Postoperative Pain Perception Research Articles

COMPARISON OF SUBCOSTAL TRANSVERSUS ABDOMINIS PLANE BLOCK WITH PORT SITE INFILTRATION OF LOCAL ANAESTHESIA IN LAPAROSCOPIC CHOLECYSTECTOMY

Objective: To compare the efficacy of ultrasound guided subcostaltransversus abdominis plane block and port site infiltration of local anaesthesia in patients undergoing laparoscopic cholecystectomy.
 Study Design: Comparative cross sectional study.
 Place and Duration of Study: Anesthesiology department, Pak Emirates Military Hospital, Rawalpindi, from Jan to Jun 2019.
 Methodology: A sample size of 62 patients calculated by World Health Organization calculator were randomized in a doubleblind study to undergo Sub costal transversus abdominis plane block or port site infiltration by non-probability, consecutive sampling into two equal groups. Group A received sub costal transversus abdominis plane block and group B local anaesthetic. Postoperative pain perception was measured using visual analogue scale.
 Results: The mean age of patients in group A was 33.39 ± 8.91 years and in group B was 33.77 ± 8.45 years. Out of 62 patients 38 (61.29%) were males and 24 (38.71%) were females. Mean pain score in group A (ultrasound guided sub costal transversus abdominis plane block) was 1.61 ± 0.91 while in group B (port site infiltration of local anaesthetic) was 3.61 ± 1.05 (p-value 0.0001).
 Conclusion: The mean pain score was less following use of ultrasound guided sub costal transversus abdominis plane block in patients undergoing laparoscopic cholecystectomy as compared to port site infiltration of local anaesthesia.

Unidirectional Barbed Suture Versus Polyglactin 910 Suture for Vaginal Cuff Closure in Total Laparoscopic Hysterectomy.

Introduction and objectiveLaparoscopic suturing of the vaginal cuff and knotting is the most challenging step in total laparoscopic hysterectomy (TLH) and requires surgical skill. The objective of this study was to compare the efficacy and safety of unidirectional barbed suture (V-LocTM 180; Covidien, Mansfield, MA) with the conventional polyglactin 910 suture (coated Vicryl; Covidien) for vaginal cuff closure in patients with benign uterine diseases undergoing total laparoscopic hysterectomy.Methods A prospective observational study was carried out at the department of obstetrics and gynecology, All India Institute of Medical Sciences (AIIMS), Rishikesh, for two years. A total of 109 patients with benign uterine diseases planned for TLH were included in the study. Laparoscopic vaginal cuff closure was performed with the unidirectional barbed suture (V-Loc) in 44 patients and with the standard polyglactin 910 suture (Vicryl) in 65 patients. The primary outcome measure was vaginal cuff closure time. Secondary outcome measures included total operative time, blood loss, average number of stitches, postoperative pain perception, duration of hospital stay, vaginal cuff-related complications, and dyspareunia.ResultsDemographic variables and baseline characteristics were similar in both groups except for body mass index (BMI). The mean vaginal cuff closure time was significantly less in the V-Loc group (8.84 ± 2.18 min) than in the Vicryl group (11.66 ± 1.74 min) (p = <0.01). Mean operative time was comparable in both groups (V-Loc group - 109.36±33.02 and Vicryl group - 108.49±40.48; p = 0.91). Other intraoperative parameters, such as blood loss and number of stitches in cuff closure, and postoperative characteristics, such as pain score, duration of hospital stay, vaginal cuff-related complications (vault cuff dehiscence, hematoma, or abscess), and dyspareunia, were comparable in both the groups.ConclusionsThe unidirectional barbed suture significantly reduces vaginal cuff closure time. It is a safe, effective, and well-tolerated alternative to conventional Vicryl suture for vaginal cuff closure in TLH without increasing the risk of postoperative vaginal complications particularly where affordability is not an issue and resources are accessible.

