Preemptive Analgesia Research Articles

The prevalence and factors associated with acute postoperative pain in elective gynecologic surgical patients at two referral hospitals in Addis Abeba, Ethiopia, 2021: a cross-sectional study.

This study aimed to determine the prevalence and factors associated with acute postoperative pain. A cross-sectional study was conducted at Minilik and Zewditu Referral hospitals from October to December 2021 and chart review and face-to-face interviews were the methods of data collection. The pain was measured at the 2, 12, and 24h postoperatively through a numerical rating scale, and the pain was categorized as no pain (score=0), mild pain (score 1-3), moderate pain (score 4-6), or severe pain (score 7-10). All independent variables with P less than or equal to 0.2 in the univariable logistic regression were reanalyzed with multivariable logistic regression at 95% CI to determine predictive factors and a P-value of less than 0.05 was considered statistically significant. In the study period, a total of 368 eligible patients were involved, out of this 11 patients were discharged before 24h, four patients refuse to participate two incomplete documentation and one patient was ICU admitted, therefore 350 patients were involved with a response rate of 95.1%. Among those patients 73.1% of respondents' experience at least one episodes of moderate to severe postoperative pain within the first 24h. Preoperative anxiety (AOR: 2.2, 95% CI: 1.2, 5.1), urban residency (AOR: 2.3, 95% CI: 1.2, 50), participants who have not formal education (AOR: 2.5, 95% CI: 1.3, 4.1), surgical patients without pre-emptive analgesia (AOR: 2.7, 95% CI: 1.3, 3.6), abdominal incision greater than 10cm (AOR: 3.5, 95% CI: 2.1, 7.2), and surgical duration greater than or equal to 60min (AOR: 2.3, 95% CI: 1.1, 3.1) were factors associated with acute postoperative pain following elective gynecologic surgery. In this study, the overall incidence of moderate to severe postoperative pain after gynecologic surgery was unacceptably high, and patients undergoing gynecologic surgical procedures suffer sufficient postoperative pain need of intervention.

Retrospective Analysis of Factors Affecting Chronic Postoperative Pain After Thoracotomy: Single Center Experience.

Despite various pain management methods, chronic pain is still a challenging issue after thoracotomy. This retrospective study was designed to determine the possible factors affecting the development of chronic pain following open thoracotomy. The study included patients who underwent elective open thoracotomy at Ankara University İbni Sina Hospital, between 01.01.2016 and 31.12.2020. The medical files and electronic records of the patients were scanned from the system. Patient history, analgesic methods, and surgical details were recorded. The need for and usage analgesic drugs after the surgery were also recorded. A total of 229 patients who underwent thoracotomy were included in the study, and 83 (36.2%) patients had chronic pain. Duration of surgery, doses of remifentanil, fentanyl or NSAI drugs, duration or number of chest tubes (more than 4 days, or more than 2 tubes), diabetes, or PCEA usage were found as variables affecting pain. Logistic Regression, Multilayer Perceptron, Naive Bayes, AdaBoost, and Random Forest methods were used to evaluate the prediction performances. According to the model created with logistic regression, the rate of the correct classification was 90.8%. The duration of surgery, remifentanil administration, chest tube for more than 4 days, and diabetes were found to be risk factors for developing chronic pain. Fentanyl bolus, PCEA-bupivacaine, and NSAID bolus were determined as preventive factors. A careful analysis of risk factors should be performed for each patient to prevent chronic pain after thoracotomy, and preemptive effective analgesia methods should be performed.

COMPARISON OF PRE-EMPTIVE PARACETAMOL AND PARACETAMOL-DICLOFENACCOMBINATION FOR POSTOPERATIVE PAIN AFTER SURGERIES UNDER GENERAL ANESTHESIA - A SINGLE-BLINDED RANDOMIZED CONTROL STUDY

