Postoperative Pain In Patients Research Articles

Utilization of Neutrophils-to-Lymphocytic Ratio as a Marker for Post-operative Pain in Patients Undergoing Harmonic Cholecystectomy

Objectives: Our study aimed to investigate the pre-operative neutrophils-lymphocytes ratio (NLR) in patients who underwent cholecystectomy and to identify whether it discriminates between chances of developing pain or not and at what interval. Materials and Methods: A cross-sectional study was conducted in a single center in Saudi Arabia over a period of 2 months. Analysis was conducted using SPSS 22nd edition; numeric variables were presented in mean ± standard deviation and compared using the Mann–Whitney U-test after normality testing. Results: The study included 69 patients diagnosed with acute cholecystitis and underwent cholecystectomy. The minimum identified NLR in our study was 0.3 and the maximum identified variable was 15.0. Highest sensitivity and specificity were found to be 93.8% and 24.5% after 36 h of performing the procedure, respectively. Conclusion: NLR utilization as a pain marker post-operatively has promising outcomes which will highly impact the reduction of disease burden on patients.

Intraperitoneal Bupivacaine versus Nalbuphine in Postoperative Pain Relief after Laparoscopic Cholecystectomy: A Randomised Clinical Study

Introduction: The rationale for using an intraperitoneal route for instilling a drug, local anaesthetic or opioid is that the exposure of peritoneum to visceral nociceptive conduction provides additional mechanism of analgesia. Aim: To compare the effectiveness of intraperitoneal bupivacaine and nalbuphine for postoperative pain relief after laparoscopic cholecystectomy. Materials and Methods: The present study was a randomised clinical study in which 80 patients underwent laparoscopic cholecystectomy, received either bupivacaine or nalbuphine intraperitoneally. Each patient was monitored postoperatively, as per the institution protocol. Severity of pain was assessed using the Visual Analog Scale (VAS) at rest and at movement Immediately After Recovery (IAR), after one hour and every four hours thereafter. The time to first rescue analgesic was compared. The data analysis was carried out with unpaired Student’s t-test and Chi-square test using software Statistical Package for the Social Sciences (SPSS) 20.0 version. Results: The study included 35 males and 45 females, with a mean age of 42.8±7.1 years. Both groups were well-matched demographically. There was no significant difference in the Heart Rate (HR) or Mean Arterial Pressure (MAP) between the groups postoperatively. However, VAS score was significantly lower in nalbuphine group at one hour (2.52±0.640) as compared to bupivacaine group (2.88±0.791, p=0.028), but on movement at 16 hours it was lower in bupivacaine group (1.43±0.501), as compared to Nalbuphine group (1.67±0.474, p=0.030). The mean time of first rescue analgesic in nalbuphine group was 20.25±7.983 minutes, while in bupivacaine group it was 26.9±6.95 minutes (p-value-0.0002). Postoperative Nausea and Vomiting (PONV) was significantly higher with nalbuphine (35% vs 12.5%). No other significant complication was noted in either group. Conclusion: Intraperitoneal instillation of nalbuphine is an effective and safe way to reduce postoperative pain in patients undergoing laparoscopic cholecystectomy