A COMPARATIVE STUDY OF POSTOPERATIVE ANALGESIA FROM INTRAPERITONEAL INSTILLATION OF ROPIVACAINE V/S ROPIVACAINE + FENTANYL IN LAPAROSCOPIC CHOLECYSTECTOMY SURGERIES

Background and Aim: This study is designed and conducted to compare the efcacy of intra-peritoneal instillation of ropivacaine to that of a combination of ropivacaine and fentanyl in reducing post-operative pain and the side effects of the same. Aim: To compare the effects of intra-peritoneal instillation of ropivacaine to a combination of ropivacaine and fentanyl on postoperative morbidity in terms of: 1. Post-operative pain 2. Post-operative adverse effects Methods and Material: After approval of the Institutional Ethics Committee (IEC) [IEC/HMPCMCE/105/Faculty/12/107/19] and the Clinical Trials Registry of India [CTRI/2020/04/024616], consenting patients were randomized into two groups of 26 participants each. One group was given intraperitoneal instillation with 15ml of ropivacaine 0.75% diluted in normal saline to make a solution of 45ml and other group was given 15ml of 0.75% ropivacaine with fentanyl 50mcg(1ml) diluted in normal saline to make a solution of 45ml, intra-operatively, and post-operative pain perception and occurrence of adverse effects was recorded. Statistical Analysis: Two sample t-test with equal variances, chi-square test and Fisher's exact test. P value&lt;0.05 was considered signicant Results: Group receiving intraperitoneal instillation of plain ropivacaine was found to have signicantly higher VAS scores and VRS scores (p&lt;0.001) and lesser mean time to requirement of rst-dose of analgesic post-operatively (p&lt;0.001), and lesser incidence of bradycardia (p=0.01) Conclusion: Intraperitoneal instillation of combination of ropivacaine and fentanyl is superior to ropivacaine alone for reducing post-operative pain in patients undergoing laparoscopic cholecystectomy surgery.

Do the positions of the impacted third molars affect the preoperative anxiety levels and probable postoperative pain levels of the patients?

Objectives: The aim of this study is to evaluate the effects of the position of the impacted third molar teeth on preoperative anxiety and possible pain levels of patients. Material and Methods: Fifty patients with impacted third molar teeth (full bone retention) in the horizontal and vertical positions were included in the study. Sociodemographic data of the patients were recorded. The patients have watched the impacted third molar surgery videos which were the position of horizontal and vertical. Subsequently, preoperative anxiety levels of patients were evaluated with The Spielberger State-Trait Anxiety Inventory-STAI part of the state anxiety inventory. In addition, pain levels that patients thought they might feel after the surgeries were evaluated with Visual Analogue Scale (VAS). P <0.05 and p <0.001 were considered significant in all statistical analyse. Results: The study included 50 patients (25 males and 25 females) who mean the age of was 21.00 ± 2.08. A statistically significant difference was found between the levels of anxiety created by the positions of the impacted third molar teeth (p<0.001, p<0.05). Anxiety levels were higher in female patients than in men (p<0.001, p<0.05). A statistically significant difference was found between the levels of pain that patients could feel postoperatively and position of third molars (p<0.001, p<0.05). Conclusion: The position of the third molars are associated with anxiety, stress, and postoperative pain in patients undergoing impacted third molar surgery. Addressing these factors preoperatively may reduce anxiety, probable postoperative perception of pain, and provide more positive treatment results.

Effectiveness of Antianxiety Drugs on Postoperative Pain Perception After Implant Placement: An In Vivo Study

Aim: To evaluate the effectiveness of midazolam and zolpidem on postoperative pain perception in patients undergoing implant placement. Materials and Methods: In the present in vivo study 60 patients undergoing implant placement were selected based on the inclusion criteria framed and were randomly allocated using sequentially numbered, opaque, and sealed envelope (SNOSE) method into 3 groups with 20 patients each after obtaining informed consent. Group A was the control group, Group B received midazolam 7.5 mg 30 minutes before the procedure. Group C received zolpidem 5 mg 30 minutes before the procedure. The anxiety level of patients was recorded using the Corah scale and postoperative pain was recorded after 2 hours of implant placement using the VAS scale. Statistical analysis was done using analysis of variance (ANOVA), one-way multivariate analysis of variance (one-way MANOVA), and then Tukey’s Honestly Significant Difference (HSD) test for comparison among groups at the 0.05 level of significance. Results: Group A had a mean anxiety level of 16 ± 1.451, Group B had a mean anxiety level of 11.2 ± 2.858, and Group C had a mean anxiety level of 13 ± 2.9019 and a statistically significant difference between the groups was observed ( P &lt; .05). The mean for the postoperative pain perception for Group A was 6.8 ± 1.1965, for Group B was 3.8 ± 1.3611, and Group C was 5 ± 1.451 and a statistically significant difference between the groups was observed ( P &lt; .05). Conclusion: This study concluded that both midazolam and zolpidem significantly reduced anxiety levels and postoperative pain in patients undergoing implant placement.

