Risk Of Postoperative Pain Research Articles

Effects of intramedullary nailing and internal fixation plates on postoperative wound infection and pain in patients with distal tibia fractures: A meta-analysis.

A meta-analysis was performed to assess the effects of intramedullary nailing (IMN) and internal fixation plates (IFP) on postoperative wound infection and pain in patients with distal tibia fractures, to provide evidence for the selection of surgical options for this group of patients. Computerised searches were performed on PubMed, Cochrane Library, EMBASE, MEDLINE, CNKI and Wanfang databases from the inception of each library to August 2023. All published randomised controlled trials (RCTs) comparing IMN with IFP for the treatment of patients with distal tibial fractures were selected. Literature screening, data extraction and literature evaluation were independently completed by two researchers. Data analysis was performed using the Review Manager 5.4 software. Overall, 25 RCTs with a total of 2011 patients were finally included, comprised by 1009 patients in the IMN group and 1002 patients in the IFP group. The rate of wound infection was significantly lower in the IMN group than that in the IFP group (5.05% vs. 9.58%, odds ratio [OR]: 0.52, 95% confidence intervals [CIs]: 0.37-0.73, p < 0.001). Meanwhile, the IMN group had a significantly higher rate of joint pain than that of the IFP group (14.57% vs. 2.90%, OR: 4.93, 95% CIs: 3.02-8.03, p < 0.00001), whereas the difference between the two surgical procedures in terms of operative time was not statistically significant (standardised mean differences: 0.08 95% CIs: -0.58-0.74, p = 0.82). Current clinical evidence suggests that both IMN and IFP are excellent treatments for distal tibial fractures. Although IMN is better in reducing postoperative wound infection, the risk of postoperative pain is higher. Thus, an appropriate surgical procedure should be selected in clinical practice in accordance with the actual situation of the patient, and IFP is used to reduce the incidence of postoperative joint pain when the anterior tibial soft tissue of the distal tibial fracture is in good condition, and vice versa. IMN is used to reduce the risk of infection.

New parameters measured via preoperative tonsil photos to evaluate the post-tonsillectomy pain: an analysis assisted by machine learning.

Postoperative pain is the most common complication after tonsillectomy. We aimed to explore new parameters related to post-tonsillectomy pain, as well as to construct and validate a model for the preoperative evaluation of patients' risk for postoperative pain. Data collected from patients who underwent tonsillectomy by the same surgeon at Beijing Chaoyang Hospital from January 2019 to May 2022 were analyzed. Preoperative tonsil images from all patients were taken, and the ratios of the distance between the upper pole of the tonsil and the base of the uvula (L1 for the left side and R1 for the right side) to the width of the uvula (U1) or the length of the uvula (U2) were measured. The following six ratios were calculated: L1/U1, R1/U1, LR1/U1 (the add of L1 and R1, and then divide U1), L1/U2, R1/U2, LR1/U2 (the add of L1 and R1, and then divide U2). The post-tonsillectomy pain was recorded. In addition, machine learning (ML) algorithm and feature importance analysis were used to evaluate the value of the parameters. A total of 100 patients were involved and divided into the training set (60%) and the validation set (40%). All six parameters are negatively correlated with post-tonsillectomy pain. The accuracy, sensitivity, and specificity of the model were 75.0%, 72.7%, and 77.8%, respectively. LR1/U1 and LR1/U2 are the most valuable parameters to evaluate post-tonsillectomy pain. We have discovered new parameters that can be measured using preoperative tonsil images to evaluate post-tonsillectomy pain. ML models based on these parameters could predict whether these patients will have intolerable pain after tonsillectomy and manage it promptly.

Is It Safe to Perform Laparoscopic Cholecystectomy and Transabdominal Preperitoneal Hernia Repair Simultaneously?