POST-OBTURATION PAIN AND ITS RELATIONSHIP WITH REFERENCE TIME AND OTHER RISK FACTORS

Objective: To evaluate incidence and intensity of postoperative pain in patients treated in the Residency Programin Endodontics at the State University of Maringá. The influence of factors inherent to the patient and treatmenton preoperative pain was also the focus of our study. Material and Methods: 99 patients participated in this studyand underwent non-surgical endodontic treatment. Initially, palpation, vertical and horizontal percussion wereperformed on the tooth to be treated. After the root canals filling, patients received a printed Numerical RatingScale and were instructed to record the level of pain in the postoperative periods of 24, 48 and 72 hours. For eachpostoperative period, the patient recorded the values. A descriptive analysis of the data and a model of generalizedestimation equations were performed to verify the relationship between the variables and postoperative pain, ata significance level of 5%. Results: During the follow-up period, the pain rates found were low represented by16%, 11% and 7% in the periods of 24, 48, and 72h, respectively. In addition, the rates significantly decreasedafter 72h. Only one case of flare-up was recorded. Presence of pain on palpation, use of reciprocating file anduse of 2.5% sodium hypochlorite influenced the results (p<0.05), increasing the changes of post-operative painby 3.36, 0.4 and 0.2 times, respectively. Conclusion: Incidence and intensity of postoperative pain monitoredin the residency program reduced significantly after 72 hours. Postoperative pain was associated with pain onpalpation, use of reciprocating files and irrigation with 2.5% hypochlorite.KEYWORDSEndodontics; Postoperative pain; Pain measurement; Endodontic treatment; Root canal therapy.

Effect of preoperative anxiety on postoperative pain in patients undergoing elective lower-segment cesarean section under spinal anesthesia: A cross-sectional study in South India

Background: Anxiety is often encountered but overlooked in patients undergoing elective surgery. Anxiety may influence the perception of postoperative pain which is one of the major concerns for all patients. This study aimed to evaluate the effect of preoperative anxiety on postoperative pain and to find if any relation exists between demographic variables and anxiety in cesarean patients. Methodology: One hundred and twelve patients undergoing elective cesarean section under spinal anesthesia were evaluated for preoperative anxiety on the day before surgery using the Amsterdam Preoperative Anxiety and Information Scale questionnaire-based face-to-face interview, and postoperative pain was recorded every 6 h after surgery for 24 h using the Visual Analog Scale (VAS). Results: The prevalence of preoperative anxiety in the study subjects was 36%. The need for high information was 22%. The mean for anesthesia-related anxiety, information desire component, combined anxiety score, and VAS scores was 4.21 ± 2.63, 3.23 ± 2.15, 8.72 ± 4.60, and 5.30 ± 1.86, respectively. Postoperative pain was found to be correlating with higher levels of preoperative anxiety (r = 0.25, P < 0.01). Information desire component was found to have a positive, moderate, and significant correlation with anxiety score (r = 0.49, P < 0.01). No statistically significant relationship was found between sociodemographic characteristics and preoperative anxiety. Conclusion: This study demonstrated a positive and statistically significant correlation between preoperative anxiety and postoperative pain. Well-conducted randomized controlled studies are required to determine whether reducing anxiety before a surgery results in reduced postoperative pain response. Anxiety-reducing measures can be employed throughout the preoperative period in the surgical population to reduce postoperative pain in addition to analgesics.

Effect of pre-operative administration of single-dose of gabapentin on postop surgical pain in patients undergoing sternotomy for CABG.

Objective:To investigate the efficacy of perioperative administration of a single dose of gabapentin on postoperative pain in patients undergoing sternotomy for CABG.Methods:A cross-sectional analytical study was conducted at the cardiology ward of Ch. Pervaiz Elahi Institute of Cardiology, Multan, form 9th June 2020to 9th June 2021. The participants were consecutively enrolled in the Gabapentin group, who received 1200 mg of Gabapentin two hours before the surgery for the two days, and the placebo group. The outcomes measurement involved the need for fentanyl intake in the first two postoperative days; pain at rest and in the moment in the first three postoperative days; postsurgical sleep scores; and patients reported quality of recovery.Results:A total of 50 patients were enrolled in the study, 25 in each group. No significant difference was found between the two groups in terms of fentanyl intake, sleep scores, visual analog pain score, and the need for any adjunctive pain medication (p>0.05). Similarly, no significant difference was found in terms of occurrence of side-effects and quality of recovery (p>0.05).Conclusion:Pre-operative administration of a single dose of Gabapentin doesn’t significantly influence the post-operative pain, opioid consumption, sleep quality, or quality of recovery in patients undergoing cardiac surgery.

Is the injection of tramadol effective at control of pain after impacted mandibular third molar extractions? A systematic review and meta-analysis.

