperative recovery of pediatric surgical patients.

Lasers efficacy in pain management after primary and secondary endodontic treatment: a systematic review and meta-analysis of randomized clinical trials

Postoperative pain is a common concern following root canal treatments (RCT), impacting both patients and oral health practitioners. This systematic review and meta-analysis aimed to evaluate the effectiveness of laser treatment modalities in reducing postoperative pain compared to conventional methods after primary and secondary RCT in permanent mature teeth. A search of three electronic databases (PubMed, ScienceDirect, and The Cochrane Library) was conducted, using a broad range of keywords and terms. Gray literature and manual searches were conducted to complement the search. The inclusion criteria included randomized clinical trials based on the objective of the secondary study. A minimum sample size of 10 participants per group and a clearly defined criterion for postoperative pain assessment were required. The characteristics of the included studies were presented as tables. The Cochrane collaboration tool RoB 2.0 was used to assess the risk of bias within each study. Two reviewers extracted the data and assessed the studies independently, and discrepancies were resolved through consultation with a third reviewer. A random-effects model was employed for meta-analysis to estimate the overall effect measure. Heterogeneity was evaluated using Cochran’s Q test and the I2 index. Publication bias was explored via Funnel plots and Egger’s test. Subgroup analyses and meta-regression were conducted to assess variations among laser methods and examine the influence of independent factors. The significance threshold for all analyses was set at 5% (α = 0.05). Intraoral laser therapy demonstrated no significant advantage over conventional treatments but consistently outperformed placebo, particularly from 4 to 72 h post-treatment. Low-level laser therapy provided slight pain reduction in the first 8 h, though its effectiveness diminished in retreatment scenarios. Photodynamic therapy and laser disinfection showed marginal benefits, especially shortly after treatment, with reduced efficacy in longer-term or retreatment contexts. Further research is needed to explore different applications of laser modalities and assess distinct prognostic factors in more detail.

Statistical analysis of total hip arthroplasty at rural hospital in Maharashtra under MJPJAY: a prospective study

Background: Total hip arthroplasty (THA) is one of the most common orthopedic surgeries globally, particularly in Western countries. In India, its prevalence has increased over the last two decades. However, most data on THA are from Europe and the United States. This study analyzes the clinical and demographic characteristics of patients undergoing uncemented THA at a rural hospital in Maharashtra, India, under the Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY). Methods: A prospective study was conducted in the Department of Orthopedics at Mahatma Gandhi Institute of Medical Sciences, Sevagram, from January 2020 to October 2022. A total of 123 patients (130 hips) who underwent uncemented THA, were included. Patients were categorized by age, gender, and primary indication for surgery. Preoperative evaluations, radiographic analysis, and postoperative follow-ups assessment of pain, range of motion, and complications were done. Results: The mean age of patients was 40.32±12.53 years, with males (85.36%) outnumbering females (14.64%). Bilateral hip involvement was seen in 56.9% of cases and osteonecrosis of the femoral head was the most common indication (89.23%), with 57.6% idiopathic, 12.3% alcohol-related and 6.1% steroid-induced. The complication rate was 3.8%, with dislocation being the most frequent (2.1%). Revision surgeries performed in 2.1% of cases. Conclusions: THA under MJPJAY demonstrates comparable clinical outcomes to international standards. Idiopathic osteonecrosis remains the leading cause, with a male predominance. Standardized protocols for the Indian population are needed.

A Review on the Use of Physiological Signals for Assessing Postoperative Pain

The assessment of pain intensity after surgery is important for guiding pain management. Due to the limitations of current pain evaluation tools, there is increasing interest in using objective methods to assess pain in clinical settings. This literature review aims to provide an overview of physiological methods for postoperative pain evaluation. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines were followed to perform a literature search on the Scopus database from 2002 to March 2024. Sixty-one studies were included in this review investigating parameters derived from six physiological signals, including Electrocardiogram (ECG), Photoplethysmogram (PPG), Skin Conductance (SC), Electroencephalogram (EEG), Electromyogram (EMG), and pupil size and reflexes. Parameters extracted from ECG, PPG, and SC signals were the most commonly studied. While there is evidence to support the use of physiological parameters as measures for postoperative pain evaluation, further research is needed to establish the reliability and generalizability of these parameters to develop an indicator that can be consistently applied across various clinical settings. For this purpose, this review describes current research findings and identifies limitations and directions for future work that should be considered in upcoming research on postoperative pain assessment.