Abstract Background/Aims: Cholecystectomy and inguinal hernia repair are the most common operations in general surgery. With the laparoscopic approach, the risk of postoperative pain and infection is lower, patients can return to their daily activities in a shorter time, and the cosmetic appearance is better. However, surgical procedures in which laparoscopic cholecystectomy and transabdominal preperitoneal hernia repair (TAPP) are performed simultaneously are limited. The safety of this procedure is questioned in this article. Methods: The records of 38 patients who had undergone simultaneous laparoscopic cholecystectomy and TAPP were retrospectively reviewed, and patient demographic characteristics, indications for surgery, parameters associated with surgery, and postoperative complications were elicited. Results: The mean age of the patients was 48 ± 6.7 years, the youngest patient was 32 years old, and the oldest patient was 68 years old. The average operation time of the patients was 124 ± 26 minutes, and the average postoperative hospital stay was 2.1 ± 0.4 days. As for intraoperative complications, bleeding due to a double cystic artery in one patient, and perforation of the gallbladder in one patient were observed. In the postoperative period, one patient was found to have a seroma in the hernia area (in the patient with gallbladder perforation), and one patient had a recurrence in the hernia area in the late phase. Conclusions: Our study demonstrated that laparoscopic cholecystectomy and TAPP surgery could be safely performed simultaneously. The results of our study also include that prioritizing cholecystectomy does not increase the mesh infection rate.

Postoperative Pain after Different Transscleral Laser Cyclophotocoagulation Procedures.

As the number of surgical options in glaucoma treatment is continuously rising, evidence regarding distinctive features of these surgeries is becoming more and more important for clinicians to choose the right surgical treatment for each individual patient. For this retrospective data analysis, we included glaucoma patients treated with either continuous wave (CW-TSCPC) or micropulse transscleral cyclophotocoagulation (MP-TSCPC) in an inpatient setting. Pain intensity was assessed using a numeric rating scale (NRS) ranging from 0 (no pain) to 10 (worst imaginable pain) during hospitalization. CW-TSCPC was performed using OcuLight® Six (IRIDEX Corporation, Mountain View, CA, USA) and MP-TSCPC was performed using the IRIDEX® Cyclo-G6 System (IRIDEX Corporation, Mountain View, CA, USA). A total of 243 consecutive cases of TSCPC were included. Of these, 144 (59.26%) were treated with CW-TSCPC and 99 (40.74%) with MP-TSCPC. Using the univariable model, the risk for postoperative pain was observed to be lower in MP-TSCPC compared with CW-TSCPC (unadjusted: OR 0.46, 95% CI 0.24-0.84, p = 0.017), but this did not hold using the multivariable model (adjusted: OR 0.52, 95% CI 0.27-1.02, p = 0.056). Simultaneously conducted anterior retinal cryotherapy was associated with a higher risk for postoperative pain (OR 4.41, 95% CI 2.01-9.69, p < 0.001). We found that the occurrence of postoperative pain was not different in CW-TSCPC compared with MP-TSCPC in a multivariable model. In cases of simultaneous anterior retinal cryotherapy, the risk for postoperative pain was significantly higher.

Does closure of the direct hernia defect in laparoscopic inguinal herniotomy reduce the risk of recurrence and seroma formation?: a systematic review and meta-analysis.

Recurrence is a known complication to inguinal herniotomy with an incidence of 10 to 15 percent (Hernia Surge Group in Hernia 22:165, 2018). Previous studies have shown that direct hernia or large defects are risk factors for postoperative seroma formation (Morito et al. in Surg Endosc https://doi.org/10.1007/s00464-021-08814-2 , 2021). These types of defects are often closed during open herniotomy (Rosenberg et al. in Dan Med Bull 58: C4243, 2011). This is not routine during laparoscopic surgery. A recent study has indicated that closure of the medial defect during laparoscopy may reduce recurrence and seroma formation. As a result, we performed the present systematic review to evaluate the efficacy of this add on to the standard procedure. An extensive search was carried out in PubMed and Embase. All studies involving adults undergoing laparoscopic direct hernioplasty were enrolled and screened with predefined inclusion criteria, to be part of a systematic review with data synthesis and meta-analysis. The search identified 108 publications of which four met the inclusion criteria. Two studies (Ng et al. in Hernia 24:1093-1098, 2020; Usmani et al. in Hernia 24:167-171, 2020) showed reduced risk of recurrence. The remaining studies (Zhu et al. in Surg Laparosc Endosc Percutan Tech 29:18-21, 2019; Li and Zhang in Surg Endosc 32:1082-1086, 2018) reported no recurrence in any of the patients included. Two articles (Usmani et al. in Hernia 24:167-171, 2020; Zhu et al. in Surg Laparosc Endosc Percutan Tech 29:18-21, 2019) showed a decrease in risk of postoperative seroma, one showed a significant increase (Ng et al. in Hernia 24:1093-1098, 2020). None of the included studies showed an increase in the risk of postoperative pain or postoperative complications. This review suggests that closure versus non-closure of the medial hernia defect in laparoscopic inguinal hernioplasty reduces the risk of recurrence and seroma formation without an increase in postoperative pain or complications. Further randomized controlled trials are needed for further evaluation.