Third molar extraction is among the most common surgical procedures performed by oral-maxillofacial surgeons. Postoperative pain, swelling and trismus are common, especially in wisdom teeth, due to trauma to local tissues and the duration of the surgical procedure, among other factors. This systematic review was conducted in accordance with the 'Preferred Reporting Items for Systematic Reviews and Meta-Analyses' in order to answer the focused question: 'Is the local submucosal injection of tramadol effective at the control of postoperative pain in patients submitted to impacted mandibular third molar extractions?'. We analyzed papers published until March 30, 2021 in the MEDLINE|PubMed, Web of Science and Cochrane Library databases. Gray literature was also consulted. Standard pairwise meta-analyses of direct comparisons were performed using a fixed-effect model; I2 ≥ 50 % or ≥ 75 % indicated moderate or high heterogeneity, respectively. Risk of bias was assessed by Cochrane Collaboration's tool. In total, 172 participants (98 males and 74 females, aged 18 or over) from three randomized placebo-controlled trials were considered for analysis. The submucosal injection of 2 ml of tramadol adjacent to the impacted mandibular third molar was effective in controlling pain up to 6-hours after surgery, in increasing the onset of consumption of rescue analgesic and in reducing the total number of rescue analgesics used. The submucosal injection of tramadol can be considered a safe and effective procedure for pain control after impacted mandibular third molar extractions.

Post-endodontic pain with different engine-driven endodontic instruments in multi-visit root canal therapy: A systematic review and meta-analysis

Aim: Post-endodontic pain during root canal treatment (RCT) is inevitable. Previous meta-analysis reported a lesser post-endodontic pain in using continuous rotation instruments compared with using reciprocating instruments in a single-visit root canal therapy. No evidence has been elucidated to prove the same in multi-visit root canal therapy. The aim of this systematic review was to compare the intensity of post-instrumentation pain on using continuous and reciprocating motion engine-driven systems in multi-visit root endodontic treatment. Materials and Methods: An extensive literature search in PubMed, Cochrane Library, and Google Scholar was performed to identify investigations that evaluated the effect of continuous and reciprocating instrument systems on post-operative pain. The certainty of evidence was assessed using GRADEpro (GRADEpro GDT software, https://gradepro.org). We included two trials in this review, and their risk of bias was found to be low. A fixed-effects model was used to pool the mean post-operative pain as this was found by less heterogeneity. Results: Pooled results showed no difference in the mean post-instrumentation pain measured using a visual analog scale between continuous and reciprocating instrument systems with a mean difference of −0.13 (P = 0.48; I2 = 26%). Also pooled relative risk showed no difference in the risk for post-endodontic pain between continuous and reciprocating instrument systems with a relative risk of 0.53 (P = 0.08; I2 = 34%). Conclusion: The use of both continuous and reciprocating instruments had lower intensity of post-operative pain in patients who received multi-visit RCT with no significant difference between them. Further clinical trials with high quality are needed to understand the effect of continuous and reciprocal engine-driven instrumentation systems in multi-visit RCT.

Opioid Usage after Hallux Valgus Correction Surgery

Category:Bunion; OtherIntroduction/Purpose:More than 200,000 surgeries for hallux valgus correction occur annually in the United States. Due to the post-operative pain associated with the procedure, opioids are often prescribed to help manage pain. Given the lack of objective data on opioid use and the difficulty of addressing a patient's post-operative pain, we sought to quantify, through a prospective analysis, patient's narcotic use after hallux valgus surgery. The purpose of our study was to determine the average quantity and type of post-operative opioids consumed after hallux valgus surgery and to assess potential predictive factors for increased opioid consumption.Methods:Adult patients undergoing primary hallux valgus surgery were recruited from two foot and ankle fellowship trained orthopedic surgeons at a single institution. At the pre-operative visit, patients were consented and completed a demographical questionnaire. Data was collected from the operative and PACU record, as well as the 2, 6, and 12-week post-operative visits. A statistical analysis was performed to determine the average quantity of opioid and non-opioid pain medication consumed post- operatively, as well as any statistically significant correlations.Results:For the 58 subjects who completed treatment and data collection in the PACU, 53 consumed opioids. Initial prescriptions for these patients included Hydrocodone, 39 (73.58%) Oxycodone, 13 (24.52%) and Meperidine, 1 (1.89%). The average number of opioid pills collectively consumed at the two-week and 12-week post-operative visit was 19.99 and 22.52, respectively. At the two-week postoperative visit, only patient BMI showed a statistically significant association with increased opioid use.Conclusion:On average, patients consumed 22-24 narcotic pain pills after hallux valgus reconstruction surgery. If a physician prescribed 24 narcotics pills after surgery to patients that are not currently utilizing narcotic pain medication, there is a 95% chance they will not need additional pain medication during the two-week postoperative period.