Use of butorphanol as a local anaesthetic for pain management in calves undergoing umbilical hernia repair.

The aim of the study was to compare the analgesic efficacy of butorphanol and lidocaine, alone or in combination, in calves undergoing surgical repair of umbilical hernia. The study was conducted in 60 calves of different breeds. Xylazine 0.3 mg/kg was administered intramuscularly to all animals in the study. The animals were then divided into three groups (n = 20) that received different treatments with lidocaine at 4.5 mg/kg and butorphanol at 0.02 mg/kg. The L group received lidocaine both by infiltration of the surgical planes and intraperitoneally, the B group received butorphanol both by infiltration of the surgical planes and intraperitoneally, and finally the LB group received lidocaine by infiltration of the surgical planes and butorphanol intraperitoneally. Heart and respiratory rates, haemoglobin oxygen saturation, non-invasive blood pressure and temperature were recorded during surgery. Response to the surgical stimulus was scored on a cumulative numerical scale that included percentage changes in HR, RR and SAP. Postoperative pain was assessed by three independent observers, blinded to treatment, using the UNESP-Botucatu Unidimensional Composite Pain Scale (UNESP-Botucatu UCPS-IV) for the assessment of postoperative pain in cattle. The course of physiological variables was appropriate for patients under anaesthesia. No subject required rescue intraoperative analgesia. In group L, 4 subjects at 40 m and 5 subjects at 50 m required postoperative rescue analgesia. Both butorphanol alone and the combination of butorphanol and lidocaine showed excellent intraoperative and postoperative scores. Furthermore, this combination did not cause any cardiopulmonary or other adverse effects. Based on the results of this study, both butorphanol alone and the co-administration of butorphanol and lidocaine administered locally proved to be safe and effective in providing adequate and long-lasting analgesia in calves, helping to reduce postoperative discomfort and maintaining adequate animal welfare.

A Novel Transverse Ultrasound-Guided Approach for Puncturing the Cervical Dorsal Root Ganglion at the Level of Articular Pillar for Radiofrequency Treatment.

Currently, minimally invasive intervention surgery for cervical spondylotic radiculopathy mostly involves the use of cervical dorsal root ganglion (DRG) block or radiofrequency modulation therapy. Here, we proposed a novel transverse ultrasound-guided approach for puncturing the cervical dorsal root ganglion at the level of joint column for radiofrequency treatment. A retrospective analysis of the clinical data of 30 patients with cervical spondylotic radiculopathy admitted to the Pain Department of Taihe Hospital Affiliated with Hubei Medical University from January 2021 to March 2024 was performed. During surgery, motor electrical stimulation was used to induce movement in the nerve-innervated area, and the relationship between the puncture needle tip and the cervical DRG position was verified using a C-arm X-ray machine. The numerical rating scale (NRS) was used for preoperative and postoperative pain assessment, clinical treatment effectiveness was evaluated, surgical duration and the associated complications were also recorded. Thirty patients exhibited clear cervical DRG images under ultrasound guidance, and the punctures were successful in all patients. Motor electrical stimulation induced movement in the corresponding nerve innervation area in the range of 0.3-0.8 mv in all patients. No serious complications occurred during the procedure. The transverse ultrasound-guided approach for puncturing the cervical dorsal root ganglion at the level of joint column for radiofrequency treatment is effective, convenient, and safe.

Feasibility, Safety, and Efficacy of Segmental Spinal Anesthesia with Predominantly Isobaric Levobupivacaine: A Tertiary Care Hospital Study