Analysis of the factors determining the development of postoperative pain in patients after knee and hip replacement surgery

Chronic postoperative pain (POP) is a serious complication of total replacement (TR) of the knee (KJ) and hip (HJ) joints.Objective: to determine the factors associated with POP in patients after TR of KJ or HJ.Patients and methods. The study group consisted of 124 patients with knee osteoarthritis or hip osteoarthritis (age 63.6±9.9 years, 63% women and 37% men) who underwent TR of KJ or HJ. POP was defined as pain ≥40 mm on a numerical rating scale persistent for ≥3 months. Its presence was assessed after 3 and 6 months by telephone survey. Comparison of patients with POP and without it was carried out for a number of factors identified before surgery.Results and discussion. The incidence of POP was 27.4%. There was no difference in the incidence of POP in patients after TR of KJ or HJ: 28.1% and 26.9% (p=0.88). POP was statistically significantly associated with parameters such as higher body mass index (BMI); the intensity of pain at rest; general assessment of impairment; WOMAC index pain, stiffness and overall; severity of symptoms of neuropathic pain (PainDETECT); signs of depression and anxiety (HADS).The risk of POP was significantly higher (p&lt;0.05) with BMI &gt;30 kg/m2 (odds ratio, OR 2.755; 95% confidence interval, CI 1.053–7.206), rest pain ≥40 mm on a visual analog scale (OR 1.349; 95% CI 0.478–3.803), PainDETECT scores ≥13 (OR 3.598; 95% CI 1.048–12.36) and HADS depression ≥8 (OR 2.193; 95% CI 0.745–6.454), presence of ≥2 sources of pain (OR 6.996; 95% CI 2.358–20.756).Conclusion. It was found that the risk of POP after TR of KJ and HJ is higher in patients with overweight, severe preoperative pain, signs of neuropathic pain and depression, as well as in the presence of several sources of pain (except for the affected joint, that was replaced surgically).

Polymorphisms of the KCNS1, COMT and OPRM1 genes and development of postoperative pain in patients with osteoarthritis who underwent total knee or hip replacement

Postoperative pain (POP) is a serious complication that reduces the result of total knee (TKA) or hip arthroplasty (THA) in patients with osteoarthritis (OA). The search for predictors of postoperative pain is an actual problem.The aim of the study – to assessing relationship the polymorphisms of the KCNS1, COMT and OPRM1 genes and the development of POP in OA patients who underwent TKA or THA.Material and methods. The study group consisted of 95 patients with OA knee or hip (64.6% of women, 65.4±9.0 years) who underwent TKA (47.8%) or THA (52.2%). The presence of POP was determined when pain in the area of surgical intervention ≥40 mm (100 mm visual analog scale, VAS) persisted or appeared 3 and 6 months after surgery. All patients underwent genotyping of polymorphisms of the genes KCNS1 (rs734784), COMT (rs6269, rs4633) and OPRM1 (rs1799971) by polymerase chain reaction in real time using original sequence-specific primers and samples labeled with various fluorescent labels. Registration and interpretation of the obtained results were carried out on the DT-96 amplifier (DNA-Technology LLC, Russia).Results. POP was observed in 32.6% of patients who underwent TKA or THA. The frequency of POP after TKA and THA was 30.2% and 34.0% (p=0.882). Statistical analysis revealed no differences in the frequencies of the genotypes of the studied genes (p&gt;0,05). The presence of a homozygous genotype of the GG polymorphism of the KCNS1 gene (rs734784) was associated with the presence of POP in accordance with the recessive genetic model (GG vs AA+AG; odds ratio (OR) – 3.96 [95% confidence interval (CI): 1.51; 10.37]; p=0.005). The presence of the mutant allele T (TT+CT) in the genotype of the COMT polymorphism (rs4633) reduced the risk of POP compared to the carrier of the CC genotype (OR=0.32 [95% CI: 0.12; 0.83]; p=0.02) in accordance with the dominant genetic model. There was no significant correlation between the development of POP and the carrier of different genotypes and alleles of the COMT (rs6269) and OPRM1 (rs1799971) genes.Conclusions. There is a statistically significant association the polymorphism of the KCNS1 (rs734784) and COMT (rs4633) genes and the development of chronic POP in patients who underwent TKA or THA. Further studies of the genetic predisposition to POP are required on more clinical material.