The feasibility of thoracoscopic-guided intercostal nerve block during uniportal video-assisted thoracoscopic lobectomy of the lung.

Uniportal thoracoscopic surgery has become widely accepted for its favourable outcomes with regard to pain. However, post-operative pain is still a concern associated with thoracic surgery. The objective of this study was to evaluate the post-operative pain of patients undergoing uniportal video-assisted thoracoscopic surgery (VATS) lobectomies using an intra-operative intercostal nerve block. All consecutive patients undergoing uniportal VATS lobectomies between October 2018 and October 2019 were reviewed retrospectively. Twenty consecutive patients in Group A underwent uniportal VATS lobectomies without intra-operative intercostal nerve blocks. The other 20 consecutive patients in Group B underwent uniportal VATS lobectomies with intra-operative intercostal nerve blocks. Numeric Pain Rating Scale (NRS) scores were recorded at 1, 12 and 24 h postoperatively. The number of anti-inflammatory drugs (non-steroidal anti-inflammatory drug [NSAIDs]) consumed until the time of chest tube removal was also recorded. There was no difference between the groups with regard to sex, age, chest tube duration, length of stay, operative time or laterality. There was a significant difference in post-operative NRS scores at 1 h (P < 0.001) and 12 h (P = 0.014) between the groups. The NSAID consumption was significantly lower in Group B than in Group A (P = 0.038). Intra-operative intercostal nerve blocks with bupivacaine provided immediate post-operative pain relief and reduced post-operative opioid consumption in patients who underwent uniportal VATS lobectomies.

A pilot study of intraoperative intercostal nerve block during uniportal thoracoscopic wedge resection of the lung

BACKGROUND AND AIMS:Uniportal thoracoscopic surgery has been reported to result in alleviating the postoperative pain when compared with traditional video-assisted thoracoscopic surgery (VATS). However, postoperative pain is still the main concerns associated with thoracic surgeries. The objective of this study is to evaluate the postoperative pain of patients undergoing uniportal VATS, especially wedge resection, with the use of intraoperative intercostal nerve block.METHODS:All consecutive patients undergoing the uniportal VATS wedge resection between January 2019 and March 2020 were reviewed retrospectively. Twenty consecutive patients in Group A underwent the uniportal VATS wedge resection without intraoperative intercostal nerve block. The other 20 consecutive patients in Group B underwent the uniportal VATS wedge resection with intraoperative intercostal nerve block. The numeric pain rating scale (NRS) scores were recorded at 1, 12, and 24 h, postoperatively. The number of opioid consumption was also recorded until the time to chest tube removal.RESULTS:There was no difference between groups with regard to sex, age, chest tube duration, length of stay, operative time, laterality time, and diagnosis. There was a significant difference in postoperative NRS scores at 1 h (P = 0.001) and 12 h (P = 0.022) between the groups. The opioid consumption was significantly in Group B lower than those in Group A (P = 0.025).CONCLUSION:The intraoperative intercostal nerve block with bupivacaine provided immediate postoperative pain relief with reducing the postoperative opioid consumption compared in patients who underwent uniportal VATS, especially wedge resection of the lung.

