While most adolescents display a steady recovery trajectory following surgery, some develop chronic postsurgical pain (CPSP), which can significantly impact their functioning. Psychosocial factors are known to play a role in the recovery from pain following surgery, but positive psychosocial factors have received little attention in the literature. This study aimed to address this gap by investigating parental and adolescent positive affect and optimism as predictors of postsurgical pain recovery and positive outcomes in adolescents. This study uses data collected as part of a larger longitudinal project that involved administering questionnaires to adolescents and their parents over multiple timepoints. Adolescent participants aged 12 to 18 years old with a diagnosis of adolescent idiopathic scoliosis, and scheduled for spinal fusion surgery, were recruited across 4 Belgian hospitals along with their parents. Structural Equation Modelling was used to investigate how parental and adolescent positive affect and optimism predicted postsurgical outcomes, including mood, quality of life, and functional disability in adolescents. The study comprised 94 adolescent-parent dyads. Parental optimism before surgery predicted increased adolescent mood following surgery. Adolescent positive affect before surgery predicted increased mood and decreased pain intensity following surgery, while adolescent optimism predicted increased quality of life. None of the optimism or positive affect variables were significantly related to adolescent functional disability following surgery. Study findings identify parental and adolescent positive affect and optimism as potential predictors of postsurgical recovery and positive outcomes in adolescents. However, the multifaceted and complex nature of these relationships warrants further investigation.

Total knee arthroplasty (TKA) is commonly performed to reduce pain and improve functional limitations associated with late-stage osteoarthritis. However, 1 in 4 patients experience persistent post-surgical pain (PPSP); a complaint that is associated with higher peri-operative pain. Cannabidiol (CBD) possesses analgesic and anti-inflammatory properties that may reduce the risk of persistent pain among TKA patients. We designed a pilot trial to assess the feasibility of a definitive trial comparing CBT to placebo for reducing PPSP in patients undergoing TKA. We propose a randomized, controlled, pilot trial in which 40 patients scheduled to undergo TKA will be randomized to receive MPL-001 (an oral CBD-dominant formulation) or placebo, in addition to standard care. The feasibility outcomes of this pilot trial are as follows: (1) our ability to recruit 40 patients in 6 months, (2) achieve ≥75% treatment adherence among patients, and (3) <15% loss to follow-up. Secondary outcomes are the effects of MPL-001 relative to placebo on PPSP, opioid use, peri-operative pain interference, physical and emotional function, return to functioning, sleep, and adverse events (AEs) up to 6months post-surgery. The results of our pilot study will inform the feasibility of a definitive trial to establish the effectiveness of CBD to reduce PPSP after TKA. If no major changes to our protocol are required, we will treat this study as a vanguard trial and enroll our pilot patients into a definitive trial. We prospectively registered our trial on ClinicalTrials.gov (identifier: NCT03825965) before enrolling any patients.

Hidradenitis suppurativa is a burdensome chronic inflammatory skin disorder. While surgery can be essential for many patients, preferences and values regarding surgery are insufficiently characterized. This study aimed to investigate preferences of adult patients with hidradenitis suppurativa in the USA when choosing an hidradenitis suppurativa surgery method. A discrete choice experiment was conducted. Patients were asked to choose between two hypothetical procedures 15 times. Literature review and patients with hidradenitis suppurativa and expert interviews informed treatment attributes selection. A mixed logit model was applied to estimate preference coefficients. Subgroup analyses and a latent class model were conducted. Relevant attributes for the 205 participants (90% female, aged 41 years) ranked as follows: effectiveness on lesion improvement (36.75%), recurrence/persistence risk (15.02%), out-of-pocket costs (13.27%), post-surgical wound care (13.27%), post-surgical pain duration (9.64%), recovery time (7.12%) and complications risk (4.94%). A latent class model revealed participants in class 1 including more people of White/Caucasian, Asian and Latino ethnicity and full-time and part-time employed and non-working people put a higher value on risk of return and less priority on wound care post-surgery and out-of-pocket costs. For participants of class 2 consisting of more people of Black or other ethnicity and self-employed, students or retired people, the opposite was observed. Of the evaluated attributes, effectiveness for improvement, recurrence risk, out-of-pocket costs and post-surgical wound care contributed most to patient preference. Surgeons should account for these aspects of procedures when offering surgical interventions. Studies of surgical outcomes should place high value on these aspects of procedural outcomes.