Predictors of maximal postoperative pain at rest in adult patients undergoing elective surgery - A multicenter observational study.

The aim of this prospective cohort study was to assess the maximum intensity of postoperative pain at rest in 620 adults after an elective surgery as well as to determine demographic and clinical predictors of pain. The Hospital Anxiety and Depression Scale was used to evaluate the preoperative mental condition of the patient. Preoperative and postoperative pain were assessed at rest based on the Numeric Rating Scale (range: 0-10). The total median maximum intensity of pain was 3 (interquartile range: 1-5). The linear regression model for the maximum intensity of postoperative pain was statistically significant and very well fitted - the coefficient of determination was 62%. Preoperative anxiety, pain, cancer, a medical history of thyroid (vs abdominal) surgery, and an operation resulting in major (vs moderate) tissue injury have a positive impact on the maximum intensity of postoperative pain. Eye surgery and lower limb operations gave lower scores than abdominal surgery. The early identification of these predictors in patients at risk for postoperative pain will help in preparing an individual pain management plan.

COMPARISION OF THE INCIDENCE OF POSTOPERATIVE PAIN AFTER USING TWO CONTINUOUS ROTARY FILE SYSTEM WITH CONVENTIONAL NEEDLE AND ULTRASONIC IRRIGATION IN SINGLE VISIT ENDODONTICS: AN INVIVO STUDY

Aim: The aim of this study was to compare the incidence of postoperative pain after using protaper gold (Dentsply Maillefer) and Neoendo (Orikam) rotary file system with conventional needle and ultrasonic irrigation system in single visit endodontics.&#x0D; Materials and Methods: Sixty patients requiring endodontic therapy were included in this study and divided into four groups, each group consisting of 15 patients. Group I (n = 15), was instrumented using ProTaper Gold followed by needle (Neoendo side vent) irrigation using 2 ml 3% sodium hypochlorite. In Group II, teeth were instrumented using ProTaper Gold followed by 3% sodium hypochlorite irrigant and activated using Endoactivator (Orikam Ultra X) for 30 seconds. In Group III (n = 15), teeth were instrumented using Neoendo (Orikam) rotary file system followed by conventional needle irrigation using 3% sodium hypochlorite as mentioned in Group I. In Group IV (n = 15), teeth were instrumented using Neoendo rotary file system followed by 3% sodium hypochlorite irrigant which were activated using Endoactivator for 30 seconds as mentioned in Group II. Each root canal will be obturated using the single cone technique using Zinc oxide sealer. Postoperative pain response of patients was evaluated using the visual analogue scale (VAS) score. Results: For VAS pain scores, a statistically significant difference was found between the PTG and Neo Endo files (p= 0.000). Group II showed the least incidence of pain for a follow up period of one week followed by Group I and Group IV. Group III showed the highest incidence of pain among the four group. Conclusion: Within the limitations of this study, we may conclude that the PTG system along with the Passive Ultrasonic Irrigation System is a technique that is able to minimize the risk of postoperative pain after single visit root canal therapy compared to the other technique used in this study. However, all the techniques used in this study significantly reduced the post-operative pain within a time interval of one week.&#x0D; Key words: Protaper Gold, Neo Endo Files, Passive Ultrasonic Irrigation, Side Vent Needle, Controlled Memory Files

Randomized Clinical Trial of Gabapentin Versus Placebo for Pain After Sacrospinous Ligament Fixation

Given the risk of postoperative pain and specifically neuropathic gluteal pain after a sacrospinous ligament suspension, we conducted a randomized trial to compare a 2-week course of gabapentin versus placebo on postoperative pain after a sacrospinous ligament fixation. This double-blinded, randomized, placebo-controlled trial compared 2 weeks of gabapentin (300 mg nightly for 3 days and then 300 mg twice a day for 11 days) versus identical-appearing placebo after a sacrospinous ligament fixation procedure. The primary outcome was participant-reported average pain during normal activity in the past 24 hours (score 0-10 on the validated Surgical Pain Scale) assessed on postoperative day (POD) 7. We also assessed average pain at rest and gluteal (buttocks) pain (score 0-10). We needed 17 participants per group to detect a 2.5-point difference in Surgical Pain Scale score with an SD of 2.6 (α = 0.05; power, 80%). The final intention-to-treat analysis compared 19 (49%) in the gabapentin group versus 20 (51%) in the placebo group. Between the gabapentin and placebo groups, average pain (2.0 ± 2.0 vs 3.4 ± 2.8, P = 0.09, respectively) and gluteal pain (2.1 ± 2.0 vs 3.4 ± 2.4, P = 0.09) during normal activity on POD 7 were not significantly different. However, average pain at rest on POD 7 was lower with gabapentin (1.6 ± 1.5 vs 3.2 ± 2.6, P = 0.04). Although a 2-week course of gabapentin did not significantly decrease overall pain with normal activity after a sacrospinous ligament fixation procedure, pain at rest was lower with gabapentin compared with placebo.

