Prevention Of Postoperative Pain Research Articles

Management of anesthesia in elderly patients, special considerations and challenges

Introduction: Anesthesia management in elderly patients presents distinct challenges due to physiological changes related to aging. Comorbidities, physical frailty and increased risk of postoperative complications are important aspects to be considered. Methods: Systematic reviews of the literature and analyzes of clinical and experimental studies that addressed the management of anesthesia in elderly patients were carried out. Articles published in English, Spanish and Portuguese were selected. The keywords used were "anesthesia in the elderly", "preoperative assessment", "anesthetic techniques", "intraoperative monitoring", "postoperative pain control" and "prevention of complications". Results: Comprehensive and individualized preoperative assessment was identified as crucial for identifying and treating comorbidities and physical frailty in elderly patients. The choice of the appropriate anesthetic technique depends on the type of surgery and the patient's clinical conditions. Careful monitoring during anesthesia, including blood pressure, heart rate, oxygenation and capnography, is essential to detect and intervene early on hemodynamic and respiratory changes. Postoperative pain control in the elderly requires an individualized approach, with appropriate use of analgesics and regional blocks. Complication prevention strategies, such as optimizing hydration, glycemic control, early mobilization and appropriate use of medications, are essential to reduce the risk of delirium, infection and cognitive dysfunction. Conclusion: Anesthesia management in elderly patients requires an individualized and comprehensive approach, taking into account physiological changes related to aging and associated comorbidities. Careful preoperative assessment, appropriate choice of anesthetic technique, strict intraoperative monitoring, postoperative pain control and prevention of complications are essential to ensure a safe perioperative period and successful recovery in the elderly. Keywords: anesthesia in the elderly, preoperative assessment, anesthetic techniques, intraoperative monitoring, postoperative pain control, prevention of complications.

Pain Levels Following Cosmetic Breast Surgery and An Easy-To-Use Pain Treatment Algorithm for Plastic Surgeons.

The purpose of this study was to examine the degrees of pain experienced following various breast cosmetic surgery procedures and to evaluate the existing pain treatment methods. Patients who underwent subpectoral breast augmentation, mastopexy, or breast reduction between 2017 and 2022 were evaluated retrospectively. A total of 90 patients were randomly selected, with 30 patients in each group. The visual analog scale (VAS) was used to assess pain levels. The data were analyzed using the statistical program SPSS 22.0 (IBM Corp., Armonk, NY, USA). The subpectoral breast augmentation group exhibited the highest recovery VAS score. Postoperative 1, 2, 4, 6, 12, and 24-h VAS values were higher in the breast augmentation group than in the breast reduction and mastopexy groups. No statistically significant difference observed between mastopexy and breast reduction in terms of VAS scores during the evaluation periods. Statistically significant higher VAS scores were observed for subpectoral breast augmentation at all times compared to the preoperative period. Subpectoral breast augmentation is associated with higher levels of postoperative pain compared to breast reduction and mastopexy. Effective postoperative pain prevention is crucial following aesthetic breast surgeries. It not only helps to reduce hospital stays but also aids in patient recovery, facilitates a quicker return to daily activities, and enhances patient satisfaction. To achieve this objective, it is advantageous to utilize a practical pain treatment algorithm that is readily applicable. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Diagnosis and management of complications following pelvic organ prolapse surgery using a synthetic mesh: French national guidelines for clinical practice

Diagnosis and management of complications following pelvic organ prolapse surgery using a synthetic mesh: French national guidelines for clinical practice

Usefulness of ultrasound-guided serratus-anterior block in prevention of postoperative pain after breast surgery. A cohort study

