Postsurgical Pain Relief Research Articles

Surgical vs ultrasound-guided lumbar erector spinae plane block for pain management following lumbar spinal fusion surgery.

Spinal surgery is associated with severe diffuse pain in the postoperative period. Effective pain management plays an essential role in reducing morbidity and mortality. This study is designed to compare the ultrasound-guided erector spinae plane (ESP) block and surgical infiltrative ESP block for postoperative analgesia management after lumbar spinal fusion surgery. The patients who underwent two or three levels of posterior lumbar spinal fusion surgery were randomly allocated into one of three groups with 30 patients each (Group SE = Surgical ESP block; Group UE = ultrasound-guided ESP block; Group C = Controls). The primary aim was to compare postoperative opioid consumption, and the secondary aim was to evaluate postoperative dynamic and static pain scores and the incidence of opioid-related adverse effects. There was a significant difference in terms of opioid consumption, rescue analgesia on demand, and both static and dynamic pain scores between groups at all time periods (p < 0.05). Group SE and Group UE had lower pain scores and consumed fewer opioids than the controls (p < 0.05). However, the Group UE had lower pain scores and opioid consumption than the Group SE. The sedation level of patients was significantly higher in the control group than in the other two groups. Also, nausea was more common in controls than in the other groups. While both surgical and ultrasound-guided ESP blocks reduced opioid consumption compared to the controls, the patients who received ultrasound-guided ESP blocks experienced better postsurgical pain relief than those in the other groups (surgical ESP and controls).

Comparison of USG guided with Anatomical Landmark guided TAP Block following Total Abdominal Hysterectomy

A crucial part of a multimodal anaesthetic strategy utilized to accelerate recovery following lower abdominal procedures is the Transversus Abdominis Plane (TAP) Block. The TAP Block is administered in the petit triangle, with its base being formed by the iliac crest, the external oblique in front of it, and the latissimus dorsi at its rear. The intercostal, subcostal, iliohypogastric, and ilioinguinal nerves are housed in this interfascial plane. The TAP block reduces pain from the incision site during both inpatient and outpatient surgical procedures, as well as open and laparoscopic abdominal operations, by obstructing sensory signals from the nerves providing the anterior wall of the abdomen (anterior division of the segment of the spinal cord responsible for T6-L1). Postoperative pain can be effectively alleviated with TAP blocks. Through the use of supplementary drugs such as opioids, opioid agonist antagonists, ketamine, and alpha-2 agonists, including Nalbuphine, clonidine, and dexmedetomidine in blockade of peripheral nerves and field blocks, the duration of pain relief following surgery can be extended. Specifically, a combination of 10 mg of Nalbuphine and bupivacaine, on either side with a volume of 20 ml, improves patient comfort and pain management, allows for early patient mobilization, prolongs postsurgical pain relief, and lowers the need for rescue analgesia. This research aims to assess the efficacy of the Anatomical Landmark against Ultrasound-Guided TAP Block for patients undergoing Total Abdominal Hysterectomy under Subarachnoid Block.

Efficacy of Ultrasound-guided Transverse Abdominis Plane Block versus Epidural Block in Nephrectomy Patients: A Randomised Controlled Study