Objective: To assess feasibility, safety, and efficacy of segmental spinal anesthesia with isobaric levobupivacaine in patients undergoing various abdominal and lower limb surgeries. Methods: This was a prospective cohort study conducted at the department of anesthesiology and critical care of Kota heart institute and group of hospitals in India. The study involved 100 patients undergoing various abdominal and lower limb surgeries under segmental spinal anesthesia (SSA). Isobaric levobupivacaine 0.5% with fentanyl 20-25 μg or dexmedetomidine 5-10 as adjuvant or hypobaric levobupivacaine 0.167% was injected in intervertebral space depending on the surgery. Hemodynamic parameters, postoperative pain level, and adverse effects were analyzed with a p-value less than 0.05 was considered statistically significant.Results: An overall male predominance was observed with a 1:0.515 male-to-female ratio. The most affected age group was 41-50 years (37%), with a mean age of 44.51 ± 11.72 years. ASA classification indicated 34% of patients in ASA I, 40% in ASA II, 24% ASA III and 2% in ASA IV . The primary surgery was laparoscopic cholecystectomy (26%) in normal risk group and orthopedic in high-risk group(20%). Postoperative pain assessment showed mean VAS scores ranging from 1.92 to 3.42 at different time intervals. Common adverse effects were hemodynamic instability (13%), shoulder tip pain (33%), PONV (3%), headache (6%), pruritis (2%) and urinary retention (1%). The hemodynamic instability showed less incidence in ASA III/IV category.Conclusion: Segmental spinal anesthesia can be used successfully for abdominal and lower limb orthopedic surgeries in patients of ASA I to ASA IV.

Validation of the Japanese version of Algoplus® for the assessment of acute postoperative pain in older patients with cancer.

This study aimed to validate a Japanese version of the Algoplus® tool by assessing postoperative pain in older Japanese patients with cancer and examining the scale's psychometric properties. After translating Algoplus® into Japanese, we conducted a cross-sectional study of patients aged 65 years or older who underwent surgery to remove malignant tumors. Two registered nurse-certified investigators used the Numerical Rating Scale, the Japanese version of Algoplus®, and the Japanese version of the Abbey Pain Scale before and after analgesic use on postoperative days 3 and 5 to evaluate response to pharmacologic therapy. Validity was tested by a correlation analysis between the Japanese version of Algoplus®, two pain scales, and nine hypotheses related to demographic variables and surgical invasions. The Kuder-Richardson-20 test and Cohen's Kappa coefficient were used for internal consistency and inter-rater reliability, respectively. The total score of the Japanese version of Algoplus® showed strong to moderate correlations with the two pain scales. Demographic characteristics were not associated with the total score of the Japanese version, but significant correlations with operative time and postoperative analgesia administration existed. The scale demonstrated good internal consistency (Kuder-Richardson-20 α: .70) and inter-rater reliability (Kappa coefficient .72). The total score of the Japanese version decreased significantly after analgesic use in both postoperative assessments. The Japanese version of Algoplus® is a reliable and valid instrument for nurses to easily assess acute postoperative pain in older Japanese patients with cancer and shows good responsiveness for detecting the change in pain status.

Pharmacokinetics of Injectable Meloxicam and Buprenorphine in the Naked Mole-Rat (Heterocephalus glaber).

Unique characteristics of the naked mole-rat (NMR) have made it increasingly popular as a laboratory animal model. These rodents are used to study many fields of research including longevity and aging, cancer, circadian rhythm, pain, and metabolism. Currently, the analgesic dosing regimens used in the NMR mirror those used in other rodent species. However, there is no pharmacokinetic (PK) data supporting the use of injectable analgesics in the NMR. Therefore, we conducted 2 independent PK studies to evaluate 2 commonly used analgesics in the NMR: meloxicam (2 mg/kg SC) and buprenorphine (0.1 mg/kg SC). In each study, blood was collected at 8 time points after subcutaneous injection of meloxicam or buprenorphine (0 [predose], 0.25, 0.5, 1, 2, 4, 8, and 24 h). Three NMRs were used per time point for a total of 24 animals per PK study. Plasma concentrations of meloxicam were highest between 0.5 and 1 h postinjection. Levels remained above the extrapolated dog and cat therapeutic threshold levels (390 to 911 ng/mL) for at least 24 h. Plasma concentrations of buprenorphine were highest between 0.25 and 0.5 h postinjection. Levels remained above the human therapeutic threshold (1 ng/mL) for up to 21 h. No skin reactions were seen in association with injection of either drug. In summary, these data support dosing meloxicam (2 mg/kg SC) once every 24 h and buprenorphine (0.1 mg/kg SC) once every 8 to 12 h in the NMR. Further studies should be performed to evaluate the clinical efficacy of these drugs by correlating plasma concentrations with postoperative pain assessments.