ObjectiveTo evaluate superficial serratus anterior plane block's efficacy and side effects in preventing postoperative pain after breast cancer surgery. MethodologyA prospective cohort study was conducted on 195 adult patients undergoing breast oncological surgery under general anesthesia (Group G, n = 96) or combined general anesthesia with superficial serratus anterior plane block (Group L, n = 99).Validated preoperative data, which are predictors of chronic postoperative pain of patients, were recorded (type of surgery, age, pain in the area of the intervention and the other regions; anesthetic-surgical data, analgesic doses used, duration of surgery; pain intensity (EVN scale) at immediate postoperative period, 24 h, seven days and one month after the surgery, and complications. ResultsPain intensity, measured by the EVN scale, had a mean of 1.02 +/− 1.656 in the Postoperative Unit; 1.20 +/− 1.448 at 24 h; 0.76 +/− 1208 seven days; and 0.34 +/− 0.757 one month after surgery.Patients were operated under general anesthesia (n = 96) or general anesthesia combined with the interfascial block (n = 99). Significant differences (p < 0.05) were found in age, height, and VAS scale in PACU. Ten complications were recorded, six in Group L and four in Group G. There were no differences between groups in complications. ConclusionsSuperficial serratus anterior plane blocks are effective and safe in pain control in the immediate postoperative period for breast cancer surgery as a part of the multimodal approach. No significant differences were found one week and one month after surgery.

Effect of Laser Therapy on Postoperative Pain and Endodontic Retreatment: A Systematic Review and Meta-Analysis

Root canal re-treatment (RCR) cases are considered some of the most challenging cases in the field of endodontics, as they are mostly associated with various iatrogenic errors such as ledge formation, incomplete biomechanical preparation, file separation, and incomplete obturation. These iatrogenic errors lead to defective niches within root canals that may act as reservoirs for various viable microorganisms. Such residual microbial niches may cause postoperative pain even after thorough debridement and reshaping the canals, ultimately leading to a poor prognosis for the tooth. Nowadays, prevention of postoperative pain in re-treatment cases and prognosis are effectively managed by photobiomodulation therapy (PBMT). Relevant studies in the English language published before November 2022 were identified using electronic databases like PubMed, SCOPUS, and EBSCO to conduct bibliographic research. This systematic review is based on 3 studies that were found eligible as per the inclusion and exclusion criteria. This systematic review is in accordance with PRISMA guidelines. The systematic review indicated a positive impact by significantly decreasing postoperative pain in RCR cases when treated with PBMT. The variation was statistically significant at 24 hours (P = .0002), 48 hours (P = .03), and 72 hours (P = .02). The mean difference at 24 hours was 0.65 (95% CI, 0.32-0.99), at 48 hours was 0.46 (95% CI, 0.05-0.87), and at 72 hours was 0.40 (95% CI, 0.07-0.74). There was no statistical heterogenicity at 24 hours (P > .05), but a medium heterogenicity was observed at 48 hours and 72 hours. PBMT or low-level laser therapy has shown superior results as compared to the conventional pharmacologic approach in postoperative pain management in RCR cases.

Evidence-Based Guideline on the Prevention and Management of Perioperative Pain for Breast Cancer Peoples in a Low-Resource Setting: A Systematic Review Article.

Breast surgery for breast cancer is associated with significant acute and persistent postoperative pain. Surgery is the primary type of treatment, but up to 60% of breast cancer patients experience persistent pain after surgery, and 40% of them develop acute postmastectomy pain syndrome. Preoperative stress, involvement of lymph nodes while dissecting, and the postoperative psychological state of the patients play vital roles in managing the postoperative pain of the patients. The objective of this study is to develop evidence-based guideline on the prevention and management of perioperative pain for breast cancer surgical patients. An exhaustive literature search was made from PubMed, Cochrane Review, PubMed, Google Scholar, Hinari, and CINAHIL databases that are published from 2012 to 2022 by setting the inclusion and exclusion criteria. After data extraction, filtering was made based on the methodological quality, population data, interventions, and outcome of interest. Finally, one guideline, two meta-analyses, ten systematic reviews, 25 randomized clinical trials and ten observational studies are included in this review, and a conclusion was made based on their level of evidence and grade of recommendation. A total of 38 studies were considered in this evaluation. The development of this guideline was based on different studies performed on the diagnosis, risk stratification and risk reduction, prevention of postoperative pain, and treatments of postoperative pain. The management of postoperative pain can be categorized as risk assessment, minimizing risk, early diagnosis, and treatment. Early diagnosis is the mainstay to identify and initiate treatment. The perioperative use of a nonpharmacological approach (including preoperative positive inspirational words and positive expectation) as an adjunct to the intraoperative regional anesthetic technique with general anesthesia with proper dosage of the standard pharmacological multimodal regimens is the first-line treatment. For postoperative analgesia, an extended form of intraoperative regional technique, nonpharmacologic technique, and NSAIDs can be used with the opioid-sparing anesthesia technique.