Single-flap versus double-flap approach for periodontal pocket reduction in supraosseous defects: a comparative study.

PurposeThe single-flap approach (SFA) is a minimally invasive technique with limited mucoperiosteal flap elevation to gain access to the buccal/palatal aspects, thus limiting post-surgical complications. The purpose of the present study was to gain insights into the impact of the SFA over the double-flap approach (DFA) on periodontal flap treatment outcomes and patient compliance in terms of discomfort and time taken for surgical procedures.MethodsTwenty patients with persistent probing pocket depths of ≥5 mm were scheduled for the SFA (test site) and for the DFA (control site). All the clinical periodontal parameters were recorded at baseline, 3 months, and 6 months. Radiographic bone level (cone-beam computed tomography) was evaluated at baseline and 6 months. Patients' postoperative pain perception and wound healing were also assessed.ResultsThe SFA showed a significant reduction in periodontal pocket depth, gain in clinical attachment level (CAL), and gain in bone level when compared with the DFA. The SFA substantially improved wound healing and induced less postoperative pain than the DFA.ConclusionsThe SFA resulted in substantial improvement in the composite outcome measures, as shown by a reduction in pocket depth with minimal gingival recession, gain in CAL, early wound healing, less postoperative discomfort, and better patient-centered outcomes.Trial RegistrationClinical Trials Registry-India Identifier: CTRI/2018/05/013562

Pain assessment in patients undergoing lumbar spine arthrodesis: application of unidimensional and multidimensional scale

ABSTRACT BACKGROUND AND OBJECTIVES: It is possible that patients submitted to lumbar spine surgery present chronic pain and need a multidimensional assessment of postoperative pain due to the variables that influence pain. The objective of this study was to evaluate the correlation between uni and multidimensional scales for postoperative pain assessment. METHODS: Longitudinal and observational study carried out in the inpatient units of an orthopedic reference hospital in Sao Paulo. 53 patients were selected in the preoperative period of lumbar spine arthrodesis, 28 were excluded and 25 were evaluated with the numerical verbal scale and Brief Pain Inventory on the preoperative day and on postoperative day 2. RESULTS: In the sample, all patients had chronic pain with a mean previous pain time of 9.24 years. There was variation between the pre and postoperative periods on the Brief Pain Inventory in almost all items, but only the item regarding the amount of pain ‘’right now’’ (in the moment) was equivalent to the numerical verbal scale (Kappa=almost complete correlation). CONCLUSION: The numerical verbal scale and Brief Pain Inventory were not comparable since the Numerical Verbal Scale showed a worsening of postoperative pain, while the Brief Pain Inventory reflected improvement in the perception of postoperative pain. The Brief Pain Inventory seemed to be a better tool for pain assessment in this study

Multi-injection paravertebral block with low volume local anesthetic for anesthesia in radical mastectomy - randomized controlled trial.

Paravertebral block (PVB) is generally used in breast cancer surgery in combination with general anesthesia. Only multi-injection PVB can decrease the volume of local anesthetic (LA) while maintaining the efficacy of the block. The use of small LA volumes in PVB prevents its undesirable distribution from the injection site. The objective of this study was to examine the effect of multi-injection paravertebral block for anesthesia in radical mastectomy in breast cancer patients. The study analyzed 130 cases of anesthesia in radical mastectomy. The patients were randomized to two groups: Group 1 (n = 65) received general anesthesia (GA), and Group 2 (n = 65) received PVB (Th1 to Th6) with GA. In Group 2, 0.75% ropivacaine solution at 1.5 to 3.0 mL per level was used. Serum cortisol levels were measured. The post-operative acute pain perception was measured using a 100-point visual analogue scale (VAS). Fentanyl consumption in Group 1 was 70% higher than in Group 2 (P < 0.05). No increase in intra-operative cortisol levels was seen; 2 hours after surgery, cortisol levels were 3.3 times and 2.7 times higher than the baseline in Group 1 and Group 2, respectively (P < 0.05). VAS scores in Group 2 were lower at 2, 6, 12, and 48 hours after surgery (P < 0.05). Supplementation of GA with multilevel PVB decreased the intra-operative fentanyl consumption. In radical mastectomy, the intra-operative cortisol levels do not increase. The highest VAS pain scores are seen within the first 24 hours after mastectomy.