Effect of flurbiprofen axetil combined with "Cocktail" therapy on opioid dosage in patients after total knee arthroplasty.

Objectives:To investigate the effect of flurbiprofen axetil combined with “cocktail” therapy on opioid dosage in patients after total knee arthroplasty (TKA).Methods:The clinical data of 200 patients who underwent TKA in Baoding No.1 Central Hospital hospital from March 2019 to March 2021 were collected for retrospective analysis. All 200 patients were divided into two groups according to their intraoperative anesthesia methods: the control group (100 cases) and the experimental group (100 cases). Patients in the control group were treated with “cocktail” therapy intraoperatively, while those in the experimental group were treated with flurbiprofen axetil combined with “cocktail” therapy intraoperatively. The hip pain scores in resting state and motion state were compared between the two groups at different postoperative time points, and postoperative pain relief, adverse reactions, and patient satisfaction with analgesia were statistically analyzed to evaluate the postoperative quality of life of the patients.Results:A statistically significant difference was observed in the intergroup and temporal effects of pain scores in resting state and motion state between the two groups (p<0.05). By comparison at each time point, the pain scores in the experimental group were significantly lower than those in the control group at the time point T1-T6 in resting and motion states, with a statistically significant difference (p<0.05). The frequency and dosage of remedial medication per capita in the experimental group were significantly lower than those in the control group, with a statistical significance (p<0.05). There was no significant difference in the scores of life quality items between the two groups preoperatively (p>0.05), while the scores of each item in the experimental group were significantly higher than those in the control group postoperatively (p<0.05). The satisfaction degree of the experimental group was significantly higher than that of the control group, showing a statistically significant difference (p<0.05).Conclusions:Flurbiprofen axetil combined with “cocktail” therapy is a safe treatment regimen that can improve the quality of life and safety of patients. With such a regimen, postoperative pain of patients undergoing TKA can be effectively relieved, and the use of opioids can be reduced.

Spiral Computed Tomography Imaging Analysis of Positioning of Lumbar Spinal Nerve Anesthesia under the Concept of Enhanced Recovery after Surgery

The objective of this research was to explore the effect of perioperative anesthesia management for patients based on the concept of enhanced recovery after surgery (ERAS) and the application value of the computed tomography (CT) localization method in lumbar spinal nerve anesthesia, reducing the damage caused by anesthesia. One hundred and twenty patients who underwent the lumbar spinal anesthesia in lower limb surgery were selected as the research subjects. According to puncture positioning and nursing intention, the patients were classified into the control group with 30 patients (method of anatomical landmarks), CT group with 50 patients (the CT localization), and ERAS group with 40 patients (the CT localization and the ERAS management). The effects of the anesthesia positioning method and the ERAS management were compared and analyzed. The results showed that d (0.32) and r (0.27) of exponential filtering function were notably smaller than those of R-L filtering function (d = 0.40, r = 0.39) and of S-R filtering function (d = 0.37, r = 0.36) (P < 0.05). Puncture time ((9.23 ± 0.32) min vs. (13.11 ± 0.45) min), puncture direction change (20% vs. 33.33%), abnormal puncture sensation (22% vs. 40%), and nerve root touch (4% vs. 23.33%) in the CT group were all lower than those in the control group. The proportion of Degree I anesthesia effect (94%) of the CT group was greatly higher than that of the control group (76.67%) (P < 0.05). The VAS score, time of activity and gastrointestinal function recovery, and the incidence of adverse reactions (2.5% vs. 28%) in the ERAS group were lower than those in the CT group (P < 0.05). All in all, the CT localization method can improve the difficulty of anesthesia puncture and improve the anesthetic effect; the ERAS nursing concept can improve the postoperative pain of patients and contribute to the prognosis of patients and have a good clinical value.