Prevention of postoperative pain after total hip arthroplasty in patients with proximal femur fractures

Introduction Proximal femur fractures can be associated with nailing and total hip arthroplasty (THA). Treatment of elderly inpatients necessitates adequate postoperative pain relief. Obese patients require specific inpatient and outpatient treatments.The objective was to evaluate the effectiveness of pain relief in obese patients at the stages of rehabilitation after primary THA performed for a proximal femur fracture.Material and methods VAS score was compared in two groups of 60 clinical cases to evaluate the effectiveness of postoperative multimodal pain relief using the author's method.Results Comparable results of an effective and stable pain relief were obtained in the two groups by the time the patient was discharged from the hospital 5-6 days after THA. Multimodal analgesia with a glucocorticosteroid injected in the projection of the sacroiliac joint provided an effect being greater by 29 % than with use of opioids after two postoperative days and by 11 % after five postoperative days.Discussion Old age, comorbidities are associated with optimal surgical strategy. THA in patients with extra-articular proximal femur fractures can improve the rehabilitation potential early after surgery and general clinical and functional results providing high quality of life in the late rehabilitation period.Conclusion THA demonstrated a stable positive effect of pain relief in the study group of patients with proximal femur fractures, regardless of the weight and the height. Positive dynamics in pain relief was seen in patients with elevated BMI of any gradation, including those with BMI ≥ 40.

Variation in prescribing for the prevention of postoperative nausea, vomiting, and pain following abdominal surgery: A retrospective study.

Adequate postoperative analgesia and prevention of post-op nausea and vomiting (PONV) are core components of modern day anaesthesia and peri-operative care. As well as contributing to overall morbidity, postoperative pain and PONV are frequently cited as one of the most unpleasant and distressing aspects of surgery for patients. Variation in healthcare delivery is known to exist but has often been poorly described. A first step to understanding the consequences of variation is to describe the extent of variation. We aimed to assess variation in pharmacological strategies to prevent postoperative pain, nausea and vomiting in patients undergoing elective major abdominal surgery at a tertiary hospital in Perth, Western Australia, over a three-month period. Retrospective cross-sectional study. We observed considerable variation in prescribing of postoperative analgesia and PONV prophylaxis and suggest that despite adequate evidence based guidelines, they are often overlooked in practice. Measurement of the consequences of variation requires randomised clinical trials that evaluate differences in outcome and cost, associated with the strategies that exist within the spectrum of variation.

Strategies for the prevention of postoperative chronic pain: Perioperative pain management after total joint replacement: a systematic review

Strategies for the prevention of postoperative chronic pain: Perioperative pain management after total joint replacement: a systematic review

Strategies for the prevention of postoperative chronic pain: Perioperative pain management after total joint replacement: a systematic review

Strategies for the prevention of postoperative chronic pain: Perioperative pain management after total joint replacement: a systematic review

CCL17 Blockade by CCL17mAb/GSK-J4 Ameliorates Hyperalgesia in a Rat Model of Postoperative Pain.

C-C motif chemokine ligand 17 (CCL17), an important chemokine, plays a vital role in regulating immune balance in the central nervous system. In this study, we explored the potential roles of CCL17 in a rat postoperative pain model and that of blocking CCL17 in the prevention of postoperative pain in rats. A right plantar incision in rat was used as a model of postoperative pain. A behavioral change was measured preoperatively and postoperatively using mechanical withdrawal thresholds and thermal withdrawal latency. CCL17 and its upstream Jmjd-3 mRNA levels in the spinal cord were detected using real-time PCR, CCL17 levels in the serum were measured using enzyme-linked immunosorbent assay (ELISA), and the expression of interferon regulatory factor 4 (IRF4), which interacts with Jmjd-3, was detected by immunohistochemistry staining. After that, rats were intraperitoneally injected with either anti-CCL17 monoclonal antibody (mAb) or GSK-J4 (the Jmjd3 inhibitor) to evaluate the protective effects of blocking CCL17 on postoperative pain. We found that CCL17 and Jmjd-3 were significantly increased in the spinal cords of the postoperative pain rat, consistent with changes in hyperalgesia. In addition, our results showed that the mechanical and thermal allodynia was significantly ameliorated using anti-CCL17mAb or GSK-J4. Moreover, we found that anti-CCL17mAb or GSK-J4 treatment decreased c-fos expression in response to peripheral stimulation. Finally, our preliminary exploration found that anti-CCL17mAb or GSK-J4 had a protective effect on tissue damage. These findings indicated that high expression of CCL17 played a critical role in postoperative pain induced by plantar incision and that CCL17 blockade may serve as an effective approach to managing postoperative pain.