Background: Postoperative pain control is a critical component of patient care. Effective pain control can improve patient comfort and reduces the risk of complications. Multimodal analgesia is one of the approaches used for postoperative pain control. The idea of combining analgesics is to reduce the side effects of each drug yet effectively deal with postoperative pain. The present study aimed to compare the time for the first analgesia request and compare the total amount of analgesic consumption in the two groups in the postoperative period in the first 24 hrs. Methods: The present study was a single-blinded randomized control study, done in the Department of Anesthesiology, MRMC, and Basaveshwar Teaching and General Hospital, Kalaburgi, Karnataka State. Patients undergoing surgeries under General Anaesthesia with ASA I/II categories were randomly allocated to two groups. Group A n=25 patients with Tab. Paracetamol oral(2gm). Group B n=25 patients with Tab. Paracetamol oral(1gm). + Inj Diclofenac 75mg IM. Postoperative NRS and first demand for rescue analgesia and total consumption of analgesic in two groups were compared. Results: The mean values of NRS scores were found to be lesser in group B as compared to group A indicating better pain control in group B as compared to group A. The time for 1st analgesia request was seen in 60% of group A in 2nd hour and 32% in 1st hour. Time for 1st analgesia request was seen in 60% of patients in group B in the 3rd hour and 20% in the 2nd hour. The overall consumption of analgesics at the end of 24 hours was greater in Group A as compared to Group B. Conclusion: Pre-emptive analgesia with inj. diclofenac is more effective when compared to a tab. paracetamol group alone in post-operative analgesia following elective surgeries. It can further improve the quality of multimodal analgesia during the post-operative period and can reduce the hospital stay and financial burden on the patient. Both paracetamol and diclofenac drugs are safe to provide analgesia in the postoperative period without any major significant side effects.

Postoperative effect of sufentanil preemptive analgesia combined with psychological intervention on breast cancer patients

ObjectivesTo explore the postoperative effects of sufentanil preemptive analgesia combined with psychological intervention on breast cancer patients undergoing radical surgery.Methods112 female breast cancer patients aged 18–80 years old who underwent radical surgery by the same surgeon were randomly divided into 4 groups, and there were 28 patients in each group. Patients in group A were given 10 µg sufentanil preemptive analgesia combined with perioperative psychological support therapy (PPST), group B had only 10 µg sufentanil preemptive analgesia, group C had only PPST, and group D were under general anesthesia with conventional intubation. Visual analogue scoring (VAS) was used for analgesic evaluation at 2, 12 and 24 h after surgery and compared among the four groups by ANOVA method.ResultsThe awakening time of patients in group A or B was significantly shorter than that in group C or D, and the awakening time in group C was significantly shorter than that in group D. Moreover, patients in group A had the shortest extubation time, while the group D had the longest extubation time. The VAS scores at different time points showed significant difference, and the VAS scores at 12 and 24 h were significantly lower than those at 2 h (P < 0.05). The VAS scores and the changing trend of VAS scores were varied among the four groups (P < 0.05). In addition, we also found that patients in group A had the longest time to use the first pain medication after surgery, while patients in group D had the shortest time. But the adverse reactions among the four groups showed no difference.ConclusionsSufentanil preemptive analgesia combined with psychological intervention can effectively relieve the postoperative pain of breast cancer patients.

Frequency of opioids prescribing in the postoperative period and ways to reduce their need

Objective ‒ to explore the need for additional analgesia during surgical interventions on the respiratory organs, by evaluating the consumption of opioids in the postoperative period.Materials and methods. The data of 157 patients, who underwent open surgery for lung cancer were analyzed. Patients were divided into four groups: Multimodal analgesia group (n=39): 1000 mg of paracetamol IV 1 hour before the incision, as well as IV administration of dexketoprofen 50 mg, in the postoperative period dexketoprofen and paracetamol were administered every 8 hours with epidural analgesia using ropivacaine 2 mg/ml (3‒14 mL/h). Thoracic epidural analgesia group (n=37): epidural analgesia: in the postoperative period – ropivacaine 2 mg/ml (3‒14 mL/h). Preemptive analgesia group (n=41): according to the concept of preemptive analgesia ‒ 1000 mg of paracetamol IV 1 hour before the incision, as well as IV administration of dexketoprofen 50 mg, in the postoperative period ‒ dexketoprofen and paracetamol were administered every 8 hours. Control group (n=40): patients received dexketoprofen 50 mg and, if necessary, an opioid analgesic. Pain syndrome was assessed using a visual analog scale from 0‒100 mm.Results. The lowest average dose of morphine consumption was not statistically significantly different in the multimodal analgesia and preemptive analgesia groups (p=0.933), and was significantly lower than in the control and thoracic epidural analgesia groups.Conclusions. The use of a preventive approach to perioperative analgesia in thoracic surgery, which involves the use of paracetamol and dexketoprofen, is not statistically significantly different in terms of pain indicators and the dose and number of morphine prescriptions compared to intravenous administration of paracetamol and dexketoprofen in combination with epidural ropivacaine analgesia (p&gt;0.05).