Anxiety and Depression Affect Early Postoperative Pain Dimensions after Bariatric Surgery.

Uncontrolled postoperative pain and prolonged immobilization after bariatric surgery have been associated with increased postoperative complications and prolonged hospitalization. The aim of our study was to evaluate the postoperative pain that follows bariatric surgery and identify any psychological factors that may affect the early postoperative perception of pain. The study included 100 patients with obesity (women, n = 61; age 37.4 ± 9.9 years, mean ± standard deviation; Body Mass Index (BMI) 47.6 ± 6.5 kg/m2) who underwent bariatric surgery. Preoperative anxiety and depression were evaluated by the Hospital Anxiety and Depression Scale (HADS), and the quantitative and qualitative dimension of early postoperative pain were evaluated by the McGill Pain Questionnaire Short Form (MPQ-SF). Furthermore, the postoperative analgesia protocol was recorded for each patient. Pain declined gradually during the first 24 h postoperative. Although preoperative anxiety had no correlation with the overall pain of postoperative Day 0, patients with a higher level of preoperative anxiety had significantly more intense and more unpleasant pain at 1 h post operation. In addition, depression influences both the intensity and unpleasantness of pain at different time points (1 h, 4 h and 24 h postoperative). Preoperative pain correlated with educational level, but not with age, BMI, gender, marital status, smoking and surgery type. In conclusion, preoperative anxiety and depression influence the early postoperative pain after bariatric surgery, and their preoperative identification is of major importance to enhance the implementation of fast-track postoperative protocols to prevent complications and prolonged hospitalization.

Endoscopic versus Conventional Thyroid Surgery: A Comparison of Quality of Life, Cosmetic Outcomes and Overall Patient Satisfaction with Treatment.

Our aim was to investigate whether the surgical approach, i.e. endoscopic (ET) versus conventional/open thyroidectomy (ConT), contributes towards the improvement in quality of life (QoL), cosmetic outcomes and overall patient satisfaction with treatment. We conducted a prospective study (October 2016-August 2018) consisting of patients undergoing hemithyroidectomy for euthyroid, non-malignant solitary thyroid nodules (STNs). Patients were divided into two groups: Group I (ET)-41 patients and Group II (ConT)-52 patients. ET was performed via bilateral-axillo breast approach (BABA). A thyroid disease-specific questionnaire "ThyPRO-39hin" was used to evaluate pre- and post-operative QoL. Visual analogue scale (VAS) was used for post-operative pain. Cosmetic satisfaction, paraesthesia and overall satisfaction with treatment were evaluated using Likert-type verbal response scales. Pre- and post-operative scores (>6months) were compared, and p value < 0.05 was considered significant. Mean age (p = 0.26), gender distribution (p = 0.07), mean tumour size (p = 0.74) and preoperative scores of QoL were comparable between the two groups. Post-operatively scores of symptom domain (p = 0.03), tiredness (p = 0.03), impaired social life (p = 0.03), cosmetic complaints (p = < 0.001) and overall QoL (p = < 0.001) were significantly better in Group I. Also, post-operative pain perception at first follow-up visit (p = 0.001) was lower in patients undergoing ET/Group I, with higher scar satisfaction scores (p = < 0.001) and overall satisfaction with treatment (p = < 0.001). Post-operative paraesthesia perception was comparable (p = 0.06) amongst the two groups. In thiscohortstudy, patients undergoing endoscopic thyroid surgery reported superior post-operative QoL, cosmetic and overall satisfaction with treatment as compared to conventional/open thyroidectomy.

Preoperative Pressure Pain Threshold Is Associated With Postoperative Pain in Short-Stay Anorectal Surgery: A Prospective Observational Study.