Introduction: Partially controlled acute pain after abdominal surgery is associated with a variety of unwanted postoperative consequences, like respiratory complications, delirium, myocardial ischaemia, prolonged hospital stays, and chronic pain later on. A good postoperative recovery depends greatly on a proper analgesic regimen. While epidural analgesia has been used to provide postsurgical abdominal pain relief, peripheral nerve blockade is a good alternative. Aim: To compare the analgesic efficacy of Transverse Abdominis Plane (TAP) block and Epidural block in patients undergoing nephrectomy. Materials and Methods: In this single-blinded parallel-group randomised controlled study was conducted in the Department of Urology at the Institute f Postgraduate Medical Education and Research in Kolkata, West Bengal, India from November 2021 to October 2022. A total of 78 patients (18-65 years) with American Society of Anaesthesiologists (ASA) Grade-I and II were randomly assigned to Group-EA (Epidural) and Group-TA (TAP Block). Group-EA received 11 mL of 0.125% bupivacaine, and Group-TA received 11 ml of 0.125% bupivacaine, both given at an 8-hour interval for 24 hours. The primary outcome was to compare postoperative pain using the Visual Analogue Scale (VAS) score at 1, 8, 12, and 24 hours after surgery. Secondary outcome measures included assessing motor function using the Bromage Score, monitoring haemodynamic parameters (pulse rate, mean arterial pressure), and evaluating Postoperative Nausea and Vomiting (PONV). A p-value &lt;0.05 was considered statistically significant when comparing the data. Results: The authors found that the distribution of male and female patients (p=0.650), ASA Grades (I:II) (p=0.515), mean age (p=0.899), and mean SpO2 (p=0.404) were comparable between the two groups (p&gt;0.05). The pain scores between the EA and TA groups at 1, 8, 12, and 24 hours (0.10 vs. 0.08, 0.74 vs. 0.82, 1.00 vs. 1.31, 1.80 vs. 1.92) showed no significant difference at the specified times. However, the comparison of the mean Bromage scores in the EA and TA groups at the same time intervals (1 vs. 1.15, 1.08 vs. 2.51, 1.97 vs. 3.21, 1.97 vs. 4.74) revealed a significantly higher value in the TAP block group compared to the Epidural block group. The Epidural group had significantly lower blood pressure and pulse rate but experienced more PONV (15.4 vs. 2.6) compared to the TAP block group. Conclusion: Epidural block resulted in hypotension, bradycardia, shivering, and PONV as side-effects, which were negligible in the TAP block group. However, postoperative analgesia was quite comparable between the two groups. Postoperative pain, as assessed by VAS score, changed significantly in the TAP block group (intragroup p-value=0.0063), whereas it remained constant in the epidural group (intragroup p-value 0.094), and the difference between the two groups was statistically insignificant. The occurrence of hypotension, bradycardia, and PONV was significant in the epidural group, whereas postoperative mobility was better in the TAP group.

Efficacy of Ultrasound-guided Transverse Abdominis Plane Block versus Epidural Block in Nephrectomy Patients: A Randomised Controlled Study

Introduction: Partially controlled acute pain after abdominal surgery is associated with a variety of unwanted postoperative consequences, like respiratory complications, delirium, myocardial ischaemia, prolonged hospital stays, and chronic pain later on. A good postoperative recovery depends greatly on a proper analgesic regimen. While epidural analgesia has been used to provide postsurgical abdominal pain relief, peripheral nerve blockade is a good alternative. Aim: To compare the analgesic efficacy of Transverse Abdominis Plane (TAP) block and Epidural block in patients undergoing nephrectomy. Materials and Methods: In this single-blinded parallel-group randomised controlled study was conducted in the Department of Urology at the Institute f Postgraduate Medical Education and Research in Kolkata, West Bengal, India from November 2021 to October 2022. A total of 78 patients (18-65 years) with American Society of Anaesthesiologists (ASA) Grade-I and II were randomly assigned to Group-EA (Epidural) and Group-TA (TAP Block). Group-EA received 11 mL of 0.125% bupivacaine, and Group-TA received 11 ml of 0.125% bupivacaine, both given at an 8-hour interval for 24 hours. The primary outcome was to compare postoperative pain using the Visual Analogue Scale (VAS) score at 1, 8, 12, and 24 hours after surgery. Secondary outcome measures included assessing motor function using the Bromage Score, monitoring haemodynamic parameters (pulse rate, mean arterial pressure), and evaluating Postoperative Nausea and Vomiting (PONV). A p-value &lt;0.05 was considered statistically significant when comparing the data. Results: The authors found that the distribution of male and female patients (p=0.650), ASA Grades (I:II) (p=0.515), mean age (p=0.899), and mean SpO2 (p=0.404) were comparable between the two groups (p&gt;0.05). The pain scores between the EA and TA groups at 1, 8, 12, and 24 hours (0.10 vs. 0.08, 0.74 vs. 0.82, 1.00 vs. 1.31, 1.80 vs. 1.92) showed no significant difference at the specified times. However, the comparison of the mean Bromage scores in the EA and TA groups at the same time intervals (1 vs. 1.15, 1.08 vs. 2.51, 1.97 vs. 3.21, 1.97 vs. 4.74) revealed a significantly higher value in the TAP block group compared to the Epidural block group. The Epidural group had significantly lower blood pressure and pulse rate but experienced more PONV (15.4 vs. 2.6) compared to the TAP block group. Conclusion: Epidural block resulted in hypotension, bradycardia, shivering, and PONV as side-effects, which were negligible in the TAP block group. However, postoperative analgesia was quite comparable between the two groups. Postoperative pain, as assessed by VAS score, changed significantly in the TAP block group (intragroup p-value=0.0063), whereas it remained constant in the epidural group (intragroup p-value 0.094), and the difference between the two groups was statistically insignificant. The occurrence of hypotension, bradycardia, and PONV was significant in the epidural group, whereas postoperative mobility was better in the TAP group.