The anterior superior iliac spine is a reliable novel landmark for preemptive periacetabular analgesia in hip arthroscopy.

Appropriate post-operative (post-op) pain control has been shown to reduce length of stay and facilitate day case surgery. Periacetabular injection of bupivacaine is effective in pain reduction after hip arthroscopy. This study aims to evaluate the anterior superior iliac spine (ASIS) as an anatomical landmark to facilitate needle insertion prior to fluoroscopy. The meeting point derived from a vertical line one fingerbreadth distal to the ASIS and a longitudinal line from the greater trochanter (GT) was used as a landmark in 30 consecutive hip arthroscopy patients for periacetabular analgesia. The distance between the tip of the needle and the acetabular roof was measured via fluoroscopy. Needle location was corrected if needed, followed by periacetabular bupivacaine injection (at anterior, lateral and posterior joint aspects). Post-op pain was measured using the Visual Analog Scale (VAS) 4-6 h post-op and at discharge. The ASIS and GT were identified and used for periacetabular analgesia landmarks in all cases. Results revealed that 93.3% of needle entries fell within 10 mm of the lateral acetabular rim and only one case had fallen distal to it. The post-op mean VAS score was 1.03 (range 0-6, standard error - 0.30, median = 0). At hospital discharge, 90% (27/30 of patients) reported VAS score ≤ 5. Twenty-six of the 30 patients were discharged on the same day as the operation (remaining four patients stayed due to accommodation/traveling issues). The ASIS and GT can be used as an anatomical landmark for periacetabular analgesia in hip arthroscopy with reproducible needle location, significant analgesic effect and minimal radiation.

Effects of esketamine on postoperative rebound pain in patients undergoing unilateral total knee arthroplasty: a single-center, randomized, double-blind, placebo-controlled trial protocol.

Rebound pain, transient and acute postoperative pain after the disappearance of regional block anesthesia, has been a concern in recent years. Insufficient preemptive analgesia and hyperalgesia induced by regional block are the main mechanisms. At present, the evidence for the treatment of rebound pain is limited. The esketamine, as an antagonist of the N-methyl-D-aspartate receptor, has been proven to prevent hyperalgesia. Therefore, this trial aims to evaluate the impact of esketamine on postoperative rebound pain in patients undergoing total knee arthroplasty. This study is a single-center, prospective, double-blind, randomized, placebo-controlled trial. Participants who plan to undergo total knee arthroplasty will be randomly assigned to the esketamine group (N = 178) and placebo group (N = 178) in a ratio of 1:1. This trial aims to evaluate the impact of esketamine on postoperative rebound pain in patients undergoing total knee arthroplasty. The primary outcome of this trial is the incidence of rebound pain within 12 h after the operation in the esketamine group and the placebo group. The secondary outcome will be to compare (1) the incidence of rebound pain 24 h after the operation; (2) the time to enter the pain cycle for the first time within 24 h after the procedure; (3) the first time of rebound pain occurred within 24 h after surgery; (4) the modified rebound pain score; (5) NRS score under rest and exercise at different time points; (6) the cumulative opioid consumption at different time points; (7) patient's prognosis and knee joint function evaluation; (8) blood glucose and cortisol concentration; (9) patient's satisfaction score; (10) adverse reactions and adverse events. The effect of ketamine on preventing postoperative rebound pain is contradictory and uncertain. The affinity of esketamine to the N-methyl-D-aspartate receptor is about four times higher than levo-ketamine, the analgesic effect is 3 times higher than levo-ketamine, and there are fewer adverse mental reactions. To our knowledge, there is no randomized controlled trial to verify the impact of esketamine on postoperative rebound pain in patients undergoing total knee arthroplasty. Therefore, this trial is expected to fill an important gap in relevant fields and provide novel evidence for individualized pain management. http://www.chictr.org.cn, identifier ChiCTR2300069044.