Severe grade rotator cuff injuries require surgery, but post-surgical pain and kinesiophobia can hinder rehabilitation. Graded Motor Imagery (GMI) aids to reduce these challenges through its three phases. However, there is less supporting evidence on the effect of GMI in post-surgical shoulder rehabilitation cases. To explore the added effect of GMI combined with conventional rehabilitation on pain, kinesiophobia, functions, and joint mobility following rotator cuff repair. 16 participants (aged 45-60) were randomly assigned to experimental (GMI + conventional rehabilitation) and control (conventional rehabilitation) groups. Primary outcome was pain (NPRS), and secondary outcomes were kinesiophobia (TSK), shoulder function (Quick DASH), and mobility (goniometer). Assessments occurred pre-operatively, 3rd post-op day pre-rehab, and post---rehab after 3 weeks. Phase 1 GMI began post-immobilization (day 3) in the hospital; Phases 2 and 3 followed on alternate days after discharge via home or OPD sessions according to the convenience of the patient. At 3 weeks, experimental group showed improvements across all measures, pain (d = -2.55; P = .002), kinesiophobia (d = -3.18; P = .001), functional status (d = -1.71; P = .007) and shoulder mobility flexion (d = 4.65; P = .0001), abduction (d = 6.43; P = .0001), Internal (d = 1.48; P = .012) and External rotation (d = 2.71; P = .002). Adding GMI to conventional post-surgical rehabilitation may help to reduce pain and kinesiophobia, thereby improving functional outcomes and mobility following rotator cuff repair.

The objective of this study is to compare and analyze the clinical data differences between the use of a single ultra-fine 8Fr chest drainage tube and a single 22Fr conventional chest drainage tube, both commonly employed after single-port thoracoscopic lung cancer resection. This comparison aims to evaluate the overall postoperative effectiveness of each method. We retrospectively analyzed 697 patients undergoing this procedure over two years. After exclusions, 665 patients were categorized: Group A (8Fr tube) and Group B (22Fr tube). Propensity score matching (PSM) was then applied to eliminate confounding factors between the two groups. After PSM, 202 pairs (404 patients) were included in both groups. Outcomes compared included postoperative hospital stay, total drainage volume, pain scores (days 1-3), inflammatory markers, complications, Chronic Postsurgical Pain (CPSP), and quality of life (QOL). Group A had significantly lower pain scores on postoperative days 1, 2, and 3 (all P < 0.001), shorter hospital stay (3 [3, 4] vs. 4 [3, 4] days, P = 0.032), and less total drainage volume (180 [130-236.25] ml vs. 255 [170-330] ml, P < 0.001) than Group B. Complication rates and inflammatory markers showed no significant differences (P > 0.05). At one month, Group A reported significantly lower worst/average pain scores (P < 0.001, P = 0.018) and better QOL in activities, mood, work, relationships, and enjoyment (all P < 0.05) compared to Group B. No significant differences existed in mildest pain or walking impact (P > 0.05) or in any pain/QOL measures at 3 months (P > 0.05). Compared to 22Fr tubes, using an 8Fr ultra-fine drain after thoracoscopic lung cancer resection significantly reduces postoperative pain, drainage duration, hospital stay, and total drainage volume. Patients discharged with the 8Fr tube experienced less severe pain and better short-term QOL without increased complications or inflammation. The 8Fr ultra-fine drain is an effective, safe, and clinically valuable alternative.

