Procedure-specific Pain Management Research Articles

Anesteziyoloji ve Reanimasyon Hekimleri Arasında Sezaryen Cerrahisi ve Doğum Sonrası Ağrı Yönetiminde; Prosedüre Özgü Ağrı Yönetimi (PROSPECT) Farkındalığı Anket Çalışması

Objective: Procedure-specific pain management (PROSPECT) provides clinicians with evidence-based recommendations for postoperative pain management. It was aimed to evaluate the preferences of Anesthesiology and Reanimation physicians for postpartum analgesia management. Methods: A questionnaire consisting of 19 questions was prepared, including demographic data, cesarean surgery and postpartum analgesia practices, and whether PROSPECT recommendations were followed. This questionnaire was sent to participants via e-mail. Results: The study included 247 participants. Thirtysix percent of participants reported following PROSPECT recommendations and 55.1% of participants reported prefering opioids routinely or in combination with other techniques for cesarean surgery and postpartum analgesia. Eightyfive percent of the participants think that inadequate postpartum analgesic treatment was performed. Conclusion: Inadequate postpartum analgesia appears to be a common problem. The potential of maternofetal interaction is reported to be the most important reason for this situation. We think that training on postoperative pain management following cesarean surgery will make a significant contribution to eliminating concerns about maternal-fetal interaction. Keywords: Cesarean section, postpartum analgesia, prospect, anesthesiology and reanimation, questionnaire study

Opioids and personalized analgesia in the perioperative setting: A protocol for five systematic reviews.

Treatment with opioids is a mainstay in perioperative pain management. While the leading treatment paradigm has been procedure-specific pain management, efforts regarding personalized pain treatment are increasing. The OPI•AID project aims to develop personalized algorithms for perioperative pain management, taking demographic, surgical, and anaesthesiologic factors into account. We will undertake five parallel reviews to illuminate current evidence on different aspects of individual responses to perioperative opioid treatment. Inclusion of adult populations in English-written studies. Review-specific searches are developed for the following databases: CENTRAL, MEDLINE, Embase, clinicaltrials.gov, and clinicaltrial.eu. Two authors will independently screen citations, extract data, and assess the risks of bias in each review (QUIPS, PROBAST and RoB2, as relevant). These reviews will evaluate various aspects of perioperative opioid treatment, including individualized treatment strategies, selection of specific opioids, and individual patient responses. These will guide future development of a personalized perioperative opioid treatment algorithm (OPI•AID) that will be validated and tested clinically against standard of care.

PROSPECT methodology for developing procedure-specific pain management recommendations: an update.

The procedure-specific postoperative pain management (PROSPECT) working group develops evidence-based pain management recommendations. PROSPECT methodology is unique and rigorous. However, several limitations were recognised that needed to be addressed, and several new factors were identified that improved PROSPECT methodology. The aim of this article is to present updated PROSPECT methodology for development of recommendations for procedure-specific pain management, focusing on the methodological revisions we will implement. In future, included randomised clinical trials will need to be prospectively registered on a publicly accessible clinical trials database and the study design, including the primary outcome in the registration, should coincide with that in the published manuscript. Placebo-controlled studies in which the analgesic intervention of interest is solely paracetamol, non-steroidal anti-inflammatory drugs, cyclo-oxygenase-2-specific inhibitors or opioids will not be included. Studies comparing one drug in a particular class with another in the same class will also not be included. Future projects will use the Cochrane Collaboration risk of bias tool for quality of reporting of methodology and results. A modified Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach will be used for grading of level of evidence and strength of recommendations. Finally, the updated PROSPECT methodology addresses several other limitations and implements new factors that all add rigour and transparency to developing procedure-specific pain management recommendations.

Tailoring Postoperative Pain Management With a Procedure-specific Approach: How to Best Apply this Concept to Cesarean Deliveries

(Anaesthesia. 2021;76:587–589. doi: 10.1111/anae.15251. Epub October 14, 2020) To mitigate pain in postoperative patients, procedure-specific pain management (PROSPECT) surgeons and anesthetists have been performing systematic reviews and meta-analyses to make evidence-based and practical perioperative recommendations with a procedure-specific approach. The PROSPECT approach is now being applied to caesarean deliveries (CD) as new pain management studies and strategies have emerged. These clinical recommendations will ideally help clinicians improve maternal care, decrease hospital length of stay, reduce opioid exposure and intake, and lead to improved maternal outcomes. There is concern, however, the PROSPECT methodology is adequately patient-specific and outcome-specific for patients undergoing CD.