BACKGROUND:Postoperative pain management is key for patient satisfaction. Pressure pain threshold (PPT) has been studied in some surgical cohorts but has not been studied in relationship to acute postoperative pain in short-stay patients undergoing anorectal surgery. We hypothesized that preoperative finger PPT measurements can identify respective patients with higher postoperative pain. Aiming to understand the relationship with subjective postoperative pain perception, we tested the hypotheses that preoperative PPT is associated with postoperative Visual Analog Scale (VAS) pain scores and correlates with postoperative analgesic consumption in short-stay patients undergoing anorectal surgery.METHODS:We prospectively assessed preoperative PPT in a cohort undergoing anorectal surgery, known as a moderately to severely painful procedure. Linear mixed-effects models were used to assess the relationship with postoperative VAS pain scores at 1 and 3 days as well as 4 weeks postoperatively. Logistic regression was used to study the relationship with additional postoperative analgesic consumption.RESULTS:We studied 128 patients and found that preoperative PPT is significantly associated with postoperative pain (P value for interaction = .025). Logistic regression modeling additionally revealed an association between the preoperative PPT and the need for additional postoperative analgesics, with odds of requiring additional analgesia decreasing by about 10% for each 1-point increase in PPT (odds ratio [OR] = 0.90; 95% confidence interval [CI], 00.81–0.98; P = .012).CONCLUSIONS:Preoperative finger PPT is associated with postoperative pain and might help identify patients who are at risk of developing more severe postoperative pain on anorectal surgery. Especially in ambulatory and short-stay settings, this approach can help to address patients’ high variability in pain sensitivity to facilitate appropriate postoperative analgesia, timely discharge, and prevent readmission.

Outcomes and patient perspectives following implementation of tiered opioid prescription guidelines in gynecologic surgery

ObjectivesTo report the impact of implementing standardized guidelines for opioid prescriptions after gynecologic surgery and describe patient perspectives before and after implementation for those undergoing laparotomy for ovarian cancer. MethodsPatients undergoing gynecologic surgery between October 2017 and May 2018 were prescribed opioids at discharge using tiered guidelines; prescriptions were compared to consecutive historical controls (March 2017–October 2017). A subset of ovarian cancer laparotomy patients were surveyed regarding postoperative opioid consumption and patient experience. ResultsA total of 620 women in the tiered guideline cohort were compared with 599 historical controls. Following implementation, 95.8% of prescriptions met guidelines. Median milligram morphine equivalents (MME) prescribed decreased from 150 to 75 (p ≤ 0.001) with no change in opioid refills (7.7 vs 6.9%, p = 0.62).In surveyed ovarian cancer patients, 100% of tiered guideline patients and 92% of historical controls felt satisfied with pain control (p = 0.24), despite a 50% reduction in prescribed MME and 14.6% receiving no opioids at discharge (p = 0.002). The median (IQR) MME consumed after discharge was 15 (0, 75) in tiered guideline patients vs. 24 (0, 135) in historical controls, and 38.2% and 42.4% consumed no opioids, respectively. Mean time between surgery and opioid use cessation was <1 week in both groups; patients' perceptions of opioid prescription appropriateness did not change (p = 0.49). More than 75% of patients kept their remaining opioids rather than dispose of them. ConclusionsReducing prescribed opioids after gynecologic surgery using tiered guidelines did not increase opioid refills or worsen patients' perceptions of postoperative pain. Even after laparotomy, very little opioids were required over a short duration after dismissal. Infrequent disposal of leftover opioids highlights the need to avoid over-prescribing.

Does preoperative dental anxiety play a role in postoperative pain perception after third molar surgery?

Background:Surgical removal of the impacted third molar is associated with inflammatory morbidities which include swelling, trismus, and pain. Pain is the most common postsurgical morbidity associated with third molar surgery. It remains an important factor in patients' perception of recovery after third molar surgery with dental anxiety reported to exert influence on its threshold.Objective:The aim of the study was to determine if preoperative dental anxiety has any significant role on postoperative pain perception after third molar surgery.Materials and Methods:This was a cohort study involving sixty consecutive adult patients requiring extraction of impacted mandibular third molars under local anesthesia. Modified Dental Anxiety Scale Questionnaire was administered to each participant in the waiting area before the surgery. The visual analog scale was also given to each participant to be completed once daily at approximately the same time as the surgery time until day 7 after the surgery. Data collected were analyzed using SPSS version 23.Results:Sixty participants who consented to third molar surgery took part in this study. Five participants were lost to follow-up. There were slightly more males (50.9%) than females (49.1%). Nineteen participants in this study had moderate dental anxiety (34.5%) and 6 participants (11%) had severe dental anxiety with more females having moderate-to-severe dental anxiety. The correlation between pain perception at different days and dental anxiety was not significant (P > 0.05).Conclusion:Preoperative dental anxiety may not significantly influence pain perception after third molar surgery.