TACKoMesh – A randomised controlled trial comparing absorbable versus non-absorbable tack fixation in laparoscopic IPOM + repair of primary incisional hernia using post-operative pain and quality of life - Reliatack™ versus Protack™

There is a clinical need to better understand and improve post-operative pain for patients undergoing laparoscopic repair of incisional hernia. The aim of this single-centre, double-blind, randomised controlled trial was to compare post-operative pain between absorbable and non-absorbable tack fixation in patients undergoing IPOM + repair. Patients with primary incisional hernia (size 3–10 cm), were randomised to either Reliatack™ (n = 27), an articulating-arm device deploying absorbable polymer tacks, or Protack™ (n = 36), a straight-arm device deploying permanent titanium tacks. The primary outcome was reported pain on activity using a visual analogue scale at post-operative day 30. Clinical and patient-reported outcome measures (PROMs) were assessed pre-operatively (day 0), and at 1-, 6-, 30- and 365-days post-surgery. No significant differences in reported pain ‘on activity’ were found at any timepoint. Less reported pain ‘at rest’ was found on post-operative day-1 with absorbable tacks (p = 0.020). Significantly longer mesh-fixation time (p < 0.001) and the use of more knots for fascial closure (p = 0.006) and tacks for mesh-fixation (p = 0.001) were found for the absorbable tack group. There were no differences in other clinical and PROMs between groups. For the whole trial cohort (n = 63) several domains in the Short-Form-36 showed a reduction from baseline scores at day 30 that improved at day 365. At post-operative day 30, 75.0% of patients reported ‘a lot of pain’ since discharge. This study found no difference in reported pain when choosing absorbable or non-absorbable tack fixation. The utility of “early” post-operative pain assessment as a comparator following incisional hernia repair needs clarification.

Intrathecal Morphine Enhances Postoperative Analgesia and Recovery in Robotic-Assisted Laparoscopic Partial Nephrectomy: A Retrospective Study of 272 Patients.

BACKGROUND Robot-assisted laparoscopic partial nephrectomy (RAPN) has been increasingly used for treating renal tumors due to its advantages over other approaches. However, RAPN can induce acute incisional, peritoneal, visceral, and referred pain. Therefore, acute pain control in robotic surgery is a concern. This retrospective study aimed to evaluate the efficacy of intrathecal morphine (ITM) for postoperative analgesia and recovery after RAPN. MATERIAL AND METHODS We retrospectively investigated consecutive patients who underwent RAPN at our institute between 2020 and 2021. Among the 272 patients who met the inclusion criteria, 135 patients were administered 200 µg of ITM preoperatively (ITM group), while 137 patients were not (control group). Postoperative pain assessments using the numeric rating scale (NRS), opioid requirements, and recovery profiles during the first postoperative 24 h were compared between the 2 groups. RESULTS As the primary endpoint, the incidence of moderate-to-severe pain (24-h average NRS pain score ≥4) was significantly lower in the ITM group than in the control group (36.3% vs 61.3%, P<0.001). Pain scores and cumulative opioid requirements were also significantly lower in the ITM group for all assessments (P<0.001). Moreover, the ITM group had a higher score on the Quality of Recovery-15 questionnaire on the first postoperative day (129 vs 120, P=0.003) despite an increased rate of postoperative nausea/vomiting (27.4% vs 13.1%, P=0.003). CONCLUSIONS Our findings indicate that ITM provided superior pain control during the early period following RAPN, with reduced postoperative opioid requirements. Moreover, ITM improved patient satisfaction with recovery.

Nurses' Knowledge and Attitudes about Adult Post-Operative Pain Assessment and Management: Cross Sectional Study in Qatar.

Pain is a complex and challenging phenomenon. People have different pain experiences, but everyone has the right to effective pain management. Pain assessment and management are integral components of a nurse's role. To assess the knowledge and attitudes of nurses in Qatar about adult post-operative patients' pain assessment and management, and the factors that may be associated with such knowledge and attitudes. Post-operative registered nurses from all peri-operative areas at Hamad Medical Corporation participated in a cross-sectional online survey using a self-administered questionnaire. A knowledge and attitudes (K&A) score was calculated. Associations between K&A and potential explanatory variables were assessed using t-tests and one-way ANOVA. A total of 151 post-operative nurses participated in the study. The mean knowledge and attitudes (K&A) score was 19.6 ± 4.5 out of 41 (48%), indicating a large deficit in nurses' knowledge and attitudes about adult post-operative pain. There were no statistically significant differences in the mean K&A scores of participants based on gender, nationality, education level, marital status, workplace facility, current job designation, or hours of pain education. There is a significant deficit in post-operative nurses' knowledge and attitudes about pain across the nursing workforce in post-operative care. Implications for nursing education and policy: Evidence-based, innovative nursing education courses are needed to improve nurses' knowledge and attitudes about pain assessment and management. Health service policy is required to ensure that evidence-based in-service education on pain management is compulsory for all nurses. This study was not registered.