Editorial introductions.

Editorial introductions.

Procedure Specific Pain Therapy - the PROSPECT Idea

Acute pain therapy following operative or interventional procedures has become a compulsory component of a modern perioperative patient management. A structured pain regimen has several clear advantages: it leads to an improvement of the patients' quality of life in the short term, it reduces perioperative morbidity in the medium term, it reduces pain chronification in the long term, at the same time improving the economic efficiency due to an accelerated mobilization, a reduction of the hospitalization and an avoidance of complication inherent costs.This article provides detailed information on the change of paradigm, away from a generalized and rather unspecific acute pain therapy towards a problem oriented procedure specific regimen. It points out two examples of the PROSPECT (PROcedure SPECific pain managemenT) methodology and explains its background.

Transmuscular quadratus lumborum (TQL) block for laparoscopic colorectal surgery: study protocol for a double-blind, prospective randomized placebo-controlled trial

BackgroundThoracic epidural anesthesia is no longer considered the gold standard for perioperative analgesia in laparoscopic colorectal procedures. In the search for alternatives, the efficacy of the transverse abdominal plane (TAP) block and other abdominal wall blocks such as the transmuscular quadratus lumborum (TQL) block continues to be investigated for postoperative pain management. Most of the initial studies on TAP blocks reported positive effects; however, the amount of studies with negative outcomes is increasing, most probably due to the fact that the majority of abdominal wall blocks fail to mitigate visceral pain.The TQL block could prove attractive in the search for better postoperative pain relief after laparoscopic colorectal surgery. In several cadaveric studies of the TQL, a spread of dye into the thoracic paravertebral space, the intercostal spaces, and even the thoracic sympathetic trunk was reported.Given the advantage of possibly reaching the thoracic paravertebral space, the potential to reach nerves transmitting visceral pain, and the possible coverage of dermatomes T4–L1, we hypothesize that the TQL provides superior postoperative analgesia for laparoscopic colorectal surgery as compared to patient-controlled intravenous analgesia with morphine alone.Methods and designIn this prospective, randomized, double-blind controlled clinical trial, 150 patients undergoing laparoscopic colorectal surgery will be included. Patients will be randomly allocated to two different analgesic strategies: a bilateral TQL with 30 ml ropivacaine 0.375% each on both sides, administered before induction of anesthesia, plus postoperative patient-controlled intravenous analgesia with morphine (TQL group, n = 75), or a bilateral TQL block with 30 ml saline each on both sides plus postoperative patient-controlled intravenous analgesia with morphine (placebo group, n = 75). Our primary outcome parameter will be the morphine consumption during the first 24 h postsurgery. Secondary endpoints include pain intensity as assessed with the numerical rating scale (NRS) for pain, time to return of intestinal function (defined as the time to first flatus and the time to the first postoperative intake of solid food), time to first mobilization, the incidence of postoperative nausea and vomiting during the first 24 h, length of stay on the post anesthesia care unit (PACU) and in the hospital, the extent of sensory block at two time points (admission to and discharge from the PACU), the doses of morphine IV as requested by the patient from the PCA pump, the total dosage of morphine administered IV, the need for and dose of rescue analgesics (ketamine, clonidine), free plasma ropivacaine levels after induction and at discharge from the PACU, and the incidence of adverse events during treatment (in particular, signs of local anesthetic systemic toxicity (LAST)).Epidural analgesia is no longer the standard of care for postoperative analgesia in laparoscopic colorectal surgery. Until now, the most effective analgesic strategy in these patients especially in an enhanced recovery program is still unknown. Several abdominal wall blocks (TAP, fascia transversalis plane block) are known to have an analgesic effect only on somatic pain. Recognizing the importance of procedure-specific pain management, we aim to investigate whether a transmuscular quadratus lumborum block delivers superior pain control in comparison to patient-controlled intravenous analgesia with morphine alone.Trial registrationEudraCT identifier 2019-002304-40. Registered on 17 September 2019

The Management of Acute Pain for Musculoskeletal Conditions: The Challenges of Opioids and Opportunities for the Future.