Chronic postsurgical pain (CPSP) after hip arthroplasty is a major complication that affects patients' long-term quality of life. However, reliable tools for the individualised prediction of CPSP risk after hip arthroplasty are lacking. This study aims to develop and validate a nomogram model to predict CPSP risk in patients undergoing hip arthroplasty. This prospective observational cohort study will consecutively recruit 300 patients undergoing primary hip arthroplasty at the Department of Orthopaedics and Joints, Nanping First Hospital Affiliated with Fujian Medical University. The primary outcome is CPSP assessed at 3 months postoperatively (Visual Analogue Scale score ≥4). Candidate predictor variables have been identified based on literature review and clinical expertise, and include demographics, comorbidities, preoperative pain, psychological status and surgical and perioperative management. The dataset will be randomly split into development and internal validation sets in a 7:3 ratio. We will employ Least Absolute Shrinkage and Selection Operator regression to select variables and will use multivariable logistic regression to build the final prediction model. Internal validation will be performed using bootstrap resampling (1000 repetitions). The model's discrimination, calibration and clinical utility will be assessed using the C-statistic (area under the curve), calibration plots and decision curve analysis, respectively. The final model will be presented as a nomogram. The study protocol has been approved by the Ethics Committee of Nanping First Hospital (Approval No: NPSY202412034). All participants will provide written informed consent. The results will be submitted for publication in a peer-reviewed academic journal. ChiCTR2500107193; https://www.chictr.org.cn/showproj.html?proj=282634.

One potential risk after surgery is the development of chronic post-surgical pain (CPSP). Physical activity (PA) has emerged as a potential non-pharmacological approach for reducing the risk of CPSP. This systematic review synthesized and evaluated the current scientific evidence on the use of PA-based interventions for the prevention or reduction of CPSP. We conducted a systematic review of randomized controlled trials published from inception through October 2025. Inclusion criteria were surgical patients who completed a pain assessment ≥3 months post-surgery, comparing PA interventions with a control group. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Synthesis Without Meta-Analysis guidelines, conducted a risk-of-bias assessment using the Cochrane risk-of-bias tool 2, and interpreted changes in CPSP relative to established minimal clinically important differences (MCIDs). Thirteen studies (sample size mean: 86.5; median: 67; range: 20-194) met inclusion criteria, enrolling 1,155 patients (67.8% female, 32.2% male) across four main surgery types (spine, total knee/hip arthroplasty, mastectomy, lung resection). Our descriptive synthesis found that PA programs were implemented predominantly post-surgically, and varied in terms of modality, duration, frequency, and session length. Control groups also differed, with only two studies describing active controls. Low-quality evidence supports that PA interventions significantly reduce CPSP compared to control, with two studies demonstrating pain reductions exceeding MCIDs thresholds. Only three studies were considered overall low risk of bias. Findings suggest that PA interventions may offer some benefit in reducing CPSP, although the evidence remains inconclusive. Evidence from available studies is insufficient to establish the definitive efficacy of PA in preventing or reducing CPSP. Future trials should clearly define intervention parameters and employ active control groups to strengthen methodological rigor. Incorporation of more comprehensive pain assessments will allow investigation of mechanisms of efficacy, as well as differential impact among patients.PROSPERO ID CRD42025626850.