HPR152 Continuous Wound Infiltration: A Post-Surgical Pain Relief Solution That Reduces Opioid Use but Causes Pain in the Patient’s Wallet Due to Lack of Insurance Reimbursement

Emphasis is being placed on putting the patient at the center of healthcare decisions and public reporting of quality outcomes while insurance reimbursement for patient-centered solutions is not keeping pace resulting in financial burden to patients.

Occult proximal femoral fracture with radiating leg pain masquerading as sciatica: a case report

BackgroundOccult proximal femoral fractures do not appear as fracture lines in radiographs, causing misdiagnosis and delayed diagnosis unless additional imaging studies, such as computed tomography or magnetic resonance imaging, are performed. Here, we present a 51-year-old male with an occult proximal femoral fracture who experienced radiating unilateral leg pain that took 3 months to be diagnosed because his symptoms mimicked lumbar spine disease.Case presentationA 51-year-old Japanese male experienced persistent lower back and left thigh pain after falling off a bicycle, and was referred to our hospital 3 months thereafter. Whole-spine computed tomography and magnetic resonance imaging revealed minute ossification of the ligamentum flavum at T5/6 without spinal nerve compression, but this did not explain his leg pain. Additional magnetic resonance imaging of the hip joint revealed a fresh left proximal femoral fracture without displacement. He underwent surgery for in situ fixation using a compression hip screw. Post-surgical pain relief was immediate.ConclusionsMisdiagnosis of occult femoral fractures as lumbar spinal disease may occur if distally radiating referred pain is present. Hip joint disease should be considered as a differential diagnosis in cases of sciatica-like pain with an unknown spinal origin and no specific findings on spinal computed tomography or magnetic resonance imaging accounting for the leg pain, especially following trauma.

Syringomyelia Associated with Chiari 1 Malformation in Adults: Positive Outcome Predictors after Posterior Fossa Decompression with Duraplasty.