Importance of preemptive analgesia and pain assessment as perceived by intensive care unit nurses.

The importance and efficacy of Preemptive analgesia in reducing pain for patients undergoing painful procedures still debatable and seldom investigated. The aim of this study was to describe intensive care nurses' perception of the importance of pain assessment and Preemptive analgesia prior painful procedures in critical care settings in Jordan. A cross-sectional descriptive design was used. The sample consisted of 300 registered nurses recruited from 22 intensive care units in Jordan. The data was gathered using a self-administered questionnaire. The results showed that nurses considered pain assessment moderately and extremely important for surgical (n = 263, 87.7%), burn (n = 261, 87%), and trauma patients (n = 256, 85.3%). The majority of nurses rated pain assessment as moderately to extremely important for invasive line placement 80.3%, wound care 78.3%, and drain removal 69%. Nurses assessed the need for Preemptive analgesia more frequently before wound care 70.7%, and before invasive line placement 69.7%. Nurses perceived pain assessment for Preemptive analgesia as less priority for unconscious patients. Effective assessment and management of pain for critically ill patients is mandatory. Thus, it is important to improve nurses' knowledge regarding the Preemptive analgesia and its effects in relieving post-procedural pain in critically ill patient. It is recommended to ensure proper clinical training on how to assess critically ill patients and auditing system.

Comparison of Pregabalin and Gabapentin as Pre-emptive Analgesics in Patients Undergoing Abdominal Surgeries

Objective: To compare the analgesic effects of Pregabalin and Gabapentin during elective abdominal surgeries.&#x0D; Study Design: Quasi-experimental study.&#x0D; Place and Duration of Study: Combined Military Hospital, Rawalpindi Pakistan, from Feb to Aug 2021.&#x0D; Methodology: Patients with ASA physical status I, II, and III were enrolled in the study. The total number of patients was 152,divided into Group-A, which received 300mg of oral Gabapentin. In contrast, Group-B received 75 mg of oral Pregabalin an hour before induction of general anaesthesia. In addition, the analgesic requirement in the postoperative period, pain visual analogue scores and side effects were recorded.&#x0D; Results: Out of 152 patients recruited in the study 68(44%) were males whereas 84(56%) were females with a mean age of 42.86±7.07 years. Based on ASA classification, 33(22%) patients were from ASA-I, 91(60%) patients were from ASA-II, and 27(18%) patients were from ASA-III. Pregabalin was a potent analgesic with a significant influence on the visual analogue score, increased duration to the first analgesic administration and a decreased consumption of opioids post-operatively compared with Gabapentin revealing significant results (p-value &lt;0.001). However, no statistically significant association was derived regarding adverse effects between the two groups.&#x0D; Conclusion: Pregabalin significantly reduces post-operative visual analogue scores, increased duration to first analgesic dose requirement and Opioid consumption post-operatively when compared with Gabapentin with no significant difference in adverse effect profile.