Chronic postsurgical pain (CPSP) is particularly relevant in thoracoscopic lung cancer surgery, a procedure predominantly performed in older adults, yet it remains a major clinical challenge with few effective preventive strategies. Repetitive transcranial magnetic stimulation (rTMS) has demonstrated analgesic potential and may offer a novel approach for CPSP prevention. This study investigated whether early postoperative rTMS could reduce CPSP in older patients undergoing thoracoscopic surgery and explored its potential mechanisms. In this randomized controlled trial, 286 patients were screened and 230 undergoing thoracoscopic surgery were randomized to receive either active or sham rTMS targeting the left dorsolateral prefrontal cortex (10Hz, 100% resting motor threshold, 2000 pulses per session) immediately after extubation in the PACU. A total of 198 patients completed the 3-month follow-up, during which clinical and biochemical outcomes were assessed by blinded evaluators. In the modified intention-to-treat analysis, the incidence of CPSP was significantly lower in the active rTMS group than in the sham group (24.3% vs 43.5%; RR, 0.56; 95% CI, 0.39-0.80; P = 0.002). In addition to reducing CPSP, active rTMS resulted in significant improvements in anxiety (26.0 [IQR, 25.0-26.0] vs 29.0 [IQR, 27.5-30.0]; P < 0.001) and depression scores (26.0 [IQR, 25.0-26.0] vs 29.0 [IQR, 27.5-30.0]; P < 0.001) at 3months. Additionally, serum CXCL10 levels-an inflammation-related biomarker associated with chronic pain-were significantly lower in the active rTMS group (68.9 [48.1-85.7] vs 82.6 [67.3-105.5] ng/mL; P = 0.018). Exploratory analyses further demonstrated that CXCL10 had good predictive accuracy for CPSP (AUC = 0.90; cutoff = 90.5pg/mL). Early postoperative rTMS targeting the DLPFC effectively reduces the development of CPSP after thoracoscopic surgery and may be associated with CXCL10-related inflammatory processes. CXCL10 may represent a promising candidate biomarker for identifying patients at high risk of CPSP. ClinicalTrials.gov (NCT06392919).

A substantial proportion of patients report no pain after surgery, resulting in an excess of zero values that pose challenges for analysis using traditional statistical models. The present study was designed to test the hypothesis that a two-part model, commonly used in healthcare expenditures research, would demonstrate superior performance in predicting postsurgical pain when compared to traditional models, and would secondarily better identify predictors of this clinically important outcome. This study analyzed a prospectively collected single-center dataset (n=3925) of chronic postsurgical pain to compare a novel two-part modeling framework with logistic and linear regression. The two-part model first estimated the probability of experiencing postsurgical pain at 3 months (binary outcome), followed by the severity of pain among those affected (on a 1-10 numeric rating scale). To obtain an unbiased assessment of model performance, the data were randomly split into training (n=3000) and testing (n=925) datasets. Models were trained on the training dataset and evaluated on the testing set. This process was repeated 400 times to compute average performance estimates. As a secondary aim, the study assessed the associations of 15 baseline factors, including validated measures of patient-reported pain, functional and psychological measures, comorbidities, and surgical details, across the different modeling approaches. The two-part model demonstrated superior predictive performance compared to linear regression alone, with a higher mean R² value (0.075 vs. 0.050, p<0.0001), lower root mean square error (RMSE: 1.466 vs. 1.485, p<0.0001), and lower mean absolute error (MAE: 1.020 vs. 1.030, p<0.0001). Statistical comparison with logistic regression alone was not possible due to the shared binary component. The two-part model identified 7 baseline preoperative covariates as independently associated with postsurgical pain that were missed by either logistic or linear models, or both: self-reported race, education level, ASA classification, overall body pain, widespread pain, symptom severity, and anxiety level. Significant baseline factors identified in all three models were patient sex, surgical type, and surgical site pain. A two-part model may offer a superior statistical approach to linear and logistic regression, better identifing patient- and clinical care-related risk factors of chronic post-surgical pain, primarily by distinguishing factors that drive the occurrence of chronic pain from those that are associated with pain severity.