Effectiveness of Thoracic Wall Blocks in Video-Assisted Thoracoscopic Surgery, a Network Meta-Analysis.

Thoracic epidural analgesia (TEA) and thoracic paravertebral blocks (PVB) are well-established techniques for pain management in thoracotomy. Here, we examine the efficacy of various thoracic fascial plane blocks vs TEA and PVB for intraoperative and postoperative analgesia for video assisted thoracoscopy surgery (VATS) with network meta-analysis. A search for prospective randomized control studies using adult patients undergoing VATS with general anesthesia. The interventions of interest were any regional anesthesia techniques used for postoperative pain control after VATS. Primary outcomes of interest were 24-hour opioid requirement and 24-hour pain scores. A Bayesian network meta-analysis was conducted. We identified 42 studies that fulfilled our inclusion criteria. For patients who underwent VATS, TEA (MD = -27MME, 95% CI = -46.2 to -9MME), ESP (MD = -20MME, 95% CI -33 to -7.9MME), PVB (MD = -15MME, 95% CI = -26 to -4.5MME) demonstrated significant opioid sparing efficacy, as well as reduction in cumulative 24-hour static pain scores. However, exclusion of one study due to high risk of bias revealed that TEA did not significantly reduce opioid consumption, nor did it reduce the incidence of PONV, pulmonary complications, or LOS when compared to ESP, SAP, PVB, ICN, or PECS blocks. Our findings suggest that TEA did not provide superior pain relief compared to ESP, SAP, PVB, ICN, or PECS blocks following VATS. Therefore, we propose ESP as a suitable intervention for the prevention of postoperative pain after VATS.

Ultrasound navigation during blockade in children with retinoblastoma with enucleation of the eyeball

Introduction. Regional blockades in children in ophthalmology operations are used not only for analgesia in the intra- and postoperative period, but also for the prevention of oculocardial reflex (OCR), postoperative nausea and vomiting (PONV). But there is still no convincing data on the advantages of the methods of retrobulbar blockade (RBB) performed under ultrasound guidance and parabulbar blockade (PBB) performed under ultrasound guidance. Aim. In the present study, we investigated the efficacy and safety of RBB under ultrasound guidance with ropivacaine 0.5 % for the prevention of OCR and postoperative pain, as well as PONV when detected with PBB of ropivacaine 0.5 % under ultrasound guidance upon detection of enucleation of the eyeball. Materials and methods. A prospective randomized arterial study was performed for the period 2016–2022. The study included 110 patients with established inclusion criteria. The patients were divided into two groups: 55 patients who performed a RBB + ultrasound and 55 patients who performed a PBB + ultrasound. Evaluated: the likelihood of the introduction of opioid analgesics, the quality of anesthesia, the duration of the block and the likelihood of complications. Results. There was a decrease in intraoperative diseases in the RBB + ultrasound group, where the average dose of fentanyl was increased by 4.1 ± 1.4 μg/kg, and in the PBB + ultrasound group it was 9.7 ± 1.8 μg/kg (p &lt; 0.05 ). The time to the first frequency of the analgesic in the postoperative period was 6.7 ± 1.8 hours in the PBB + ultrasound group, and 11.7 ± 3.3 hours in the RBB + ultrasound group (p &lt; 0.05). Conclusions. There was a significant difference in analgesic efficacy between RBB + ultrasound and PBB + ultrasound. It was revealed that RBB + ultrasound reduces intraoperative opioid requirements, stable intraoperative hemodynamics and longer postoperative analgesia. Therefore, the use of RBB + ultrasound for enucleation of the eyeball in children with retinoblastoma is the preferred technique.