Syringomyelia (Syr) in patients with Chiari 1 malformation (CM1) may be attributable to abnormal dynamics of cerebrospinal fluid (CSF) in the upper cervical segment; fourth ventricle enlargement has been reported in association with a worse clinical and radiological presentation, independently of the posterior fossa volume. In this study, we analyzed presurgery hydrodynamic markers to evaluate if their changes could be associated with clinical and radiological improvement after posterior fossa decompression and duraplasty (PFDD). As a primary endpoint, we aimed to correlate improvement in the fourth ventricle area with positive clinical outcomes. In total, in this study, we enrolled 36 consecutive adults with Syr and CM1 who were followed by a multidisciplinary team. All the patients were prospectively evaluated with clinical scales and neuroimaging, including CSF flow, the fourth ventricle area, and the Vaquero Index by using a phase-contrast MRI before (T0) and after surgical treatment (T1-Tlast, with a range of 12-108 months). The CSF flow at the craniocervical junction (CCJ), the fourth ventricle area, and the Vaquero Index changes were statistically analyzed and compared to the clinical and quality of life improvement after surgery. The good outcome prediction ability of presurgical radiological variables was tested. Surgery was associated with positive clinical and radiological outcomes in more than 90% of cases. The fourth ventricle area significantly reduced after surgery (T0-Tlast, p = 0.0093), but no significant associations with clinical improvement were found. The presurgical presence of CSF flow at the CCJ was able to predict a good outcome (AUC = 0.68, 95% CI 0.50-0.87 and LH+ = 2.1, IC 95% 1.16-3.07) and was also significantly associated with post-surgical pain relief (rho = 0.61 and p = 0.0144). Presurgery CSF flow at the CCJ is proposed as a radiological marker with the ability to predict a positive outcome after PFDD in adults with syringomyelia and CM1. Measurements of the fourth ventricle area could be useful additional information for evaluating surgical long-term follow-up; further experience on larger cohorts is required to better define the prognostic yield of this radiological parameter.

COMPARATIVE ANALGESIC EFFECTS OF SINGLE-DOSE PREOPERATIVE ADMINISTRATION OF PARACETAMOL (ACETAMINOPHEN) 500 mg PLUS CODEINE 30 mg AND IBUPROFEN 400 mg ON PAIN AFTER THIRD MOLAR SURGERY

Efficacy and rapid onset of postsurgical oral pain relief are critical to improve clinical outcomes and reduce the risk of excessive dosing with analgesic drugs. To compare analgesic effects of preoperative administration of paracetamol 500 mg plus codeine 30 mg in single-tablet and effervescent formulation to ibuprofen 400 mg, and placebo in the management of moderate to severe postoperative pain after mandibular third molar surgery. One hundred twenty healthy outpatients aged 15-29 years undergoing surgical removal of 1 bony impacted mandibular third molar were enrolled in this, single-center, prospective, randomized, triple-blind parallel-group, placebo-controlled, clinical trial. Study participants were randomly assigned to three treatment arms. According to the concealed allocation, each patient 30 minutes before surgery received paracetamol 500 mg plus codeine 30 mg (group APAP/COD), ibuprofen 400 mg (group IBU) or placebo (group PLA). Rescue therapy allowed in the postoperative period was paracetamol 500 mg plus codeine 30 mg in groups APAP/COD and PLA and ibuprofen 400 mg in group IBU. Patients recorded on Numerical Rating Scale-11 (NRS-11) the pain intensity, total number of postoperative-supplement medications and time of the first intake, until 12-hours after surgery and over extra 2 days, RESULTS: Over postoperative 3 days, patients in the APAP/COD group (2.33 ± 1.99) displayed significantly (P< .001) less pain intensity than IBU (3.43 ± 2.47) and placebo (3.57 ± 2.62) groups. The first-day postoperative pain was significantly (P < .001) higher in group PLA than in groups APAP/COD and IBU, but not between the latter 2 groups. However, at 2 hours postdose, the IBU group displayed average pain intensity lower than APAP/COD group (P> .05). On the next 2 days, pain intensity was significantly (P< .001) lower in group APAP/COD than in groups IBU and PLA but failed to reach statistical significance between groups IBU and PLA. Although the time to the first using rescue therapy was longer (445.88 ± 159.96 minute) in group IBU, compared to groups APAP/COD (392.67 ± 138.90 minutes) and PLA (323.00 ± 143.95 minutes), the number of supplemented tablets was significantly higher in group IBU (2.89 ± 2.13) than in groups APAP/COD (1.24 ± 1.79) (P= .001) and PLA (1.53 ± 1.67) (P = .008). No adverse events were registered for all groups. Within the limits of the present study, over postoperative 3 days, a statistically significant intensity pain reduction and decreased rescue therapy consumption were recorded in the paracetamol-codeine group than to ibuprofen group. Nevertheless, lower pain intensity at 2 hours postdose and longer time using rescue therapy was found in the ibuprofen group without statistical significance. No adverse events occurred over the studied period.