Chronic postsurgical pain (CPSP) affects 20% to 30% of pediatric patients at 12 months after surgery. We hypothesized that differences in biopsychosocial and somatosensory profiles exist between patients with CPSP and those with chronic primary pain (CPP) and that these differences affect treatment outcomes. This cohort included prospectively collected, retrospectively analyzed data from adolescents treated at the Edwards Family Interdisciplinary Center for Complex Pain between May 2016 and May 2022. During clinic intake, patients completed the Functional Disability Inventory, Revised Child Anxiety and Depression Scale, and Pittsburgh Sleep Quality Index to assess for disability, anxiety, depression, and sleep quality, respectively. Baseline quantitative sensory testing/conditioned pain modulation (QST/CPM) was performed to characterize somatosensory functioning. The primary outcome was a score of 6 ("much better") or 7 ("very much better") on the Patient Global Impression of Change (PGIC) measure at treatment end. Of 99 patients (14.8 ± 2.0 years, 90% female), 46 had CPSP and 53 had CPP. Compared to CPP, patients with CPSP had less baseline functional disability, coexisting depression, and social phobia and better sleep quality. After adjusting for psychosocial differences, patients with CPSP were more likely to score ≥6 on PGIC than patients with CPP (odds ratio = 3.0 [95% confidential interval: 1.3-7.7], P = 0.01). Patients with dynamic mechanical allodynia and/or temporal summation were less likely to score ≥6 on PGIC compared to patients without (odds ratio = 0.33 [95% confidential interval: 0.13-0.82], P = 0.02). Differences in biopsychosocial factors, somatosensory profiles, and treatment outcomes exist between patients with CPSP and CPP. The presence of centrally driven pain hypersensitivity on baseline QST/CPM was associated with worse recovery prognosis.

Chronic postsurgical pain (CPSP) is associated with reduced health-related quality of life and disability. In some patients, it can result in long-term opioid use even after minor surgery. Epidemiological studies have reported highly varying rates of CPSP, largely because researchers have used different definitions with self-defined cut-offs for pain scores. With the introduction of the 11th revision of the World Health Organisation International Classification of Diseases and Related Health Problems (ICD-11), chronic pain is now recognised as an entity of its own, its biopsychosocial nature is emphasised, and its definition is standardised. Compared with the ICD-11 definition, the prevalence of CPSP might have been overestimated in previous studies. The ICD-11 provides a multifactorial assessment of pain severity, referring to pain intensity, pain-related interference, and pain-related distress, which cover the biopsychosocial aspects of chronic pain. These three scores can be added as extension codes to any pain diagnosis. Harmonisation of the CPSP criteria within the different coding levels of the ICD-11 might improve discrimination of CPSP from other chronic pain conditions not induced by surgery. Although neuropathic CPSP increases pain severity and requires alternative therapeutic approaches to nociceptive pain, a specific code to differentiate between neuropathic and non-neuropathic CPSP is not available. For clinical practice and research, the evidence-based ICD-11 definition, which provides clear-cut diagnostic criteria, should generally be used instead of pain scores alone. This will improve the comparability of data, form the basis for future diagnostic and therapeutic approaches, and facilitate communication.

Long-term predictive validity of the pediatric pain screening tool for chronic postsurgical pain and pain-related quality of life impairment: Associations with risk stratification groups in Spain.

In situ injectable lyotropic liquid crystal depot for sustained taphalgin release in acute postsurgical pain management.

Erector spinae plane block for postoperative analgesia in vertebral surgery: An updated meta-analysis of randomized controlled trials with trial sequential analysis and meta-regression.

Somatic and psychological predictors of chronic postsurgical pain in cancer patients: a machine learning approach in a longitudinal two-centre study.

Chronic postsurgical pain (CPSP) is a common complication following total knee arthroplasty (TKA), affecting up to 30% of patients. Altered nociceptive processing may underlie CPSP mechanisms. The study aimed to compare conditioned pain modulation (CPM), local and widespread sensitization between patients with and without CPSP. A prospective case-control study was conducted among 117 patients undergoing TKA due to primary knee osteoarthritis. Participants were classified as CPSP or non-CPSP based on pain intensity (≥30mm on the visual analog scale) at 3 months postoperatively. Quantitative sensory testing assessed CPM, local pressure pain thresholds (PPTs), and remote PPTs at tibial and forearm locations. Measures were taken at 3 and 6 months after surgery. Group comparisons and linear mixed-effects models were applied. Patients with CPSP (n=53) exhibited significantly lower CPM responses at both local and remote sites compared to non-CPSP patients (n=64), with differences persisting over time. Local PPTs were significantly reduced in the CPSP group across all periarticular sites, suggesting enhanced peripheral sensitization. At remote locations, lower PPTs were observed at both tibiae and at the ipsilateral forearm at 3 months; at 6 months, group differences were restricted to the ipsilateral tibia, indicating spatially selective alterations in pain modulation rather than generalized hypersensitivity. CPSP following TKA is associated with persistent differences in descending pain inhibition and increased local pressure sensitivity. These findings suggest that persistent dysfunction in descending inhibitory pathways and localized peripheral sensitization are associated with pain persistence beyond the expected healing period.