Pain and quality of life after endodontic surgery with or without advanced platelet-rich fibrin membrane application: a randomized clinical trial.

Clinical evidence of the autologous platelet concentrates effects on the patient-reported outcome measures (PROMs) after endodontic surgery is still limited. To investigate the effect of the advanced platelet-rich fibrin (A-PRF+) membrane application upon patient postoperative pain, and quality of life in endodontic surgery. A two-parallel-arm randomized clinical trial was made comparing endodontic surgery with or without A-PRF+ as adjunctive treatment. Fifty individuals comprehending 50 apical lesions (second premolar to the second premolar) of upper maxilla were included. Pain perception and quality of life (functional limitations and other symptoms) were assessed 1week after surgery using a visual analog scale and a Likert scale-based questionnaire. Descriptive analysis was done using χ2 and t test. Binary logistic regression, ANOVA-type statistic, and GEE analysis were used for inferential analysis. Pain perception was mild in both groups [A-PRF+ 12.7 ± 8.5] versus [no A-PRF+ 20.7 ± 16.3]; it proved less variable during the first 4days in test group, showing lower extreme pain values (p = 0.096). Analgesic use was similar in both groups. Controls reported significantly worse sleep and speech functions (p < 0.05). Bleeding and bad taste/breath were the most discriminative symptoms. Postoperative pain perception was mild in endodontic surgery of the upper anterior maxilla. Differences in pain perception were not statistically significant. The use of A-PRF+ afforded less variable pain perception than in the controls. Altered quality of life parameters were more prevalent in the control group and prove significant for speech and sleep functions. Patient-related outcomes are of utmost importance in clinical practice. The use of A-PRF+ provides an affordable and safe alternative to improve postoperative quality of life in endodontic surgery.

P56. Preoperative patient activation is not associated with inpatient pain or narcotic utilization after minimally invasive lumbar discectomy

BACKGROUND CONTEXT Minimally invasive lumbar microdiscectomy (MIS LD) is a commonly utilized treatment for symptomatic lumbar disc herniations. Recent investigations have focused on the role of patient engagement and involvement in their postoperative outcomes, referred to as patient activation. Increased patient activation has been associated with superior pain relief and functional recovery after spine procedures. However, no previous study has investigated the association of patient activation with immediate postoperative pain and narcotic consumption following MIS spinal procedures. PURPOSE To determine if an association exists between preoperative Patient Activation Measure (PAM) score and inpatient postoperative pain scores and narcotic utilization after MIS LD. STUDY DESIGN/SETTING Retrospective analysis. PATIENT SAMPLE Forty-seven patients with complete PAM scores and postoperative pain records who underwent primary, single-level MIS LD from 2015-2017. OUTCOME MEASURES Inpatient Visual Analogue Scale (VAS) pain score and inpatient narcotic consumption, quantified as oral morphine equivalents (OMEs). METHODS A prospectively maintained surgical database of patients who underwent primary, single-level MIS LD from 2015-2017 for degenerative pathology was retrospectively reviewed. Patients were grouped by top and bottom halves of preoperative PAM score (≤62, >62). VAS pain scores were used to characterize postoperative pain perception in patients. Inpatient narcotic consumption through discharge were quantified as OMEs. PAM score group was tested for an association with preoperative demographic and perioperative characteristics using student's t-test and chi-square analysis for continuous and categorical variables, respectively. Multivariate linear regression was used to test for an association between PAM score group and inpatient pain scores, and narcotic consumption on postoperative day (POD) 0. RESULTS Of the 47 patients were included in this analysis, 46.8% (22) had a PAM score of ≤62, while 53.2% (25) had a PAM score of >62. There were no significant differences in age, gender, body mass index, smoking status, preoperative comorbidity burden, or preoperative VAS pain score between cohorts (p>0.05 for each). Additionally, there were no significant differences between PAM score groups in regards to perioperative variables including operative time, estimated blood loss, and length of inpatient stay (p>0.05 for each). Finally, there were no significant differences in VAS pain scores or total and hourly narcotic consumption between PAM score groups and on POD 0 after MIS LD (p>0.05 for each). CONCLUSIONS Patient engagement and involvement, as measured by PAM score, was not associated with demographic or perioperative differences among those undergoing MIS LD. Additionally, patient activation was not a predictive factor for perceived pain and narcotics use in the immediate postoperative period after MIS LD. The reduced surgical trauma of MIS LD compared to other spine procedures limits the degree of postoperative pain that patients experience, thus reducing overall narcotic requirement. This may minimize the effect of patient motivation and therefore patient activation on postoperative narcotic use in this cohort. More investigation is required, specifically analyzing the role of patient activation in long-term, post-discharge narcotics usage and dependence after MIS procedures. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Postoperative pain in small-for-gestational age infants after hernia repair, orchidopexy and urethral reconstruction surgery: A pilot study