Drainage procedure for pancreatolithiasis: re-examination of the pancreatic duct diameter standard.

PurposePancreatic duct decompression relieves pancreatic duct stone (PDS)-associated abdominal pain, though a consensus indication for the drainage procedure of the main pancreatic duct (MPD) is lacking. Moreover, major prognostic factors for postsurgical long-term pain relief and recurrence are largely unknown.MethodsThe clinical outcomes of 65 consecutive PDS patients undergoing surgery from 2008–2012 with 3+ years of follow-up were assessed.ResultsAt postsurgical follow-up (median, 4.5 years; range, 3–7 years; procedure: Partington, n = 32; Frey, n = 27; pancreatoduodenectomy, n = 3; distal pancreatectomy, n = 3), the early complication and complete stone clearance rates were 29.2% and 97%, respectively. Long-term, complete and partial pain relief were 93.9%, 83.1%, and 10.8%, respectively. The risk of pancreatic fistula was higher in the <8 mm group than in the >8 mm group (P < 0.05), and 80% of the pancreatic fistula cases occurred in the <8 mm group. A shorter pain duration (P = 0.007), smaller MPD diameter (P = 0.04), and lower Izbicki pain score (P < 0.001) predicted long-term pain relief. Pain recurrence after initial remission occurred in 5 patients and was only related to pain duration (P = 0.02). Stone recurrence and pancreatic exocrine functional and endocrine functional deterioration occurred in 2, 5, and 11 patients, respectively.ConclusionSurgery provides excellent stone clearance, long-term pain relief, and acceptable postoperative morbidity. Using 8 mm as the criterion for drainage surgery can minimize the postoperative pancreatic fistula risk. Individualized and timely surgical treatment may improve the effect of surgery.

Ultrasound practice for chronic pain procedures: A comprehensive review.

Chronic pain management techniques have evolved in recent years. With regard to this, ultrasound (US) technology has become a standard for most acute pain procedures and essential for postsurgical pain relief and enhanced recovery after surgery protocols. This manuscript summarizes clinical studies evaluating US use for chronic pain management and compares efficacy with standard techniques including fluoroscopy (FL). US possesses several uniquebenefits when compared with FL, including elimination of radiation exposure while providing similar clinical outcomes. In summary, US use for chronic pain procedures is emerging as a viable, safe, and effective modality. Additional studies are needed to best appreciate US and its role in chronic pain management.

Effectiveness of nursing educational interventions in managing post-surgical pain. Systematic review.

Objective. Analyze and integrate studies that inquire on the benefits of nursing educational interventions to manage post-surgical pain.Methods. A systematic search was conducted in the databases of Scopus, Medline (Pubmed), Web of Science, The Cochrane Library, and CINAHL of systematic reviews, randomized clinical trials, and quasi-experimental studies published in English and Spanish until 2018 that analyzed the effectiveness of educational interventions in managing post-surgical pain in adult patients.Results. Twelve studies complied inclusion criteria, of which nine reported less pain in the group receiving the educational intervention. These interventions also helped to diminish the level of anxiety and improved functionality to perform activities of daily life. The level of quality of the studies was medium.Conclusion. Although the review showed that nursing educational interventions could influence on the relief of post-surgical pain, more rigorous studies are necessary, with bigger sample sizes and higher methodological quality, which help to establish the real effectiveness in managing post-surgical patients with pain.

Theoretical Investigation of Design Space for Multi Layer Drug Eluting Bioresorbable Suture Threads.