The Comparison of Short-Term Postoperative Pain in Single- versus Multiple-Visit Root Canal Treatment: A Systematic Review and Meta-Analysis Study

Postoperative pain after root canal therapy (RoCT) is an unpleasant experience for patients, and it could be affected by different factors. The times of visits could be one of these factors that were evaluated in various studies. However, there is inconsistent evidence on the relation between postoperative pain and the times of visits. Therefore, the current systematic review aimed to summarize the results of these studies and meta-analyze them. For this purpose, a comprehensive search was conducted in four main databases (Cochrane Database of Systematic Reviews, Web of Science, PubMed, and Scopus databases) for related English articles from 1978 to August 2020. The quality of studies was evaluated using the Delphi checklist. The heterogeneity of studies was determined by I2 statistic, and publication bias was assessed using the funnel plot and the Begg test. The results were presented by using relative ratio (RR) estimates and standard mean difference (SMD) with its 95% confidence intervals (CI) using a random-effects model. Initial searches from mentioned databases identified 1480 papers; of which only 27 of them met the inclusion criteria. In quality assessment, thirteen studies had quality scores of more than 7, two studies had 4 scores, and the rest had 5 scores. Overall, based on the available evidence, the meta-analysis showed that the risk of postoperative pain in single-visit was 1.02 times (CI 95% (0.99, 1.19), I2 = 60.7%, p = 0.001 ) higher than that of the multiple-visit treatment. The mean difference of postoperative pain in single-visit was −0.30 (CI 95% (−0.36, −0.25), I2 = 0.94.4, p = 0.001 ) compared with the multiple-visit treatment. Based on the results of this meta-analysis, the risk of postoperative pain in single-visit RoCT was higher than that in multiple-visit RoCT with acceptable statistical heterogeneity and moderate quality of the studies.

Clinical analysis of pain after transvaginal mesh surgery in patients with pelvic organ prolapse

BackgroundThe purpose of this study was to investigate the relevant factors of pain after transvaginal mesh (TVM) surgery for the treatment of pelvic organ prolapse and to analyse the management and relief of the pain.MethodsA multicentre retrospective study of a clinical database of patients who underwent TVM surgery was conducted, and pain related aspects were analysed.ResultsA total of 1855 patients were included in the study. We divided the patients into two groups: pain-free (1805 patients) and pain (50 patients) group. The incidence of pain after TVM surgery was 2.70%, with a median occurrence time of 7.5 months. Pain mainly involved the vagina, perineum, buttocks, groin, inner thighs, and lower abdomen. Excessive intraoperative blood loss (OR = 1.284, 95% CI 0.868–2.401) and postoperative anatomic failure (OR = 1.577, 95% CI 0.952–3.104) were analysed as risk factors with statistical significance. Mesh exposure rate in the pain group was 38%, showing a significant difference between the groups (P < 0.01). Forty patients underwent non-surgical treatment, with a relief rate of 40.0%, 33 patients received surgical treatment, 15 underwent partial mesh removal, and 18 underwent complete mesh removal, with a relief rate of 84.8%. The total relief rate was 88% within all 50 patients suffering from pain.ConclusionsExcessive intraoperative bleeding and unsatisfactory postoperative anatomic outcomes can increase the risk of postoperative pain; mesh exposure is also associated with the pain. Most patients can get pain relief with proper management, more than half of whom may need mesh removal with differing approach.