BackgroundMachine learning (ML) was used to predict pain scores and opioid consumption after elective spine surgery in the presence and absence of erector spinae plane block (ESP).MethodsA single-center retrospective chart review of 2796 cases was conducted. These cases were divided into the control group (N=1255) consisting of patients who did not receive the ESP blocks and the treatment group consisting of patients who received the blocks (N=1541). The gradient boosting ensemble tree methodology was employed to develop the AI predictive models. Feature importance for each optimized gradient boosting model was quantified using impurity-based importance scores, as implemented in the scikit-learn library. Partial dependence analysis was conducted to characterize the direction, magnitude, and non-linear nature of predictor-outcome relationships across clinically relevant ranges.ResultsOn unadjusted univariate analysis, the ESP block was associated with a statistically significant (p=0.01) yet clinically irrelevant 1% increase in average postsurgical pain scores. Conversely, ESP block was associated with a statistically non-significant (p=0.13) but clinically relevant 6.7% reduction in opioid consumption (MME/kg/day). These associations are exploratory and should not be interpreted as causal. Three AI models were developed to predict postsurgical pain and opioid consumption. The best-performing model, which predicts average postsurgical pain, achieved a mean absolute error of 1.24 on a 10-point scale (approximately 12.4%). High-importance predictors across the models included preoperative pain scores, serum glucose, and white blood cell count, as well as age.ConclusionIt is feasible to use machine-learning approaches to identify risk factors for postoperative pain and predict population-level pain scores and opioid consumption in spine surgery using large datasets; these models are not intended for individual-level prediction. The role of ESP in spine surgery, however, remains uncertain, and ESP block findings should be interpreted as exploratory associations only.

Objectives: Myofascial pain syndrome (MPS) is a common musculoskeletal condition, and while percutaneous needle electrolysis (PNE) and intramuscular electrical stimulation (IMES) are emerging therapies for myofascial pain syndrome and tendinopathies, their effects remain unclear. This systematic review aimed to characterize the methodological features and synthesize the evidence on the clinical improvement and adverse events rates of PNE and IMES in treating MPS and tendinopathies. Data Sources: PubMed, Scopus, Web of Science, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform, Google Scholar, and reference lists. Searches were carried out on 10 July 2025 and repeated on 16 March 2026, just before final analysis. New results found during final searches were screened for inclusion to ensure currency of the review. Methods: We selected studies based on the PICOS framework and predefined selection criteria: Population: adults with MPS or active myofascial trigger points (TrPs), or tendinopathies; Intervention: PNE or IMES; Comparator: sham procedures, other interventions, or no intervention; Outcomes: pain intensity (e.g., Visual Analogue Scale or Numeric Pain Rating Scale), pressure pain threshold (PPT), and functional measures; and Study Design: experimental studies. Studies focused exclusively on post-surgical or neuropathic pain, studies without a relevant comparator, and studies not reporting clinically meaningful outcomes were excluded. We assessed the risk of bias of included studies and performed a narrative synthesis. Results: From 737 identified records, 30 studies met the selection criteria. PNE was generally effective in reducing pain and improving function in tendinopathies and MPS, although results varied across outcomes and follow-ups. IMES showed moderate evidence for reducing pain and enhancing function, particularly cervical range of motion and PPT. However, both interventions had inconsistent clinical improvement and adverse events rates on disability indices and quality of life. Most studies had a high risk of bias due to challenges in blinding. Reported adverse events were minor and self-limiting, indicating that both therapies are generally safe when performed by trained clinicians. Conclusions: PNE and IMES may improve pain and some functional outcomes in MPS and tendinopathies; however, these findings should be interpreted cautiously because most included studies had a high risk of bias.