Post-Cholecystectomy Pain Assessment Using Visual Analogue Scale and Numerical Rating Scale

Background: Pain defines as unpleasant sensory and emotional experience associated with actual or potential tissue damage. Postoperative pain should be assessed regularly and documented carefully as it is a significant part of postoperative care. Pain scales are useful for assessment and monitoring the effectiveness of treatment. The 100 mm visual analogue scale (VAS) and the numerical rating scale (NRS) are the most commonly used one. Objective: To compare between VAS and NRS for assessing post-operative pain in patients undergoing elective cholecystectomy. Methods: A cross-sectional study was done in Al-Imamein Al-Kadhimein Medical City from the period of 1st of October 2019 to the 1st of March 2020. Fifty patients were enrolled in this study. All underwent elective cholecystectomy. Patient consents were obtained. Pain assessment was done when patients fully recovered and asking for pain relief and then one hour after giving analgesia. Results: Of the 50 patients, females were 42 (84%). Laparoscopic cholecystectomy has been done for 45 (90%); 33 (66%) patients received parenteral opioid and paracetamol, the remaining 17 (34%) received only paracetamol. There were no significant correlations between most of the suggested risk factors and pain perception apart from type of medications used for pain control. There is strong correlation between NRS and VAS before and after analgesia (P&lt; 0.01), while no observed significant effect or relation between other demographic and surgical parameters on pain score rating. Conclusion: This study validated that both the NRS and the VAS are two comparable acute pain scores mostly used in practice. NRS, which is easy, less pain inducing and more user friendly in the post-operative period has a strong linear association with VAS, thus can be substituted for VAS in assessment of postoperative pain. Keywords: Pain, cholecystectomy, Visual analogue scale, numerical rating scale Citation: Abdulhassan BA. Post-cholecystectomy pain assessment using visual analogue scale and numerical rating scale. Iraqi JMS. 2021; 19(2): 202-212. doi: 10.22578/IJMS.19.2.10

Lumbar Erector Spinae Plane Block at L3 Level for Managing Post-operative Pain in Patients Undergoing Surgery for Proximal Femur Fractures.

Ultrasound guided erector spinae plane block (ESPB) has been widely used at thoracic level. There has been a recent interest in utilising ESPB at lumbar level. Available literature is in the form of case reports. In this series involving 10 cases with proximal femur fractures, we have described unilateral ultrasound guided lumbar ESPB at L3 level for managing postoperative analgesia with continuous local anaesthetic infusion for 48 hours. The visual analogue scale score was always below 4, and there were no adverse effect or complications due to the block.

Comparison of Intraperitoneal Bupivacaine and Intravenous Ketorolac for Postoperative Pain Management Following Laparoscopic Cholecystectomy.

BackgroundPostoperative pain following laparoscopic cholecystectomy (LC) arises from incision sites and residual intraperitoneal CO2 gas. Opioids as a class of pain-relieving drugs are broadly used to control pain after LC; however, these drugs can cause various side effects.ObjectivesThe purpose of this study was to compare the efficacy of intraperitoneal injection of bupivacaine with that of intravenous ketorolac in managing postoperative pain in patients who had undergone LC.MethodsThis randomized, double-blind clinical trial was carried out on patients who had undergone LC. Ninety patients who had undergone elective LC were randomly divided into 3 groups (n = 30 for each group). Group A received 40 mL of 0.25% bupivacaine solution intraperitoneally at the end of the operation; group B received 30 mg of ketorolac intravenously 30 minutes before surgery and every 8 hours after surgery, and patients in group C received normal saline intraperitoneally and intravenous injection. The patients were postoperatively assessed for Visual Analog Scale (VAS) scores, postoperative opioid consumption, shoulder pain, side effects (sedation, nausea, and vomiting), and satisfaction. The data were analyzed using SPSS. P values < 0.05 were considered significant.ResultsThe intraperitoneal injection of bupivacaine and intravenous injection of ketorolac were significantly effective in reducing postoperative abdominal pain, shoulder pain, and incidence of nausea and vomiting compared to the placebo group (P < 0.001). Although intraperitoneal bupivacaine and intravenous ketorolac had no significant difference in pain relief compared with each other, patients in both bupivacaine and ketorolac groups were significantly more satisfied with their analgesia compared to the control group (P < 0.001).ConclusionsIntraperitoneal injection of bupivacaine and intravenous injection of ketorolac both are safe and effective methods to control pain, nausea, and vomiting after LC.