Single Site Robotic Bilateral Salpingectomy for Removal of Sterilization Micro-Insert

Video Objective This video outlines the crucial steps in performing a single-site robotic salpingectomy with partial cornuectomy. This is presented as an alternative method for microinstert removal that is both minimally invasive and aesthetically pleasing. Setting This procedure was completed on women who were previously sterilized with hysteroscopic insertion of tubal microinsert and began experiencing pelvic pain or autoimmune-like symptoms. The procedures were performed in an ambulatory setting with same or next day discharge. Interventions Single-port bilateral salpingectomy with partial cornuectomy and closure of defect. Conclusion The women who originally opted for a microinsert sterilization had opted for a minimally invasive sterilization that did not require entry into the abdominal cavity. These women are likely to prefer a minimally invasive option with aesthetic results to reverse this procedure. Fewer incisions theoretically reduces risk of postoperative pain and reduces visible scars leading to reported patient satisfaction. Single-site robotic salpingectomy with partial cornuectomy provides these benefits in addition to preventing coil fragmentation by removing the cornua in addition to the fallopian tubes which permits avoidance of excessive manual traction on the insert that may result in fragmentation.

Effects of a Standardized Care Protocol for Patients with Degenerative Spine Disease

Background:Many patients facing spinal surgery experience fear and anxiety about surgery, anesthesia, risk of postoperative pain or complications, or even death. Spinal surgery patients often experience mobility disorders due to lasting postoperative pain and require aids such as spinal braces, which can induce depression. Alleviating patients’ anxiety and depression during the perioperative period by utilizing consistent and standardized information is required for high-quality care.Objective:We developed and assessed a standardized care protocol for degenerative spinal surgery patients.Methods:The protocol was developed through focus group interviews with spinal surgery patients and the recommendations of an expert panel. Then, a quasi-experimental design was employed to comparatively study patients undergoing spinal surgery. Ninety-eight Patients were assigned to either a treatment group (n= 49) or a control group (n= 49). The treatment group received an intervention based on the newly developed standardized care protocol, while the control group received traditional care. After treatment, participants’ anxiety, depression, uncertainty, and care satisfaction were compared between groups.Results:Patients who had received the care protocol-based intervention showed lower anxiety, depression, and uncertainty, and higher satisfaction than did those who received traditional care.Conclusion:The developed care protocol may be useful for reducing anxiety and depression and for improving the healthcare provided to spinal surgery patients, as it involves the proactive dissemination of accurate information throughout the hospitalization process. The protocol also positively affected patients’ uncertainty and satisfaction with their medical care.

Value of perioperative multimodal stratified analgesia guided by PPRS-CYMZ 2.0

Objective To evaluate the value of perioperative multimodal stratified analgesia guided by PPRS-CYMZ 2.0. Methods One hundred and sixteen patients of both sexes, aged 16-85 yr, of American Society of Anesthesiologists physical status Ⅰ-Ⅲ, scheduled for elective surgery in our hospital in August 2016, were included in this study and assigned into empirical analgesia group(group E, n=79)and stratified analgesia group(group S, n=73). The risk of postoperative pain was estimated by an experienced associate chief anesthesiologist based on his clinical experience, and the perioperative analgesic protocol was determined in group E. The risk of postoperative pain was assessed using the perioperative pain risk scale PPRS-CYMZ 2.0 by another experienced associate chief anesthesiologist, the risk was stratified according to the scores, and the corresponding stratified analgesic protocol was determined in group S. Visual analog scale scores and parents′satisfaction with analgesia were recorded on postoperative day 30.The requirement for preventive analgesia, total pressing times of patient-controlled analgesia(PCA)pump in 0-6 h, 6-24 h and 24-72 h periods, PCA background infusion dose and consumption of rescue analgesics were recorded.The development of adverse events during postoperative hospital stay and postoperative recovery were also recorded.Analgesia-related parameters of medical economics were calculated. Results There was no significant difference in postoperative pain risk stratification between group E and group S(P>0.05), and the majority of patients were at moderate risk.Compared with group E, no significant change was found in visual analog scale scores on postoperative day 30, PCA background infusion dose or incidence of postoperative adverse effects(P>0.05), the requirement for preventive analgesia and satisfaction scores were significantly increased in high risk patients, the consumption of rescue analgesics was decreased in moderate risk patients(P 0.05), the total pressing times of PCA pump was significantly decreased, and the direct analgesic cost per patient and total analgesic cost were decreased in moderate and high risk patients, and the first ambulation time and length of postoperative hospital stay were shortened in high risk patients in group S(P<0.05). Conclusion PPRS-CYMZ 2.0 can achieve perioperative multimodal stratified analgesia and individualized treatment. Key words: Analgesia; Pain, postoperative; Risk assessment