Multimodal approach to pain management in thoracic surgery

The American Cancer Society estimated that 68,820,000 men and 61,360,000 women in the United States of America would die from lung and bronchial cancer in 2022, which is equal to 21% of all cancer deaths. Patients who undergo thoracotomy have a higher risk of postoperative complications due to the severe pain syndrome that typically develops after surgery. Even though there has been extensive research on the advantages and disadvantages of various perioperative analgesia techniques, the search for the best and safest still continues.&#x0D; Objective — to improve the results of perioperative anesthesia in patients undergoing thoracotomy by choosing the optimal method of analgesia.&#x0D; Materials and methods. A total of 59 patients with lung cancer who underwent thoracotomy at the communal non‑profit enterprise «Kyiv City Clinical Hospital No 17» from 2018 to 2020 were included in an open‑label noncommercial randomized controlled clinical trial. Patients were divided into 2 groups: the multimodal analgesia (MA) group (32 patients) and the epidural analgesia (EA) group (27 patients). According to the concept of preemptive analgesia, patients in the MA group received 1000 mg of paracetamol and 50 mg of dexketoprofen intravenously 1 hour before surgery. In the postoperative period, dexketoprofen and paracetamol were administered every 8 hours in combination with epidural analgesia. During postoperative epidural analgesia, patients received 40 mg of a 2% lidocaine solution through a catheter inserted into the epidural space (Th5—Th6) and a ropivacaine 2 mg/mL (3—14 mL/h) infusion. Patients in the EA group received only epidural analgesia in the postoperative period. After placement of an epidural catheter in the epidural space (Th5—Th6), they had an injection of 40 mg of a 2% lidocaine solution and an epidural infusion of ropivacaine 2 mg/ml (3—14 mL/h).&#x0D; Results. The study groups did not demonstrate a statistically significant difference in terms of age, hight, weight, a grade of anesthesiological risk (ASA), blood loss, surgery duration, and surgical volume (р &gt;0,05). The level of analgesia was assessed using the numerological rating scale (NRS) after 3, 6, 24, and 32 hours after surgery. Every research stage revealed a significant difference in the level of pain syndrome between the study groups (p&lt;0.05). Patients in the EA group experienced more severe pain syndrome than those in the MA group. Consequently, 7 patients (26%) in the EA group were anesthetized with morphine 10 mg intramuscularly compared to 3 patients (9%) in the MA group.&#x0D; Conclusions. In patients undergoing thoracic surgery, a multimodal analgesic approach, which includes the use of COX‑2 and COX‑3 inhibitors in combination with epidural analgesia, has been shown to produce better analgesia compared to epidural anesthesia alone. The beneficial effect of multimodal analgesia was seen in a significant difference (p&lt;0.05) in the intensity of pain syndrome between the study groups in the early postoperative period after thoracotomy.

The effect of ultrasound-guided intercostal nerve block on postoperative analgesia in thoracoscopic surgery: a randomized, double-blinded, clinical trial

BackgroundIntercostal nerve block (ICNB) is a very effective analgesic method. We aimed to explore the effect of preemptive analgesia with ultrasound-guided intercostal nerve block on postoperative analgesia in thoracoscopic surgery.Methods126 patients, aged 18–70 years, with American Society of Anesthesiologists (ASA) physical status I-II and scheduled for thoracoscopic pulmonary resection were enrolled in this study. 119 patients were left for final analysis. Patients were randomly allocated to group ICNB and group CONTROL. Patients in CONTROL group were administered sufentanil with patient-controlled analgesia device after operation In group ICNB, patients received ropivacaine ICNB prior to surgery and patient-controlled analgesia device after operation. The primary outcome is visual analog scale pain score (VAS) at rest at 0,4, 8,16,24,48,72 and 168 h postoperatively and they were compared. Surgical outcomes and rescue analgesia requirement were also recorded.ResultsVAS scores were statistically significantly lower for ICNB group compared to control group at 0, 4, 8, 16, 24 and 48 h postoperatively. The duration of insertion of chest tube in ICBN group was shorter than that in control group, and the difference was statistically significant (4.69 ± 2.14 vs. 5.67 ± 2.86, P = 0.036). The postoperative hospital stay, incidence of nausea and vomiting and postoperative pulmonary infection rate in ICBN group were all lower than those in the control group, but there were no statistical differences. The frequency of rescue analgesia during 48 postoperative hours was different between the two groups (ICNB vs. Control; 9.83% vs. 31.03%, P = 0.004).ConclusionsFor patients undergoing thoracoscopic surgery, ultrasound-guided ICNB is simple, safe, and effective for providing acute postoperative pain management during the early postoperative stage.Trial registrationChinese clinical trials: chictr.org.cn, ChiCTR1900021017. Registred on 25/01/2019.

Effect of Various Protocols of Pre-Emptive Pulpal Laser Analgesia on Enamel Surface Morphology Using Scanning Electron Microscopy: An Ex Vivo Study