➢ Opioid use for chronic and acute musculoskeletal pain is common.➢ Orthopaedic surgeons are frequent opioid prescribers.➢ Opioids are commonly prescribed for acute pain, with high variation.➢ Opioid alternatives for acute pain are effective, and the incorporation of multimodal pain management in the perioperative period can decrease opioid use.➢ Although opioids are effective for the management of acute musculoskeletal pain, the morbidity and mortality related to opioid analgesics reinforce the need for robust, evidence-based guidelines.➢ Providers should evaluate patient risk preoperatively, should prescribe judiciously with multimodal pain management plans, and should integrate a preoperative discussion on opioid usage.➢ Future research should include procedure-specific pain management strategies, as well as the comparative efficacy of pharmacologic and nonpharmacologic methods of pain management.

Postoperative pain management in the era of ERAS: An overview.

Enhanced recovery after surgery (ERAS) programmes are increasingly becoming standard of care for several surgical procedures. However, compliance with ERAS protocols including pain management protocols remains poor. The PROSPECT (PROcedure-SPEcific Postoperative Pain ManagemenT) collaboration provides evidence-based, procedure-specific pain management recommendations presented as preoperative, intraoperative and postoperative interventions as well as surgical interventions that are easy to access, transparent and relevant to clinicians. This approach should facilitate incorporation of pain management recommendations in an ERAS protocol and improve compliance with the protocols. This article presents an improved approach to developing pain management guidelines as well as a pragmatic approach to procedure-specific perioperative pain management that could be incorporated in an ERAS pathway.

Development of evidence-based recommendations for procedure-specific pain management: PROSPECT methodology.

SummaryEffective peri‐operative pain management is a prerequisite for optimal recovery after surgery. Despite published evidence‐based guidelines from several professional groups, postoperative pain management remains inadequate. The procedure‐specific pain management (PROSPECT) collaboration consists of anaesthetists and surgeons with broad international representation that provide healthcare professionals with practical and evidence‐based recommendations formulated in a way that facilitates clinical decision‐making across all stages of the peri‐operative period on a procedure‐specific basis. The aim of this manuscript is to provide a detailed description of the current PROSPECT methodology with the intention of providing the rigour and transparency in which procedure‐specific pain management recommendations are developed. The high methodological standards of the recommendations should improve the quality of clinical practice.

Procedure-Specific Pain Management (PROSPECT) - An update.

Post-operative pain management protocols may be optimised by examining procedure-specific evidence and outcomes. This recognition led to the formation of the PROcedure-SPECific Pain ManagemenT (PROSPECT) collaboration of anaesthesiologists and surgeons. The aim of PROSPECT is to provide practical and evidence-based recommendations to prevent and treat post-operative pain after specific surgical procedures, thereby overcoming the limitations of generic, non-specific guidelines. Updates in the methodology of PROSPECT in 2017 have placed an increased emphasis on the clinical relevance of studies, including a focus on interventions in the context of multimodal analgesia strategies and consideration of risks and benefits of interventions in specific surgical settings. Evidence-based reviews of analgesic measures, including advice on surgical techniques and adjuvants after diverse surgical procedures, have been completed by the PROSPECT collaboration and are accessible on the website (www.postoppain.org) and published in the peer-reviewed literature. These reviews continue to identify significant gaps in clinically relevant research on post-operative analgesia and are possibly leading to a closing of some of these gaps.

Preemptive and preventive analgesia - an important element in perioperative pain management

In this review, the definition and history of preemptive analgesia and the progress of its conception will be summarized. In the physiology-pathophysiology chapter, central sensitization, the key component of the evolution of postoperative pain, and the neurochemical processes in its background will be explored. Tissue damage caused by surgical incision consists of mechanical and inflammatory components, and it has high importance in the postoperative pain management. The preemptive approach of pain management means more than just preincisional analgesia, it includes the application of multifactious synergistic medication at the same time accordingly. All of these knowledges finally became complete in the conception of the perioperative approach of preventive pain management, which covers the premedication and mental support of a patient in the preoperative setting, furthermore consumes the whole armamentarium of the preemptive (preoperative), intraoperative and postoperative analgesia regimen as well. In practice, procedure-specific pain management should be highlighted, since it is based on the different extents and types of tissue trauma caused by various operations. Orv Hetil. 2018; 159(17): 655-660.