Effect of postoperative analgesia with Loxoprofen sodium in different times on dental implant patients

Objective To investigate the effect of postoperative analgesia by using loxoprofen sodium on dental implant patients at different time points. Methods A total of 400 patients with dental implant treatment were divided into two groups by random number table method. The experimental group was firstly given loxoprofen sodium tablets (60 mg) in 30 minutes preoperatively, and the control group was firstly given on three hours after surgery (60 mg). Local anesthesia was used to all dental implant surgery. Using the Wong-Baker Smile Assessment method in operation and Numerical Rating Scale (NRS) in postoperative respectively to assess pain level in surgery and 3 h, 6 h, 12 h and 24 h after surgery. Results The percentages of painless patients of the experimental group and the control group in operation were 99%(198/200) and 97%(194/200), and there was no significant difference between them (χ2=2.041, P>0.05); the percentages of painless patients of the experimental group at 3 h, 6 h, 12 h after surgery were 60.5%(121/200), 79.0%(158/200), 83.5%(167/200), and the control group were 47.0%(94/200), 64.5%(129/200), 71.5%(143/200), and there was significant difference between the control group and the experimental group (χ2=14.255,15.447, 11.165, P=0.007, 0.004, 0.011); however, in the two groups, there was no significant difference at 24 h after surgery, the experimental group was 93.0% (186/200), the control group was 89.5% (179/200)(χ2=2.468, P>0.05). Conclusions Preoperative administration with loxoprofen sodium tablets can significantly reduce the risk of postoperative pain, and could be used as a conventional implant surgery analgesic program. Key words: Loxoprofen sodium; Analgesic; Dosing time; Dental implant

Post-operative pain management in head and neck cancer patients: predictive factors and efficacy of therapy.

SUMMARYThere is increasing interest about all aspects of pain sensation for patients undergoing head and neck surgery, and efforts have been made to better assess, monitor and reduce the occurrence of pain. The aetiology of pain is considered to be "multifactorial", as it is defined by several features such as personal experience, quality perception, location, intensity and emotional impact. The aim of this paper is: (i) to evaluate the efficacy of analgesic treatment in patients with head and neck cancer treated by surgery, and (ii) to study the variables and predictive factors that can influence the occurrence of pain. A total of 164 patients, affected by head and neck cancer and surgically treated, between December 2009 and December 2013, were included in this study. Data collected include age, gender, assessment of anaesthetic risk, tumour localisation, pathological cancer stage, TNM stage, type of surgery performed, complexity and duration of surgery, post-operative complications, postoperative days of hospital stay and pain evaluation on days 0, 1, 3 and 5 post-surgery. We studied the appropriateness of analgesic therapy in terms of incidence and prevalence of post-operative pain; we also related pain to patient characteristics, disease and surgical treatment to determine possible predictive factors. The population studied received adequate pain control through analgesic therapy immediately post-surgery and in the following days. No associations between gender, age and post-operative pain were found, whereas pathological cancer stage, complexity of surgery and tumour site were significantly associated with the risk of post-operative pain. Adequate pain control is essential in oncological patients, and particularly in head and neck cancer patients as the prevalence of pain in this localisation is reported to be higher than in other anatomical sites. Improved comprehension of the biological and psychological factors that characterise pain perception will help to enhance its control in the future.

Intraoperative Positioning of Patients Under General Anesthesia and the Risk of Postoperative Pain and Pressure Ulcers

Intraoperative positioning is a crucial component of perianesthesia care and can lead to postoperative complications. Therefore, this study explored risk factors for postoperative positioning pain and pressure ulcers that were associated with supine positioning in patients undergoing general anesthesia. In this prospective cross sectional exploratory study, 86 ASA I-II, normal BMI patients undergoing elective surgery in the supine position from February to May 2009 were included. Seven different risk factors were examined to detect possible associations between intraoperative positioning and the development of postoperative positioning pain or pressure ulcers. Only one variable was found to be a significant risk factor for postoperative positioning pain, preoperative pain (P = .017) with an odds ratio of 13.1 (95% CI 1.4-23.9). There were no associations found between positioning pain or pressure ulcers and gender, age, duration of surgery, surface of the operation room bed, and number of monitoring devices. Four patients suffered from pain in their heels; of these, two had bilateral Grade I pressure ulcers. Five patients suffered from arm pain and three patients from neck and back pain. In conclusion, the risk for positioning pain seems to be greater in patients suffering from preoperative pain. Routine documentation and follow-up of a patient's preoperative pain, intraoperative positioning and overall postoperative pain experience are emphasized.