Effect of intraperitoneal magnesium sulfate in the prevention of postoperative pain in daycare laparoscopic cholecystectomy - A prospective randomized controlled trial.

This study evaluated the efficacy of intraperitoneal magnesium sulfate (MgSO4) in preventing postoperative pain after elective laparoscopic cholecystectomy (LC). It is a prospective, double-blinded, placebo-controlled, randomized trial which included 64 patients who underwent LC. Patients were equally randomized into Groups A and B. MgSO4 and normal saline were instilled in subdiaphragmatic space in Groups A and B, respectively, after creating pneumoperitoneum and before starting dissection. The Visual analogue Scale (VAS) was used to determine postoperative pain. Patients who received intraperitoneal MgSO4 had lower average VAS scores for the first 6 h postoperatively, and also, the time for the requirement of first analgesic was longer (3.6 ± 0.4 vs. 2.3 ± 1.0 h). The incidence of vomiting and the requirement for rescue antiemetic was also lower in Group A. Intraperitoneal instillation of MgSO4 reduces postoperative pain and vomiting following elective LC without incurring additional side effects.

Effectivness of submucosal, oral and intramuscular routs of dexamethasone administration in trismus, swelling, and pain reduction after the third lower molar surgery

Background/Aim. Surgical extraction of impacted lower third molars is inevitably followed by the postoperative occurrence of trismus, swelling, and pain sensations to some degree. Corticosteroids (dexamethasone in particular) are commonly used drugs in the prevention of these complications. The aim of this study was to determine the effectiveness of dexamethasone in the prevention of postoperative complications, edema, trismus, and pain after the surgical extraction of impacted lower third molars, depending on the method of its administration. Methods. This prospective study involved 30 healthy patients, aged 18 years and above, of both sexes, with fully impacted lower third molar ? class I or II and position B or C, according to Pell and Gregory classification system and vertical position according to Winter classification. All patients were divided randomly into three groups de-pending on the way of dexamethasone administration: oral ? dexamethasone administered in the form of oral tablets in a dose of 4 mg one hour before the surgery; submucosal ? dexamethasone solution administered submucosally in a dose of 4 mg in the area of the buccal sulcus, after the inferior alveolar nerve block anesthesia and additional anesthesia for the buccal nerve; intramuscular ? dexamethasone solution administered intramuscularly in a dose of 4mg into the area of the deltoid muscle, right before the intervention. Preoperatively and at every follow-up (on the first, second, and seventh day postoperatively), interincisal distance, the degree of edema, and the level of pain with the use of a visual analog scale (VAS) were measured. On the seventh postoperative day, the total number of analgesics taken by the patients was recorded. Results. In the postoperative period, there was no statistically significant difference be-tween the examined groups in terms of effectiveness in swelling, trismus, and pain reduction (p &gt; 0.05). Conclusion. There is no significant difference in dexamethasone effectiveness in postoperative trismus, swelling, and pain reduction after the third lower molar surgery, regarding the route of administration ? oral, intramuscular, or local submucosal.

Transversus abdominis plane (TAP) blocks for prevention of postoperative pain in women undergoing laparoscopic and robotic gynaecological surgery

Transversus abdominis plane (TAP) blocks for prevention of postoperative pain in women undergoing laparoscopic and robotic gynaecological surgery

A COMPARATIVE SPLIT MOUTH STUDY TO EVALUATE THE ANALGESIC EFFICACY OF “DICLOFENAC TRANSDERMAL PATCH” AND “DICLOFENAC INTRAMUSCULAR INJECTION” IN THE IMMEDIATE POST OPERATIVE PERIOD IN PATIENTS UNDERGOING IMPACTED MANDIBULAR THIRD MOLAR REMOVAL