Achieving local anaesthesia for various clinical dental applications is a challenge that we encounter in our daily practice. Pre-emptive pulpal laser analgesia (PPLA) treatment strategy could be a promising non-pharmacological modality. Hence, our ex vivo laboratory study is aimed at evaluating the changes in enamel surface morphology when irradiated with various published PPLA protocols using scanning electron microscopy (SEM). To do so, 24 extracted healthy human permanent premolar teeth were collected, and each tooth was divided into equal halves randomised into six groups. The following laser parameter protocols based on published protocols of clinical Er:YAG laser-induced PPLA were randomly assigned for each group: 0.2 W/10 Hz/3 J/cm2 (Group A-100% water spray; Group B-no water); 0.6 W/15 Hz/10 J/cm2 (Group C-100% water spray; Group D-no water); 0.75 W/15 Hz/12 J/cm2 (Group E-100% water spray; Group F-no water); 1 W/20 Hz/17 J/cm2 (Group G-100% water spray; Group H-no water). Each sample was irradiated at an angle of 90° to the dental pulp, with a sweeping speed of 2 mm/s for a 30 s exposure time. Our results have shown, for the first time, no alteration to the mineralised tooth structure when irradiated with the following protocols: 0.2 W/10 Hz/3 J/cm2 with 100% water spray or without water spray with an irradiated area fixed at a 10 mm tip-to-tissue distance, sweeping motion with 2 mm/s speed of movement; average power output of 0.6 W/15 Hz/10 J/cm2, maximum water cooling of 100%, tip-to-tooth distance fixed at 10 mm, 30 s exposure time, sweeping motion with 2 mm/s speed of movement. The authors concluded that the current available proposed PPLA protocols in the literature might cause an alteration to the enamel surface. Hence, future clinical studies are warranted to validate our study's PPLA protocols.

Efficacy and safety of oral tizanidine premedication as pre-emptive analgesia in adult patients undergoing elective surgeries- A systematic review.

Tizanidine is a centrally acting α2 agonist which has been used as a premedication due to its opioid-sparing and sympatholytic properties. This systematic review assessed the safety and feasibility of oral tizanidine. After registering the protocol with PROSPERO (CRD42022368546), randomized controlled trials and non-randomized observational studies were searched in various databases. The primary outcome was intraoperative opioid use; the secondary outcomes were 24-hr opioid consumption, pain scores, time to rescue analgesia, and adverse events. The risk of bias scale was used to assess the quality of evidence. Out of 202 studies identified, five studies fulfilled the inclusion criteria. Intraoperative opioid consumption was significantly less in the tizanidine group (MD: -2.40; 95% CI: -4.22, -0.59; P = 0.010; I2 = 0 %). The 24-hr opioid consumption was comparable between both groups (MD: -42.53, 95% CI: -91.45, 6.39; P = 0.09; I2 = 99%). Time to rescue analgesia was comparable between both groups (MD: 308.22; 95% CI: -263.67, 880.11, P = 0.29, I2 = 100%). Pain scores at 6 and 12 hours were comparable (MD: -1.37; 95% CI: -3.68, 0.94; P = 0.24; I2 = 97%) and (MD: -1.76; 95% CI: -4.06, 0.53; P = 0.13; I2 = 95%); however, at 24 hours the scores were better in the tizanidine group (MD: -1.10; 95% CI: -1.50, -0.69; P < 0.0001 I2 = 0%). Although dry mouth was significantly more in the tizanidine group (MD: 5.35; 95% CI: 1.72, 16.62; P = 0.004; I2 = 0%), postoperative nausea/vomiting and dizziness were comparable. Tizanidine reduces intraoperative opioid consumption without significant adverse events. However, it does not provide effective opioid-sparing analgesia or reduced opioid requirement in the first 24 hours after surgery.

Comparison of preemptive analgesic efficacy of tapentadol and tramadol on postoperative pain in patients of lumbar laminectomy

Abstract Background: Preemptive analgesia is a treatment modality initiated before surgery as a part of multimodal analgesia for optimum treatment of postoperative pain. It accelerates the time to achieve recovery milestones, reduces the length of hospital stay, and improves patient satisfaction. Materials and Methods: It is a prospective, randomized, observational, cross-sectional study. Sixty patients posted for lumbar laminectomy were randomly assigned into two groups to receive tapentadol 100 mg (group A) or tramadol 100 mg (group B) orally 60 min before surgery. Intraoperative fentanyl and isoflurane requirement was recorded. Postoperatively, pain and sedation were assessed at 0, 2, 4, 6, 12, and 24 h; time of first analgesic requirement, paracetamol requirement, time to first rescue analgesia, number of patients requiring rescue analgesia, and morphine requirement were noted. Results: There was a significant reduction in the intraoperative isoflurane (P &lt; 0.05) and fentanyl requirement (P 0.036). The mean postoperative pain scores at all-time points were less in group A compared with group B (P &lt; 0.05), leading to a highly significant reduction in the mean paracetamol dose (P &lt; 0.001) and time to first analgesic requirement (P = 0.047) in group A. The number of patients requiring rescue analgesia (P = 0.0098), time first to rescue analgesia (P = 0.048), and the mean rescue analgesic requirement (morphine) (P = 0.023) were less in group A compared with group B. The incidence of vomiting was significantly higher in group B (P = 0.0385). Conclusion: Tapentadol is more effective preemptive analgesia than tramadol and has a better side effect profile.