Glide Path in Endodontics: A Literature Review of Current Knowledge.

The introduction of nickel-titanium rotary instruments revolutionized shaping procedures as they were able to produce a well-tapered preparation while reducing operator fatigue. The major drawback of rotary instruments was the high risk of fracture due to bending and torsional stress. Thus, the creation of a glide path has been advocated and recommended by most rotary instrument manufacturers. The aim of the present review is to summarize existing knowledge on glide path preparation and identify areas where further research is needed. The primary goal is to provide a comprehensive overview of the techniques and instruments used in glide path preparation, highlighting their advantages and limitations. The secondary goal is to explore the effect of glide path creation on the overall success of endodontic treatment, particularly in terms of reducing procedural errors and improving treatment outcomes. An online search on PubMed, ScienceDirect, UCLA, and Scopus databases was conducted, and 116 articles were identified. Eligible articles were divided into nine categories based on what they researched and compared. The categories included centering ability and/or root canal transportation, cyclic fatigue resistance, glide path and shaping time, tortional stress resistance, apical extrusion of debris and/or bacteria, defects in dentine walls, file separation, postoperative pain assessment, and scouting ability and performance. Establishing a glide path reduces root canal transportation, especially with rotary methods. Reciprocating and heat-treated files offer higher fatigue resistance and shorter preparation time. Instruments with shorter pitch lengths have greater torsional strength. Preparation and coronal preflaring reduce apical debris and bacteria. Glide paths do not affect dentine microcracks, file separation, or defects but reduce immediate postoperative pain and improve cutting ability. Randomized trials are needed to assess their impact on treatment outcomes.

Effect of intra-operative Magnesium sulphate on the occurrence of post-operative delirium and insomnia in patients undergoing lumbar fixation: a randomized controlled trial

BackgroundOver the last two decades, a large body of literature has focused on studying the prevalence and outcome of the postoperative delirium and sleep disturbance. The aim of this work was to evaluate the effect of intraoperative administration of Magnesium sulphate on the occurrence of post-operative delirium and insomnia in patients undergoing lumbar fixation.MethodsThis prospective randomized controlled trial was carried out on 80 patients indicated for lumbar fixation; 40 of them received conventional general anesthesia with extra administration of intraoperative magnesium sulphate (Mg sulphate group), and the other 40 received conventional general anesthesia only (control group). Both groups were submitted to pre-operative assessment of depression using Beck Depression inventory (BDI) scale, pre-operative assessment of fatigue using a fatigue questionnaire, pre- and post-operative assessment of insomnia using Insomnia severity index (ISI), post-operative assessment of delirium using Memorial delirium assessment scale (MDAS), post-operative assessment of pain using Visual Analogue Scale (VAS), and pre- and post-operative Quantitative electroencephalography (QEEG).ResultsMg sulphate administration, age, pre-operative BDI, pre-operative ISI, and post-operative VAS were independent predictors of post-operative ISI (P-value < 0.001, 0.047, 0.021, < 0.001, and < 0.001 respectively). Age and post-operative VAS were independent predictors of post-operative MDAS (P-value = 0.008, 0.013 respectively). Mg sulphate administration and pre-operative ISI were independent predictors of post-operative VAS (P-value = 0.010, 0.006 respectively).ConclusionThere was a significant relationship between intraoperative Mg sulphate administration and both post-operative insomnia and pain in unadjusted and adjusted analysis.

Crescent Mastopexy With Augmentation and Hemi-Interlocking Circumareolar Mersilene Suture: An Innovative Approach