Postoperative pain management

The importance of perioperative pain management (POPM) has recently drawn increased attention, and pain is considered to be a fifth vital sign in some healthcare institutions in Korea. Developments in POPM over the years include patient-controlled analgesia, multimodal analgesia and the establishment of acute pain service units. Over time, the prevalent approach of preemptive analgesia has changed to one of preventive analgesia. Recently developed guidelines for POPM emphasize the importance of multimodal analgesia. Using more than two analgesic drugs that have different mechanisms or act on different receptors is more effective in postoperative pain control and is associated with reduced incidence of adverse effects. In addition, multimodal analgesia involves routes of administration other than oral and intravenous, such as central regional analgesia and peripheral nerve blocks. While developments in the technological and pharmacological approaches to multimodal analgesia continue to occur, new challenges have arisen, such as chronic post-surgical pain and acute neuropathic pain in acute pain service units. Despite the existence of many guidelines for POPM, many patients continue to complain of pain after surgery. Evidence-based, procedurespecific pain management represents a promising new concept. POPM must be considered as part of a process aimed at achieving fast-track surgery that facilitates early discharge and more rapid resumption of normal activities of living. Here, we review the recent guidelines and discuss possible causes of insufficient postoperative pain control.

Putting it all together: recommendations for improving pain management in plastic surgical procedures.

The benefits of optimal pain management are well recognized. Nevertheless, treatment of postoperative pain continues to be a major challenge, and inadequate postoperative pain relief remains disturbingly high. One of the reasons for suboptimal pain management may be related to inadequate or improper application of available analgesic therapies. Use of patient-specific and procedure-specific pain management strategies should improve pain control and consequently improve perioperative outcome, including early ambulation, ability to perform rehabilitation activities, and return to activities of daily living. This article discusses the current evidence that should allow improved postoperative pain control with emphasis on the use of procedure-specific pain management.

Procedure-specific pain management and outcome strategies.

Optimal dynamic pain relief is a prerequisite for optimizing post-operative recovery and reducing morbidity and convalescence. Procedure-specific pain management initiative aims to overcome the limitations of conventional guidelines and provide health-care professionals with practical recommendations formulated in a way that facilitates clinical decision making across all the stages of the perioperative period. The procedure-specific evidence is supplemented with data from other similar surgical procedures and clinical practices to balance benefits and risks of each analgesic technique. There is emphasis on the use of multimodal analgesia and preventive analgesia aimed at reducing central sensitization. Importantly, the benefits of dynamic pain relief may only be realized if other aspects of perioperative care such as the use of minimally invasive surgery, approaches to reduce stress responses, optimizing fluid therapy and optimizing post-operative nursing care with early mobilization and oral feeding are utilized.

Procedure-specific Pain Management

Procedure-specific Pain Management

Procedure-Specific Pain Management: PROSPECT

IMILAR TO OTHER specialties, evidenceased practice is a relatively new concept ith regard to pain management. It was ntroduced to the pain management arena n the United States 15 years ago with the gency for Health Care Policy and Research AHCPR, now AHRQ [Agency for Healthare Research and Quality]) clinical pracice guideline on acute pain management. hat landmark document changed the way ealth care professionals viewed pain mangement, primarily because it presented ecommendations for pain treatment that ere based on systematic grading of evience. There has been an explosion in pain esearch since that time, and the emphasis n practical application of scientific evience continues. The devotion of a focus ssue of the Journal of PeriAnesthesia ursing entirely to evidence-based practice n June of 2006 attests to the importance of his approach in the perioperative setting.

Procedure specific pain management after surgery—“PROSPECT”

Procedure specific pain management after surgery—“PROSPECT”

Factors associated with pediculosis pubis and scabies.

To ascertain factors associated with genital pediculosis and scabies infestations among attenders at an STD clinic. Cross sectional assessment of potential risk factors by multiple logistic regression. A central city sexually transmitted diseases (STD) clinic in Adelaide, South Australia. All men and women patients attending from 1988 to 1991. Pediculosis pubis was diagnosed in 205 of 12,170 (1.7%) men and 65 (1.1%) of 6125 women, and scabies in 56 (0.5%) men and 6 (0.1%) women attending an STD clinic from 1988-1991. Independent risk factors by multivariate analysis for pediculosis pubis in women were pregnancy (odds ratio (OR) = 2.3), sex outside the state (OR = 2.2) and age under 25 (OR = 2.0). Many factors were associated with pediculosis pubis in men, including no steady partner (OR = 1.4), multiple partners (OR = 1.6), being unmarried (OR = 2.0) and homosexual behaviour (OR = 1.6). None of these factors was associated with scabies infestation which was strongly associated with being Aboriginal (OR = 6.8) and being unemployed (OR = 2.5). In this setting scabies appears to be determined by socioeconomic factors and pediculosis pubis predominantly by sexual activity factors.