BackgroundSmall-for-gestational-age (SGA) birth bears an enhanced risk of developing hypertension, obesity, insulin resistance and mental health disorders in later life as a consequence of adaptive processes in utero. Only a small number of studies on pain perception in SGA infants exist. These are indicative of a blunted stress response to pain in SGA newborns. AimWe initiated a pilot study investigating differences in postoperative pain perception between SGA and appropriate-for-gestational-age (AGA) infants. MethodsPain and alertness levels of 10 formerly SGA and 14 AGA infants at the age 0.5–2 years were evaluated by the FLACC scale, Steward and Aldrete Scores following hernia repair, reconstructive surgery of hypospadia and orchidopexy. In addition, the postoperative consumption of non-steroidal anti-inflammatory drugs was compared between SGA and AGA. ResultsPostoperative pain and alertness levels were not significantly different in SGA and AGA children. We did not observe significant group differences regarding the consumption of non-steroidal anti-inflammatory drugs. ConclusionWhile previous studies were suggestive of a suppressed stress response to pain in SGA newborns, these findings did not fully translate into an altered response to pain beyond the newborn age. Further studies in a larger cohort seem necessary to verify this finding.

Sub-urethral Mini Sling versus Transobturator Vaginal Tape for Treatment of Female Stress Urinary Incontinence, One Year Follow-up

Background: Stress urinary incontinence (SUI) is a common problem in women, which accounts about 50% of all incontinent women and affects the quality of life. The mid-urethral sling is the mainstay of SUI treatment over the last years. Tension-free vaginal tape (TVT), has been used as minimally invasive procedure for SUI. Objective: To compare outcomes of sub-urethral minisling and transobturator tape (TOT) for treatment of female SUI, one year follow up regarding operative time, length of hospital stays, postoperative pain perception, general postoperative complications, surgical site infections and early recurrence. Patients and Methods: This comparative study has been conducted in Al-Hussein and Sayed Galal Hospitals; Al-Azhar University; Cairo; Egypt and it included 96 cases, 8 patients missed communication data, 9 refused to participate, 34 in minisling group and 45 in transobturator tape (TOT) group. This a retrospective study for follow up of operated cases during the period from July 2015 to June 2018 at the Urology Department, Al-Hussein, Sayed Galal University Hospitals; Cairo; Egypt. Results: In our study, the minisling operation was associated with nearly the same hospital stay of transobturator tape (TOT). We had early recurrence rate among minisling operation. Finally, the transobturator tape (TOT) operation was associated with less recurrence rate and recurrence time postoperatively compared to the minisling. Conclusion: Minisling when compared to transobturator tape (TOT) for treating SUI; transobturator tape (TOT) yielded better outcomes regarding the postoperative 1 year follow up compared to the minisling.

Truncal blocks and teenager postoperative pain perception after laparoscopic surgical procedures.