The work presented here is focused on the development of a comprehensive theoretical model for the description of drug release from a double - layer bioresorbable suture thread and the therapeutic efficacy of the active compounds delivered in the surrounding tissue. In particular, the system under investigation is composed of a core of slow-degrading polylactic- acid-co-ε-caprolactone (PLCL), where an antibiotic compound (Vancomycin) is loaded, surrounded by a shell of a fast-degrading polylactic-co-glycolic acid (PLGA) which contains an anesthetic drug (Lidocaine hydrochloride) for the post-surgical pain relief. This system is of potential interest for the combined effects provided by the different active molecules, but the different release and polymer degradation dynamics, as well as their mutual influence, do not allow an intuitive a priori evaluation of device behavior, which can be rationalized through mathematical modeling. The model takes into account the main involved phenomena (polymer degradation and diffusion of the drugs within the device and the tissue, where they are metabolized) and their synergic effects on the overall system behavior. Model results are discussed in order to quantify the impact of the main design parameters on device performances, thanks to the use of phase diagrams (which show drug effect in time and space) whose insights are summarized in order to determine a design space according to the specific needs.

Ultrasonography-guided anterior approach for axillary nerve blockade: An anatomical study.

Combined ultrasound (US)-guided blockade of the suprascapular and axillary nerves (ANs) has been proposed as an alternative to interscalene blockade for pain control in shoulder joint pathology or postsurgical care. This technique could help avoid respiratory complications and/or almost total upper limb palsy. Nowadays, the AN blockade is mostly performed using an in-plane caudal-to-cephalic approach from the posterior surface of the shoulder, reaching the nerve immediately after it exits the neurovascular quadrangular space (part of the spatium axillare). Despite precluding most respiratory complications, this approach has not made postsurgical pain relief any better than an interscalene blockade, probably because articular branches of the AN are not blocked.Cephalic-to-caudal methylene blue injections were placed in the first segment of the AN of six Thiel-embalmed cadavers using an US-guided anterior approach in order to compare the distribution with that produced by a posterior approach to the contralateral AN in the same cadaver. Another 21 formalin-fixed cadavers were bilaterally dissected to identify the articular branches of the AN.We found a good spread of the dye on the AN and a constant relationship of this nerve with the subscapularis muscle. The dye reached the musculocutaneous nerve, which also contributes to shoulder joint innervation. We describe the anatomical landmarks for an ultrasonography-guided anterior AN blockade and hypothesize that this anterior approach will provide better pain control than the posterior approach owing to complete blocking of the joint nerve. Clin. Anat. 33:488-499, 2020. © 2019 Wiley Periodicals, Inc.

Systematic Review of the Efficacy and Safety of Gabapentin and Pregabalin for Pain in Children and Adolescents.

The barriers to opioid use in some countries necessitate the need to identify suitable alternatives or adjuncts for pain relief. The gabapentinoids (gabapentin and pregabalin) are approved for the management of persistent pain in adults, but not in children. Searches were conducted in Embase, Medline, Scopus, and Web of Science up until November 2017, for randomized controlled trials that investigated the analgesic effects of gabapentin or pregabalin in children and adolescents <18 years of age. A total of 7 publications were identified, 5 regarding gabapentin as prophylactic postsurgical pain relief for either adenotonsillectomy (n = 3) or scoliosis surgery (n = 2), and 1 for gabapentin treatment of chronic regional pain syndrome/neuropathic pain. One study investigated the efficacy of pregabalin as a treatment for fibromyalgia. Based on the studies' primary outcomes alone, neither of the chronic pain studies involving gabapentin and pregabalin showed significant efficacy compared with amitriptyline or placebo, respectively. Two of the prophylactic gabapentin studies for adenotonsillectomy and idiopathic scoliosis surgery reported significantly fewer children requiring analgesia and lower opioid requirement, respectively, compared with placebo. Two of the identified clinical trials (conducted by the same first author) on the efficacy of gabapentin for prophylactic postadenotonsillectomy pain relief were omitted from narrative synthesis due to clear evidence of fabricated data. Overall, this review identified a paucity of evidence for the analgesic effect and safety of gabapentinoids in children. We also suggest audit of any current evidence-based practice and clinical guidelines that have cited the research studies with fabricated data.

Sexual and urinary function following anterior lumbar surgery in females.