The Effect of Premedication with Curcumin on Post-Operative Pain in Single Visit Endodontic Treatment of Acute Pulpitis in Mandibular Molars: A Randomized Controlled Trial

Objective: The purpose of this randomized double-blind clinical trial was to compare the effect of a single pretreatment dose of Curcumin and placebo on post-operative pain for patients diagnosed with symptomatic irreversible pulpitis in mandibular molars treated in single visit. Methods: Forty-four patients with severe to moderate pain randomly received either Curcumin (400mg +20 mg pepper) or placebo (420 mg Starch) one hour before starting root canal treatment (n = 22 per group). Participants rated their pain using visual analogue pain scale (VAS): preoperatively and at 5 time points: immediately post-operative, 8, 12, 24 and 48 hours postoperative. Patients also stated emergency analgesic intake. The need for supplemental anesthesia during treatment was recorded. Mann-Whitney U-test compared the two groups at each time point, while Repeated-Measure ANOVA and Wilcoxon Signed Rank test compared time points within each group. A p-value &lt;0.05 was considered statistically significant. Results: Baseline characteristics of both groups showed non-significant differences (P &gt; 05). Curcumin group at 8, 12 and 24 hours revealed statistically significantly less VAS values (44.2, 26.7, 19.1) than the placebo (58.5, 43.3, 30.3), respectively, (P &gt; 05). All patients in Curcumin group did not need emergency analgesics. Curcumin group revealed statistically significantly lower percentages for the need of supplemental anesthesia (27.3%) compared to placebo (68.2%), (P &lt; 05). Conclusion: Single preoperative oral dose of Curcumin proved to be an effective premedication that reduced post-operative pain as well as the need of supplemental anesthesia for patients diagnosed with symptomatic irreversible pulpitis of mandibular molars.

Effect of preoperative anxiety on postoperative pain on patients undergoing elective surgery: Prospective cohort study

IntroductionAnxiety is a feeling of tension, apprehension, nervousness, fear, discomfort, and high autonomic activity with varying degrees of intensity resulting from anticipation of danger. Post-operative pain is associated with the emotional status, behavioural response, and high anxiety index of patients.This study aimed to assess the effect of preoperative anxiety on Postoperative Pain in Patients Undergoing Elective Surgery. MethodsAn institutional-based prospective cohort study was conducted on patients scheduled for elective surgeries from November 1, 2019, to October 30, 2020, in Dilla University Referral Hospital. Data was collected by pretested questionnaires and analysed by SPSS version 20. Categorical data were analysed by chi-square while Continuous data were analysed by student t-test and Mann Whitney U for parametric and nonparametric data respectively with a P-value of <0.05 was considered as statistically significant. ResultAs our finding revealed patients with high preoperative anxiety experienced significantly increased postoperative pain at 2 h, 4 h, 6 h, and 12 h with the P-value of 0.012, 0.01, 0.001, and 0.002 respectively and total tramadol consumption in a patient with high preoperative anxiety level is 156.5 ± 23.4 while in low anxiety 147.1 ± 39. with a p-value of 0.036. ConclusionHigh preoperative anxiety increased the immediate postoperative pain score and 24 h tramadol consumption. It would be better to decrease preoperative anxiety levels to reduce postoperative pain and 24 h analgesic consumption.