Introduction:The prevalence of moderate to severe pain is high in hospitalized teenage patients admitted to surgical services.Objectives:The aims of this study were to determine (1) the preoperative and postoperative factors influencing teenager postoperative pain perception; and (2) suffering, defined as the patient's anxiety, pain catastrophizing thoughts, and mood.Methods:Data were collected from medical records and from 2 medical interviews at the time of enrollment and postoperative day 1. Stepwise linear regression was conducted to assess variables that predicted teenagers' pain scores and suffering.Results:Two hundred two patients (mean age = 13.8 years, SD = 1.9), 56.4% females, scheduled for laparoscopic surgical procedures completed the study. The variables found to be significant predictors of pain response in teenagers were pain on the day of surgery (6.81, 95% confidence interval [CI] = 0.08–13.55, P = 0.05) and use of regional anesthesia (single-injection rectus sheath, transversus abdominis plane, and paravertebral nerve blocks) (−6.58, 95% CI = −12.87 to −0.30, P = 0.04). The use of regional anesthesia was found to predict mood responses (all patients: 2.60, 95% CI = 0.68–4.52, P = 0.01; girls: 3.45, 95% CI = 0.96–5.93, P = 0.01; 14–17-year-old teens: 2.77, 95% CI = 0.44–5.10, P = 0.02) and to negatively predict catastrophic thoughts among all patients as a group (−4.35, 95% CI = −7.51 to −1.19, P = 0.01) and among 14- to 17-year-old teens (−5.17, 95% CI = −9.44 to −0.90, P = 0.02).Conclusion:A comprehensive pain approach that includes truncal blocks may improve teenagers' postoperative pain control after laparoscopic surgeries.

Reduced Influence of Affective Disorders on 6-Week and 3-Month Narcotic Refills After Primary Complex Spinal Fusions for Adult Deformity Correction: A Single-Institutional Study

Previous studies have identified the impact of affective disorders on preoperative and postoperative perception of pain. However, there is a scarcity of data identifying the impact of affective disorders on postdischarge narcotic refills. The aim of this study was to determine whether patients with affective disorders have more narcotic refills after complex spinal fusion for deformity correction. The medical records of 121 adult (≥18 years old) spine deformity patients undergoing elective, primary complex spinal fusion (≥5 level) for deformity correction at a major academic institution from 2010 to 2015 were reviewed. Patient demographics, comorbidities, intraoperative and postoperative complication rates, baseline and postoperative patient-reported pain scores, ambulatory status, and narcotic refills were collected for each patient. The primary outcome was the rate of 6-week and 3-month narcotic refills. Of the 121 patients, 43 (35.5%) had a clinical diagnosis of anxiety or depression (affective disorder) (ADn= 43; No-AD n= 78). Preoperative narcotic use was significantly higher in the AD cohort (AD 65.9% vs. No-AD 37.7%, P= 0.0035). The AD cohort had significantly higher pain scores at baseline (AD 6.5 ± 2.9 vs. No-AD 4.7 ± 3.1, P=0.004) and at the first postoperative pain score reported (AD 6.7 ± 2.6 vs. No-AD 5.6 ± 2.9, P= 0.049). However, there were no significant differences in narcotic refills at 6 weeks (AD 34.9% vs. No-AD 25.6%, P= 0.283) and 3 months (AD23.8% vs. No-AD 17.4%, P= 0.411) after discharge between the cohorts. Our study suggests that whereas spinal deformity patients with affective disorders may have a higher baseline perception of pain and narcotic use, the impact of affective disorders on narcotic refills at 6 weeks and 3 months may be minimal after complex spinal fusion.

Cyanoacrylate Glue Versus Suture Fixation of Mesh in Adult Inguinal Hernioplasty

Background: Tissue glues have been present for over twenty years and are used in surgery for a variety of indications. Use of N butyl- 2-cyanoacrylate based in inguinal hernia surgery were practiced for the first time in the mid-nineties. These non-suture techniques was aimed to decrease the chronic groin pain after hernioplasty without adversely affecting the outcomes Aim of the work: this study was designed to compare the operative outcomes of mesh fixation with glue versus that with suture. The primary objective was to compare pain in the immediate postoperative period and also to compare chronic postoperative pain. Patients and Methods: This prospective randomized study was performed Between January 2018 and January 2019 on 40 patients with unilateral inguinal hernia for whom open hernioplasty was done in the Department of surgery, Al-Azhar University Hospital, Damietta. Results: in the present study, there was significant difference in postoperative pain perception at 24 hours, at one week and at one month (p < 0.05) between glue group and suture group with lesser pain perception in the glue group. After the first month the difference between the two groups was non-significant. The mean operative time which was 44.35 min in the glue group and 57.33 min in suture group showed significant difference. As regard to the postoperative complications, the postoperative hematoma, infection and seroma were lesser in glue group but the difference was not significant. There was no recurrence in both groups. Conclusions: Cyanoacrylate glue for mesh fixation in Lichtenstein repair of adult inguinal hernia shows advantages over mesh fixation by sutures in terms of immediate and chronic post-operative pain, operative time, and postoperative complications.