Anterior lumbar interbody fusion procedures (ALIF) and total disc replacement (TDR) with anterior exposure of the lumbar spine entail a risk of a vascular injury and dysfunction of the sympathetic and parasympathetic nerves due to disturbance of the inferior and superior hypogastric plexus. While retrograde ejaculation is a known complication of the anterior spinal approach in males, post-operative sexual as well as urinary function in females has not yet been thoroughly investigated and was hence the aim of this study. Fifteen female patients documented their sexual and urinary function preoperatively, 3 months and 6 months postoperatively, using the validated questionnaires FSFI (Female Sexual Function Index) and ICIQ (International Consultation of Incontinence Questionnaire). Randomization tests were used to statistically analyze expectation values over time (two-sided, P < 0.05). While no statistically significant change in the total FSFI score occurred over time, a significant increase in FSFI desire score was noted between preoperative (2.95 ± 0.8) and 6 months follow-up (3.51 ± 0.6, P = 0.02). Urinary continence remained unchanged over time. In summary, ALIF and lumbar TDR do not seem to negatively influence sexual and urinary function in females. In contrast, increased sexual desire was noted, likely secondary to post-surgical pain relief.

Michael Rosen: anaesthetist who championed patients’ rights to pain relief

Michael Rosen was a pioneering anaesthetist who championed patients’ rights to pain relief and fought for his profession to receive proper recognition. Determined to show that “anaesthetists work with, and...

Effect of Transcutaneous Electric Nerve Stimulation on Pain after Total Knee Arthroplasty: A Blind Randomized Controlled Trial.

Transcutaneous electric nerve stimulation (TENS) has proven to be effective for postsurgical pain relief. However, there is a lack of well-constructed clinical trials investigating the effect of TENS after total knee arthroplasty (TKA). In addition, previous investigations reported that low- and high-frequency TENSs produced analgesic tolerance after 4 or 5 days of treatment. The aim of this study is to explore the effect of burst TENS on pain during hospitalization after TKA and to investigate whether burst TENS produces analgesic tolerance after 4 or 5 days of treatment. This stratified, triple blind, randomized controlled trial was approved by the University Hospital Brussels. Sixty-eight subjects were screened for eligibility before surgery; 54 were found eligible and 53 were included in the analyses. Patients were allocated to either a burst TENS or sham burst TENS group. TENS was applied daily during continuous passive mobilization. Knee pain intensity, knee range of motion, and analgesic consumption were assessed daily. Patients received burst TENS (N = 25) or sham burst TENS (N = 28). No significant differences in knee pain intensity were found between the groups (p > 0.05). Within the TENS and the sham TENS groups, the difference in knee pain before and after treatment did not evolve over time (p > 0.05). This study found no effects of burst TENS compared with sham burst TENS on pain during hospitalization after TKA.

Effect of Bupivacaine Local Infiltration Compared with Parecoxib Intravenous Administered in Post Surgical Pain Management Following Total Abdominal Hysterectomy

Objective: To compare effect of bupivacaine local infiltration with parecoxib intravenous administered for post surgical pain relief in woman undergoing abdominal hysterectomy. Materials and Methods: From August 2014 to January 2015, 42 patients scheduled for abdominal hysterectomy under general anesthesia were randomly allocated to 2 groups. Group P (n=21) were received 40 mg intravenous parecoxib and group B (n=21) were received 0.5% bupivacaine 20 mL intraoperative injection to incisional surgical site before the subcutaneous fat and skin were closed. All patients were received morphine patient-controlled analgesia (PCA) at ward. Main outcome measures: Pain scores, morphine consumption, sedation score and nausea or vomiting were assessed at 2, 6, 10, 14 and 26 hours after surgery. Antiemetic requirement, pruritus and satisfaction scores were evaluated at 26 hours after surgery. Results: No significant differences between 2 groups in age, BMI, surgical time and intraoperative dose of fentanyl were found. Pain scores at rest were significantly lower (p=0.045) in the P group at 2, 14 hours after surgery. There were no significant differences in pain scores during movement, morphine consumption, sedation score, nausea or vomiting, antiemetic requirement, pruritus and satisfaction scores between 2 groups. Conclusion: The use of parecoxib with PCA morphine in post operative analgesia reduced pain significantly when compared with bupivacaine at 2 and 14 hours after surgery.