Introduction: Safety and patient satisfaction of crescent mastopexy and concurrent primary or revisional augmentation mammoplasty is controversial owing to secondary asymmetry and potential complications involving breast tissue and the nipple-areolar complex (NAC). The primary objective of this case series was to present a new technique that can achieve anatomic integrity and natural morphology of the NAC, while avoiding complications and minimizing scarring and hypertrophic alterations. Materials and Methods: Using white nonabsorbable 3-0 polyester mersilene suture for tension-free closure, the procedure was completed via intradermal insertion of the needleless end of the suture into the circumareolar NAC-skin junction at the inferior segment and an interlocking purse-string or spoke-wheel configuration in the superior segment, juxtaposing the NAC and cutaneous margin, thereby redistributing the tension line from the crescent scar to a circumareolar, cranially repositioned site. Patients were followed at 24 hours, 1, 3, 6, and 12 weeks, and 6 and 12 months. Postoperative pain was patient-measured using the Visual Analog Scale (possible scores ranged from 0 to 10), and esthetic satisfaction was determined by patient surveys (scores 0-5). Follow-up visits involved evaluation of scars, nipple sensation, nipple-areolar perfusion by capillary refill, asymmetry, and hypertrophic and pigmentation changes. Results: Six patients (ages 32-46) underwent 2 primary procedures and 4 revisions between January 2020 and March 2023 and were chosen retrospectively based on inclusion and exclusion criteria. One revision was completed using the traditional method while the rest were completed with the new technique. Surgical times ranged from 15:34 to 17:35 minutes, with patients reporting minimal initial and postoperative pain, high patient satisfaction, and reduced scar visibility. All patients reported postoperative pain assessments as negligible initial pain on days 0 to 3 (0) and 1 to 2 on days 4 to 7, with 1 patient scoring pain as 2 to 3. Scar visibility was minimal (&lt;0.5 mm), although 1 patient experienced 1.5 mm at 12 months. Shape of the NAC was maintained in all cases at 6 months, with 1 patient evolving to oval shape at 12 months. Patient satisfaction was scored at 4 and 5 at 6 and 12 months. No complications, scarring, or alterations in NAC shape or position were noted. Conclusion: This technique avoided resection of the mammary gland, achieved minimal tension and thereby preserved the crescent scar, corrected preoperative asymmetry and mild ptosis, proved superior aesthetic enhancement, and reduced complications compared with traditional methods. These promising results warrant further evaluation in a larger cohort.

A smart device application for acute pain service in surgical patients at a tertiary hospital in South Korea: a prospective observational feasibility study.

Pain assessment and patient education are essential for successful postoperative pain management. However, the provision of personnel for performing these tasks is often insufficient. Recently, attempts have been made to implement smartphone applications for educating and monitoring surgical patients. We developed a smartphone application (app) for postoperative pain management, and conducted a feasibility study. This single-center prospective observational study included 60 patients aged < 70 years who underwent elective surgery. This study evaluated the SmartAPS application, which offers tools for postoperative pain assessment and educational materials for pain management. The primary outcome was the active usage rate, defined as responding at least twice daily on postoperative days (PODs) 1 and 2. Additionally, we investigated patient satisfaction with the app and educational videos as well as any challenges encountered during use. Sixty patients were enrolled in the study and active app use was achieved in 56.7% of them. Response rates peaked at 85.0% for pain intensity and 83.3% for opioid-related side effects at 14:00 on POD 1 but dropped to 56.7% and 58.3%, respectively, at 18:00 on POD 2. Among the patients who responded to the survey regarding the app usage, 84.0% reported satisfaction with the app and 80% found it beneficial for managing postoperative pain. Furthermore, 92.0% did not encounter difficulties using the app, indicating a generally positive user experience. Our findings support the utility of the SmartAPS application in acute pain services, highlighting its potential for improving postoperative pain management.

Effect of the postoperative pain management model on the psychological status and quality of life of patients in the advanced intensive care unit