The influence of three different instrumentation techniques on the incidence of postoperative pain after endodontic treatment.

Apical extrusion of infected debris to the periradicular tissues is one of the principal causes of postoperative pain and discomfort. Recent researches have shown that reciprocating instrumentation techniques seem to significantly increase the amount of debris extruded beyond the apex and, consequently, the risk of postoperative pain. The goal of the present study was to evaluate and compare postoperative pain using three different nickel-titanium instrumentation techniques: a rotary crown-down technique using TF instruments (SybronEndo, Orange, Ca), a reciprocating single-file technique using WaveOne instruments (Maillefer DEntsply, Baillagues, CH), and a novel instrumentation technique (TF Adaptive, SybronEndo, Orange, Ca), using a unique, proprietary movement, combining reciprocation and continuous rotation. Ninety patients requiring endodontic treatment on permanent premolar and molar teeth with non vital pulps preoperatively were included in the study. The patients were assigned into three groups of 30 patients each, trying to make the groups very similar, concerning the number of root canals, presence of initial pain and periapical lesions. The teeth in group 1 (n = 30) were instrumented with a crown-down technique using TF instruments, whilst those in group 2 (n = 30) were instrumented with a single-file technique using Waveone 08 25. The third group (n = 30) used the 3-file Tf Adaprtive sequence. All techniques were performed following manufacturers' instructions and all canals were shaped, cleaned and obturated in a single-visit by the same operator. The assessment of postoperative pain was carried out at 3 days by using a visual analogue scale. VAS pain scores were compared using one-way ANOVA post hoc Tukey test. A value of p < 0.05 was required for statistical significance. Results for VAS pain scores showed a statistically significant difference was found between the WaveOne (p=0,021) technique and the other two techniques. No statistical significant differences were found between TF and TF Adaptive (p= 0,087). When evaluating patient experiencing sever pain the incidence of symptoms was significantly higher with the WaveOne technique. Since the incidence of preoperative pain, the type of tooth and the pulp and periodontal pathology were quite similar between the three tested groups, and all the other variables (operator, irrigation, obturation) were identical, we may conclude that the difference in postoperative pain can be mainly related to the different instrumentation techniques.

Chronic postoperative pain and sensory changes: Two sides of the same coin?

In Europe 19% of the adult population suffer from chronic pain. f these, 15% have chronic posttraumatic/postoperative pain [1]. hronic pain occurs in 10–50% of all patients after surgery [2] and ust be regarded as a major health problem. Recent research has evealed that sensory changes frequently accompany chronic postperativepainand that thesemaybekey symptoms that canhelpus o understandwhy some patients develop persistent postoperative ain and others do not [3]. The current issue of Scandinavian Journal of pain contains a clincal study by von Sperling et al. [4] that examines the prevalence, haracter, and sensory changes andpersistentpain followingbreast eduction surgery. One of themain indications for breast reduction urgery is back and neck pain. In the present study breast reduction ave total relief from back and neck pain in half and partial relief n one third of the patients. Preoperative breast pain in 11 patients as fully or partially relieved in all. However, 20% suffered new nd persistent pain in their breasts as a consequence of the surgery. his was only of median pain intensity 2/10 (range 0–10/10), but % of all patients had chronic postoperative pain of moderate to evere intensity, with significant impact on daily activities. More han half of the patients with new postoperative pain met the crieria for neuropathic pain. In concert with recent trials [3,5,6] the revalence of persistent postoperative sensory disturbanceswas as igh as 54%, with about half reporting hypoesthesia and one third eporting hyperesthesia. The presence of sensory disturbanceswas ssociated with increased risk for persistent postoperative pain. oung age, sensory abnormality, sensory hypersensitivity, compliations to surgery (infection or haematoma) were all associated ith higher risk of postoperative pain. Thepresent trial indicates that even thoughanumberofpatients ave had their pain changed from chronic back and neck pain to hronic postoperative pain, the patient satisfaction was high both mong those with and those without pain. The main reason for his was that most of the patients with persistent postoperative ain had mild pain. However, it is a concern that 7% of the patients uffer from pain strong enough to significantly affect activities of aily life two years after surgery.