PostOperative Pain Level and Narcotic Analgesic Medication Requirement Amongs Adults Undergoing Orthognathic Surgery

Bimaxillary osteotomy comprising bilateral sagittal split osteotomy and LeFort I osteotomy is one of the most common major maxillofacial operations, and has the highest reported postoperative pain scores.1 Due to the severity of this post-surgical pain, rapid onset and prolonged pain relief is ideal in this acute setting. Narcotic analgesics like Oxycodone have become successful for treating this acute postoperative pain as they have shown to provide a more rapid analgesic effect compared to most other non-opioid analgesic medications. Unfortunately, this rapid onset of opioid analgesics like Oxycodone has been shown to be a contributing factor to narcotic addiction potential.2 Identifying clinical variables that help predict narcotic medication requirements in the acute setting can potentially direct prescribing practices and thus limit overmedication of narcotics and addiction.

Use of Liposomal Bupivacaine in Major Ankle and Hindfoot Surgery

Category: Ankle Introduction/Purpose: Nearly 40% of patients undergoing ambulatory orthopedic surgery experience moderate-to-severe pain at home in spite of analgesic medication.As a result, a multimodal approach consisting of oral opioid agents and regional analgesics are recommended.Regional anesthesia is considered the primary anesthetic modality and adjunct to post-operative pain control following foot and ankle surgery, however it is not without potential complication.An ideal analgesic would provide long-term pain relief without resulting in a transiently weak or insensate limb. Extended-release liposomal bupivacaine-based analgesics as been approved by the FDA for anesthetic injection and have been shown to provide extended pain relief and decrease opioid use after bunionectomy, compared with placebo. This prospective study has been designed to evaluate the effect of surgeon applied liposomal bupivacaine on post-operative pain in patients undergoing major ankle and hindfoot surgery. Methods: 28 patients who were scheduled to undergo ankle arthrodesis, a tibiotalocalcaneal arthrodesis, hindfoot arthrodesis including, or a flatfoot procedure were enrolled prospectively. Prior to surgerypatients received a single shot popliteal block and at the conclusion of the case received 20cc of liposomal bupivacaine mixed with 10cc of normal saline injected at the surgical site. VAS pain scale at PACU admission and discharge, narcotic use, anti-emetic use, length of time in PACU and any complications were documented. A take home questionnaire documenting oral narcotic use, VAS pain scales at different intervals throughout the day, patient satisfaction with post surgical pain relief, as well as any complications for the day of surgery up to post op day 3 was completed. Patient satisfaction with post surgical pain relief and complications were also recorded at the patient’s first post- operative visit. Results: 28 total patients were enrolled ( Average age 55.6, Range 20-80). Post operatively 18/28 patients (64%) rated their satisfaction as &gt;4 (on a five-point scale). Greatest increase in VAS pain scores was seen from DOS to POD1 at 4:00 PM. Satisfaction with pain control was most strongly associated on POD3 at midday with a negative correlation (R= -0.68). Patients took the least amount of pain medications on DOS (28.83 mg) with an average total morphine equivalents consumed from DOS to POD3 of 236.68 mg. There were no complications associated with application of liposomal bupivacaine, this included postoperative wound complications, skin necrosis and persistent paresthesias. Conclusion: Extended-release liposomal bupivacaine-based analgesics when utilizedduring major ankle or hindfoot surgery did not provide complete pain relief as demonstrated by the sharp rise in pain scores seen after the resolution of the analgesic effect of the popliteal block. However it seemed that the effect of liposomal bupivacaine did contribute to lower pain scores at the conclusion of the period of efficacy, as there was no further rise in pain complaints after POD1 and lowest pain scores were seen on POD3. Application of liposomal bupivacaine appears to be safe without an increase in complications, wound problems or adverse reactions.