Objectiveit was to explore the influence of the postoperative pain management mode on the psychological state, quality of life (QOL), and nursing satisfaction of late patients in the intensive care unit (ICU) and improve the nursing effect of late patients in the ICU.Methodsseventy patients who were admitted to the postoperative ICU for gastric cancer and received treatment in our hospital from March 2021 to May 2022 were selected. The patients were assigned into a research group and a control (Ctrl) group according to a random number table, with 70 cases in each group. The Ctrl group received routine nursing intervention, while research group received nursing intervention based on routine nursing intervention with postoperative pain management mode and received psychological care. Good communication was established with the patients, and the postoperative pain assessment was well conducted. The general information, state-trait anxiety (STAI) score, World Health Organization’s Quality of Life Instrument (WHO QOL-BREF) score, and care satisfaction were compared.Resultsthe general information differed slightly, such as sex, age, and ward type, between groups, with comparability (P > 0.05). S-AI scores (13.15 ± 1.53 vs. 16.23 ± 1.24) and T-AI scores (14.73 ± 3.12 vs. 18.73 ± 3.16) in research group were inferior to those in Ctrl group (P < 0.05). The scores of patients in research group in the physiological field (78.9 ± 6.1 points vs. 72.3 ± 5.6 points), social relationship field (76.9 ± 4.5 points vs. 71.3 ± 4.8 points), psychological field (78.6 ± 6.2 points vs. 72.4 ± 5.3 points), environmental field (78.6 ± 6.7 points vs. 73.5 ± 6.4 points), and total QOL (79.5 ± 7.4 points vs. 71.6 ± 5.4 points) were higher than those in Ctrl group (P < 0.05). The total satisfaction rate with nursing care in research group (82.85%) was dramatically superior to that in Ctrl group (62.85%) (P < 0.05).Conclusionthe adoption of a postoperative pain management model in postoperative nursing interventions for patients in advanced ICUs can alleviate anxiety and depression, improve patients’ QOL and nursing satisfaction, and have clinical promotion value.

Assessment of chronic pain syndrome after laparoscopic transabdominal preperitoneal plastic surgery in patients with inguinal hernia

Aim. To assess pain syndrome in patients with inguinal hernia after laparoscopic transabdominal preperitoneal (TAPP) plastic surgery. Materials and methods. The study involved 58 patients with unilateral Nyhus type 2 and 3 inguinal hernia. The patients underwent laparoscopic TAPP plastic surgery using a mesh implant that was not fixed independently. According to the method of graft fixation, the patients were divided into two groups. In the first patient group, staple fixation of the mesh was applied – 28 (48.3 %), the second group – 30 (51.7 %) patients without mesh fixation. Patients with a history of surgical interventions on the abdominal cavity and pelvis, complicated or recurrent inguinal hernia were excluded from the study. Pain syndrome was assessed using the visual analog scale and an independent survey during postoperative follow-ups of the patients every three months for two years. Results. In the assessment of postoperative pain in the first patient group, moderate pain intensity was noted, and it was minimal in the second group, p &lt; 0.001. 9 (32.1 %) patients who underwent mesh implant fixation required opioid analgesics, compared with 4 (13.3 %) patients who did not undergo fixation, p = 0.043. At the first examination, chronic pain was detected in 6 (21.4 %) patients of the first group and in 3 (10.0 %) patients of the second group. During a year, pain syndrome gradually disappeared. After 9 months, pain was reported by 4 (14.3 %) patients in the group with mesh fixation and by 1 (3.3 %) patient without fixation. At the 6th examination in the first group, 2 (7.1 %) patients reported pain; 1 (3.6 %) patient underwent Lichtenstein hernioplasty due to recurrent, increasing acute pain. Conclusions. Laparoscopic TAPP plastic surgery without graft fixation shows a lower possibility of pain syndrome development than with mesh implant fixation. In the case of chronic pain syndrome development following the TAPP technique without mesh fixation, the general condition of patients improves more quickly.

Assessment and management of post-surgical pain in adult patients undergoing thoracic surgery: a best practice implementation project.

Effectiv. e management of post-operative pain improves the condition of patients and reduces their hospital stay. This, in turn, has an impact on caregivers, professionals, and institutions and, as such, is considered a primary indicator of quality. The aim of this project was to improve the assessment and management of post-surgical pain in thoracic surgery patients. This implementation project was conducted in a thoracic surgery unit of a tertiary hospital in Spain. The project was guided by the JBI Evidence Implementation Framework, which is grounded in an audit, feedback, and re-audit strategy. A baseline audit was conducted with 44 patients, and barriers to best practice were identified. Strategies were then implemented to improve the assessment and management of post-operative pain. Three follow-up audits were performed using nine audit criteria with 34, 40, and 46 patients, respectively. The baseline audit revealed poor compliance with best practices. After implementing strategies to address areas of non-compliance, health education for patients and caregivers improved up to 80%, while the measurement of pain upon admission and post-surgery rose to 91%. However, patients undergoing pre-operative assessment to guide their post-operative pain management at hospital discharge remained below 50%. Using a methodology to implement best practices, together with clinical audits, improved compliance with the use of validated scales to assess and manage pain. A multidisciplinary approach improves the quality of care received by patients and contributes to their recovery. http://links.lww.com/IJEBH/A240.