Practical strategies for the prevention and management of chronic postsurgical pain

Chronic postsurgical pain (CPSP) is a multifactorial condition that affects a significant proportion of patients undergoing surgery. The prevention and management of CPSP require the identification of preoperative risk factors to screen high-risk patients and establish appropriate perioperative pain management plans to prevent its development. Active postoperative pain management should be provided to prevent CPSP in patients with severe pain following surgery. These tasks have become important for perioperative team members in the management of CPSP. This review article provides a comprehensive overview of the latest research on the role of perioperative team members in preventing and managing CPSP. Additionally, it highlights practical strategies that can be employed in clinical practice, covering the definition and risk factors for CPSP, including preoperative, intraoperative, and postoperative factors, as well as a risk prediction model. The article also explores various treatments for CPSP, as well as preventive measures, including preemptive analgesia, regional anesthesia, pharmacological interventions, psychoeducational support, and surgical technique modification. This article emphasizes the importance of a comprehensive perioperative pain management plan that includes multidisciplinary interventions, using the transitional pain service as an example. By adopting a multidisciplinary and collaborative approach, perioperative team members can improve patient outcomes, enhance patient satisfaction, and reduce healthcare costs. However, further research is necessary to establish targeted interventions to effectively prevent and manage CPSP.

Perioperative Pain Management in Total Knee Arthroplasty: A Narrative Review of Current Multimodal Analgesia Protocols

Since there is no consensus on the optimal perioperative analgesic method, the present article provides a brief and practical synthesis on current multimodal pre–postsurgery analgesia protocols for primary TKA (excluding intraoperative anesthetic techniques) reported especially in recent meta-analyses and reviews. The focus is not only on the traditional aims (pain scores and opioid sparing), but also the functional recovery and patient-reported outcomes. Multimodal analgesia (pre-emptive analgesia, local infiltration analgesia, peripheral nerve blocks, and specific systemic drugs) is considered the optimal regimen for perioperative pain management of TKA.

COMPARISON BETWEEN PRE-EMPTIVE THORACIC EPIDURALANALGESIA VS CONVENTIONAL THORACIC EPIDURALANALGESIA IN PATIENTS UNDERGOING THORACOTOMY IN A TERTIARY CARE CENTRE

Background: Relative effects of timing of providing analgesia, type of surgery of local anaesthetics used for postoperative thoracic epidural analgesia and the possibility of establishment of pre-emptive analgesia as a superior mode for thoracic epidural analgesia are still in grey zone. In this observational study, we evaluated the idea of Pre-emptive thoracic epidural analgesia which can counter the post thoracotomy pain through pain scoring. Objective: To nd out whether pre-emptive thoracic epidural analgesia is superior to conventional postoperative epidural analgesia for post-thoracotomy pain. Study Design: Observational study. Place and Duration of Study: Department of Anesthesiology and Critical Care, Assam Medical College and Hospital, from Januray 2022 to January 2023. Methodology:After ethical committee approval and informed consent from patients, 22 patients undergoing thoracotomy were included in study. Preoperatively thoracic epidural catheter was inserted at T8-9 intervertebral space level. Group P was given 0.5ml/kg of 0.125% bupivacaine before induction of anesthesia; whereas group C was administered 0.5 ml 0.125% bupivacaine after closure of wound in supine position. All patients received thoracic epidural analgesia with a bolus dose of 0.1 ml/kg of 0.125% bupivacaine every 6 hourly post operatively .Visual analog scale (VAS) was used to assess pain severity at 1 and 24 hours postoperatively, both at rest and after cough (R1, R24, C1 and C24 respectively). Data were analyzed with SPSS and Microsoft Excel 2010. Results: There was no statistical difference in demographic prole of both groups in terms of age, gender, American Society of Anaesthesiologists (ASA) status or type of surgery, complications. Pain was signicantly less in group P at 1hour postoperatively (p=0.0001). However, there was no difference in pain severity at rest at 24 hours and with cough at 01 hour or 24 hours postoperatively. Conclusion: Pre-emptive thoracic epidural analgesia provides better pain control in immediate post operative period at rest. However, no such differences were observed in pain scores in immediate post operative period on coughing. No differences were observed at 24 hours at rest or coughing in both the groups