PurposeChronic postsurgical pain (CPSP) is a common complication of video-assisted thoracoscopic surgery (VATS) and substantially impairs postoperative quality of life. We evaluated whether intercostal nerve block (ICNB) with liposomal bupivacaine provides superior chronic pain control compared with ropivacaine.Patients and MethodsWe conducted a retrospective cohort study of 1325 adult patients who underwent elective VATS lung resection with ICNB administered using either liposomal bupivacaine or ropivacaine at the end of the surgery between September 2023 and August 2024. The primary outcome was the incidence of CPSP at 3 months postoperatively, defined as a numerical rating scale (NRS) pain score ≥1, a sensitive threshold to capture any postoperative pain. Secondary outcomes included NRS pain scores at rest at 24 and 48 hours postoperatively, cumulative opioid consumption within 48 hours, time to independent postoperative activities, length of hospital stay, and incidence of postoperative neuropathic pain at 3 months. Confounding was addressed using 1:1 propensity score matching with a 0.1 standard deviation caliper.ResultsThe median age was 61 years, and 59.9% were female. After propensity score matching, ICNB with liposomal bupivacaine was associated with a significantly lower incidence of CPSP at 3 months compared with ropivacaine (33.5% vs 42.3%; adjusted odds ratio, 0.68; 95% CI, 0.52 to 0.88; P=0.004). Patients receiving liposomal bupivacaine had reduced rest NRS pain scores at both 24 hours (3[2, 4] vs 4[3, 4]; P=0.002) and 48 hours (3[2, 3] vs 3[2, 4]; P=0.038). No significant differences were observed in other secondary outcomes.ConclusionICNB with liposomal bupivacaine was associated with reduced incidence of CPSP following VATS lung resection. These findings highlight the potential long-term analgesic benefit of liposomal bupivacaine and support the need for further randomised controlled trials evaluating long-term CPSP outcomes.

Magnesium plays a role in various physiological processes and has been used for treatment and prevention of diseases affecting different organ systems. Magnesium sulfate has been proposed as an adjuvant for anesthesia, but its efficacy remains debated due to conflicting findings. The present study explored the analgesic effects of different routines of magnesium sulfate administration under three common perioperative situations in rats. The study tested several doses of magnesium sulfate (e.g., 30 mg/kg, 50 mg/kg) in rats under different perioperative conditions: (1) perineural co-administration of magnesium sulfate with lidocaine, (2) intraperitoneally magnesium sulfate pre-administration before lidocaine nerve block, and (3) systemic magnesium sulfate given before or after plantar incision surgery. Sensory/motor blockade duration and mechanical pain thresholds were assessed. When magnesium sulfate is used as an adjunct to lidocaine, all doses of magnesium sulfate can reduce the sciatic nerve block caused by lidocaine. However, when administered via intraperitoneal injection, lower concentrations of magnesium sulfate (e.g., 30 mg/kg, 50 mg/kg) enhance the blocking effect of lidocaine, while higher concentrations (e.g., 150 mg/kg, 300 mg/kg) show no significant additional benefit. In a rat plantar incision model, both preoperative and postoperative intraperitoneal administration of magnesium sulfate effectively alleviated postoperative pain, with the 150 mg/kg dose yielding the most pronounced effect. Magnesium sulfate exhibits route-dependent effects: while it attenuates lidocaine-induced nerve blockade when administered locally, it enhances blockade duration and provides significant analgesia when given systemically. These findings implies that magnesium sulfate paves the way for designing safer nerve block protocols when administered locally, while its systemic application translates into more prolonged and superior postoperative analgesia, thereby reducing opioid consumption and facilitating patient recovery.