Introduction: Successful surgical treatment is based on correct surgical techniques and the prevention and management of postoperative pain and complications. For postoperative analgesia, multimodal combinations are prescribed nowadays. Aim: The present study aims to evaluate the analgesic efficacy of diclofenac trans-dermal patch and diclofenac intramuscular injection in immediate post-operative patients after extraction of impacted mandibular 3rd molar and the objective is to evaluate the side effects associated with both the modalities and to compare the analgesic efficacy of two modalities. Material and Methods: In this study, eighty bilaterally impacted third molars were selected. The study drugs (trans-dermal Diclofenac patch and Diclofenac intramuscular injection) were divided into two groups Group A (40 cases) and Group B (40 cases). Post-operative self-evaluation by the patient for pain was done. It was recorded at intervals of 2 hours, 8 hours, 16 hours, 24 hours, 2nd day and3rd day using the Visual Analogue Scale.Results and Discussion: Statistically significant higher pain score observed among group B at 8 hours (Mean rank = 28.20; p= 0.001), 16 hours (Mean rank= 30.25; p= 0.001), 24 hours (Mean rank=30.50; p= 0.001), 2 days (Mean rank= 27.05; p= 0.001) and 3rd day (Mean rank= 26.50; p= 0.001) respectively after extraction when compared with group A.Conclusion: Transdermal diclofenac patch is an effective, non-invasive, and cost-effective way of managing post-operative pain and can be used as a modality to control pain in an immediate post-operative period.

Prevention of postoperative pain in patients with hip joint pathology and obesity

Osteoarthritis today is one of the most important causes of disability and a decrease in the quality of life of older patients, which, as a rule, is due to the presence of restrictions on independent movement and self-care. Persistent pain syndrome, which is the leading manifestation of the disease, also significantly reduces the quality of life. The number of obese people is increasing every year, and so is the number of operations to replace joints with artificial ones due to the large impact of excess weight on the incidence of osteoarthritis. Objective - to evaluate the effectiveness of pain relief in overweight and obese patients who have undergone total primary hip replacement at 3.6, 12 months. and 5 years in comparison with patients with normal body weight. Materials and methods. A comparative study of 154 clinical observations was conducted using the VAS pain scale in the aspect of impaired weight characteristics of two groups of patients. Results. In the comparative aspect of the two surveyed groups of patients, comparable results were obtained after undergoing surgery for an effective persistent reduction in pain. Conclusion. Total hip arthroplasty has a persistent positive effect in relation to the leveling of pain in all patients with osteoarthritis, regardless of the etiology of the disease and, in particular, the patient's body weight.

Perioperative medicine role in painful knee prosthesis prevention.

Total knee arthroplasty is one of the most frequently performed orthopaedic surgeries. However, up to 20% of patients develop persistent postoperative pain. Persistent postoperative pain may be an extension of acute postoperative pain, but can also occur after more than 3 months without symptoms. Risk factors associated with persistent postoperative pain after arthroplasty have now been characterised within the patient's perioperative context (preoperative, intraoperative and postoperative), and can be grouped under genetic, demographic, clinical, surgical, analgesic, inflammatory and psychological factors. Identification and prevention of persistent postoperative pain through a multimodal and biopsychosocial approach is essential in the context of perioperative medicine, and has been shown to prevent or ameliorate postoperative pain.

Clinical updates on phantom limb pain : German version

Most patients with amputation (up to 80 %) suffer from phantom limb pain postsurgery. These are often multimorbid patients who also have multiple risk factors for the development of chronic pain from a pain medicine perspective. Surgical removal of the body part and sectioning of peripheral nerves result in a lack of afferent feedback, followed by neuroplastic changes in the sensorimotor cortex. The experience of severe pain, peripheral, spinal, and cortical sensitization mechanisms, and changes in the body scheme contribute to chronic phantom limb pain. Psychosocial factors may also affect the course and the severity of the pain. Modern amputation medicine is an interdisciplinary responsibility. This review aims to provide an interdisciplinary overview of recent evidence-based and clinical knowledge. The scientific evidence for best practice is weak and contrasted by various clinical reports describing the polypragmatic use of drugs and interventional techniques. Approaches to restore the body scheme and integration of sensorimotor input are of importance. Modern techniques, including apps and virtual reality, offer an exciting supplement to already established approaches based on mirror therapy. Targeted prosthesis care helps to obtain or restore limb function and at the same time plays an important role reshaping the body scheme. Consequent prevention and treatment of severe postoperative pain and early integration of pharmacological and nonpharmacological interventions are required to reduce severe phantom limb pain. To obtain or restore body function, foresighted surgical planning and technique as well as an appropriate interdisciplinary management is needed.