Effect of oral pre-emptive analgesia on pain management after total knee arthroplasty: a protocol for systematic review and meta-analysis

IntroductionTotal knee arthroplasty (TKA) is currently regarded as an effective treatment for knee osteoarthritis, relieving patients’ pain and significantly enhancing their quality of life and activity levels, allowing them to...

How I do VATS segmentectomy: the two-port approach

: The authors describe their bi-portal videoassisted thoracoscopic approach to perform anatomic segmentectomies. Operating room setting and details of individual segmentectomies performed through this approach are described. The approach consists of a 3–4 cm anterolateral utility incision performed at the level of 4th or 5th intercostal space and another 1–1.5 cm incision at the level of the 6–7th intercostal space performed just anterior to the posterior axillary line. In general, a wound protector is applied in the utility incision and a trocarless technique is used in the inferior port. The utility and the inferior incisions are used often interchangeably and the type and sequence of instrument introduced through one or the other port change depending on the type of segmentectomy. In general, for upper lobe segmentectomies, the thoracoscope is introduced in the utility incision, while for lower lobe segmentectomies it is positioned in the inferior port. All procedures start with lung inspection to identify the position of the tumour in relation to the preoperative imaging. A pre-emptive intercostal analgesia is performed. Subsequently, the segmentectomy procedure is performed with individual dissection and division of the segmental hilar structures and final division of the intersegmental plane. A systematic lymph node dissection is always performed.

Nociception Level Index-Guided Intraoperative Analgesia for Improved Postoperative Recovery: A Randomized Trial.

Nociception is the physiological response to nociceptive stimuli, normally experienced as pain. During general anesthesia, patients experience and respond to nociceptive stimuli by increasing blood pressure and heart rate if not controlled by preemptive analgesia. The PMD-200 system from Medasense (Ramat Gan, Israel) evaluates the balance between nociceptive stimuli and analgesia during general anesthesia and generates the nociception level (NOL) index from a single finger probe. NOL is a unitless index ranging from 0 to 100, with values exceeding 25 indicating that nociception exceeds analgesia. We aimed to demonstrate that titrating intraoperative opioid administration to keep NOL <25 optimizes intraoperative opioid dosing. Specifically, we tested the hypothesis that pain scores during the initial 60 minutes of recovery are lower in patients managed with NOL-guided fentanyl than in patients given fentanyl per clinical routine. We conducted a randomized, single-center trial of patients having major abdominal open and laparoscopic surgeries. Patients were randomly assigned 1:1 to intraoperative NOL-guided fentanyl administration or fentanyl given per clinical routine. The primary outcome was pain score (0-10 verbal response scale) at 10-minute intervals during the initial 60 minutes of recovery. Our secondary outcome was a measure of adequate analgesia, defined as a pain score <5, assessed separately at each interval. With a planned maximum sample size of 144, the study was stopped for futility after enrolling 72 patients from November 2020 to October 2021. Thirty-five patients were assigned to NOL-guided analgesic dosing and 37 to routine care. Patients in the NOL group spent significantly less time with a NOL index >25 (median reduction [95% confidence interval {CI}] of 14 [4-25] minutes) were given nearly twice as much intraoperative fentanyl (median [quartiles] 500 [330, 780] vs 300 [200, 330] µg), and required about half as much morphine in the recovery period (3.3 [0, 8] vs 7.7 [0, 13] mg). However, in the primary outcome analysis, NOL did not reduce pain scores in the first 60 minutes after awakening, assessed in a linear mixed effects model with mean (standard error [SE]) of 4.12 (0.59) for NOL and 4.04 (0.58) for routine care, and estimated difference in means of 0.08 (-1.43, 1.58), P = .895. More intraoperative fentanyl was given in NOL-guided patients, but NOL guidance did not reduce initial postoperative pain scores.