Analysis of the factors determining the development of postoperative pain in patients after knee and hip replacement surgery

Chronic postoperative pain (POP) is a serious complication of total replacement (TR) of the knee (KJ) and hip (HJ) joints.Objective: to determine the factors associated with POP in patients after TR of KJ or HJ.Patients and methods. The study group consisted of 124 patients with knee osteoarthritis or hip osteoarthritis (age 63.6±9.9 years, 63% women and 37% men) who underwent TR of KJ or HJ. POP was defined as pain ≥40 mm on a numerical rating scale persistent for ≥3 months. Its presence was assessed after 3 and 6 months by telephone survey. Comparison of patients with POP and without it was carried out for a number of factors identified before surgery.Results and discussion. The incidence of POP was 27.4%. There was no difference in the incidence of POP in patients after TR of KJ or HJ: 28.1% and 26.9% (p=0.88). POP was statistically significantly associated with parameters such as higher body mass index (BMI); the intensity of pain at rest; general assessment of impairment; WOMAC index pain, stiffness and overall; severity of symptoms of neuropathic pain (PainDETECT); signs of depression and anxiety (HADS).The risk of POP was significantly higher (p&lt;0.05) with BMI &gt;30 kg/m2 (odds ratio, OR 2.755; 95% confidence interval, CI 1.053–7.206), rest pain ≥40 mm on a visual analog scale (OR 1.349; 95% CI 0.478–3.803), PainDETECT scores ≥13 (OR 3.598; 95% CI 1.048–12.36) and HADS depression ≥8 (OR 2.193; 95% CI 0.745–6.454), presence of ≥2 sources of pain (OR 6.996; 95% CI 2.358–20.756).Conclusion. It was found that the risk of POP after TR of KJ and HJ is higher in patients with overweight, severe preoperative pain, signs of neuropathic pain and depression, as well as in the presence of several sources of pain (except for the affected joint, that was replaced surgically).

Comparison of the effect of high tibial osteotomy and total knee arthroplasty on postoperative pain in patients with knee arthritis.

article: Comparison of the effect of high tibial osteotomy and total knee arthroplasty on postoperative pain in patients with knee arthritis - Minerva Surgery 2022 October;77(5):516-8 - Minerva Medica - Journals

Comparative Study Between Ultrasound-guided Lumbar Paravertebral Block and Lumbar Epidural Block with Ropivacaine for Postoperative Pain Relief in Patient Undergoing Total Hip Replacement Surgery: A Prospective Randomised, Double-blind Study.

Total hip replacement (THR) is mostly performed in patients above 65 years of age. Patients of this age group typically have comorbidities, therefore safe techniques for anaesthesia and analgesia with minimal side effects should be chosen and should allow early mobilisation. Lumbar paravertebral block is less explored in this domain. The primary objective of this study is to compare the efficacy of ultrasound-guided lumbar paravertebral and epidural block using ropivacaine (0.25%) with fentanyl as adjuvant for postoperative pain in patients undergoing unilateral THR. Randomised, controlled, double-blind, prospective study carried out in the Department of Anaesthesiology at Banaras Hindu University. After receiving institutional ethical committee clearance and written informed consent from patients, this study was carried out from February 2019 to February 2020. Sixty adult patients who required THR and fulfilled the inclusion criteria were randomised into two groups. The thirty patients in Group A received a continuous infusion of 5 ml/hr (0.25%) ropivacaine + 2 mcg/ml fentanyl via lumbar epidural catheter. The thirty patients in Group B received a continuous infusion of 5 ml/hr (0.25%) ropivacaine + 2 mcg/ml fentanyl via lumbar paravertebral catheter. Visual analogue scale (VAS) was used to evaluate pain scores. Rescue analgesia use and duration of hospital stay was calculated and compared in postoperative period. The statistical analysis of data was done by using software Statistical Package for Social Sciences SPSS for Windows (Version 23.0), and chi-square test was used for categorical variables. To compare the two groups of mean Student's t-test and for more than two groups one-way analysis of variance, the ANOVA test was used. In Group A, 16.7% patients required rescue analgesic, and in Group B, 26.7% required rescue analgesia which is comparable and non-significant. The mean duration of hospital stay in Group A is 7.50 days. Compared to 6.47 days in Group B, this difference is statistically significant (p-0.000). Analgesia provided by paravertebral block is not superior to epidural block, but paravertebral block did reduce the duration of hospital stay and provided better haemodynamic stability.