Severe Postoperative Pain Research Articles

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Background: Gallstones are a common gastrointestinal disorder often requiring cholecystectomy. Laparoscopic cholecystectomy, the gold standard for gallbladder removal, involves pneumoperitoneum (PNP) using carbon dioxide (CO2) for better visibility and access. However, postoperative shoulder pain remains a frequent complication, largely attributed to CO2 insufflation. This study compares the incidence and severity of postoperative shoulder pain between low-pressure pneumoperitoneum (LPP) and standard-pressure pneumoperitoneum (SPP) during laparoscopic cholecystectomy. Materials and Methods: A prospective interventional study was conducted at SMS Hospital, Jaipur, including 80 patients with gallstone disease undergoing elective laparoscopic cholecystectomy. Patients were divided into two groups: LPP (8–10 mm Hg) and SPP (12–14 mm Hg), each comprising 40 patients. Pain was assessed using the Verbal Rating Scale (VRS) at 2, 6, 12, 24, and 48 hours postoperatively. Data were analyzed using the unpaired two-tailed t-test, with a P value < 0.05 considered statistically significant. Results: The incidence of shoulder pain was significantly lower in the LPP group (10%) compared to the SPP group (40%) (P = 0.00). Mean VAS scores at 2, 6,12,24, and 48 hours post-surgery were consistently lower in the LPP group, with significant differences noted at each time point. At 12 hours, the LPP group had a mean VAS score of 0.62 ± 0.34 compared to 2.92 ± 1.4 in the SPP group (P = 0.00). By 48 hours, no LPP patients reported shoulder pain, whereas the SPP group still reported a mean VAS score of 0.62 ± 0.21 (P = 0.00). Conclusion: LPP is associated with significantly lower incidence and severity of postoperative shoulder pain compared to SPP in laparoscopic cholecystectomy. These findings suggest that LPP could be a better option for reducing patient discomfort and improving postoperative outcomes

Comparison between Ultrasound Guided Femoral Nerve Block versus IPACK Block (Interspace between the Popliteal Artery and Capsule of the Posterior Knee) in Patients Undergoing Total Knee Replacement on Postoperative Ambulation and Pain

Abstract Background Total knee replacement (TKR) is a well-known popular surgical procedure for knee diseases, including end-stage knee osteoarthritis that causes severe postoperative pain and prolonged immobility. TKR is associated with significant postoperative pain. The need for effective analgesia without compromising function is a priority. Aim of the Work The current study aims to assess the IPACK block concerning postoperative ambulation as a primary outcome and analgesic efficacy as a secondary outcome when compared with femoral nerve block following TKR. Patients and Methods This study is a randomized controlled clinical trial was conducted on 40 random patients who were scheduled to undergo total knee replacement and were divided into 2 equal groups: Group A: Patients in group A (n = 20) received spinal anesthesia followed by FNB block at the beginning of the operation with 20ml bupivacaine (0.25%) under complete aseptic conditions, Group B: Patients in group B (n = 20) received spinal anesthesia followed by IPACK at the beginning of the operation with 20ml bupivacaine (0.25%) under complete aseptic conditions. Results As for the comparison between effect of the IPACK block and FNB regarding ambulation and postoperative pain in TKR, it showed that there is significance regarding ambulation that was delayed in FNB than IPACK using TUG test and 10-min walk test, but regarding VAS score that was used to assess postoperative pain and its intensity, it showed that FNB has more analgesic effect concerning IPACK block with less total analgesics consumption (in mg.) over 24-hour period post-operative. Conclusion Our study showed that there was delayed ambulation in FNB than in IPACK using the TUG test and 10-min walk test, but regarding the VAS score that was used to assess postoperative pain and its intensity, it showed that FNB has more analgesic effect concerning IPACK block with less total analgesics consumption (in mg.) over 24-hour period post-operative.

Subcostal TAP Block Versus Lateral TAP Block for Postoperative Analgesia in Patients Undergoing Total Abdominal Hysterectomy

Abstract Background Total abdominal hysterectomy surgeries are associated with severe postoperative pain. Effective pain management reduces the incidence of postoperative cardiac and pulmonary complications, decreases risk of postoperative deep venous thrombosis through early mobilization, provides patient satisfaction and reduces cost of hospital stay. A number of analgesic strategies have been adopted to minimize postoperative pain after abdominal surgeries. Studies suggest that abdominal wall blocks provide effective pain relief and faster postoperative rehabilitation than systemic analgesia. Objective To compare the effectiveness of subcostal versus lateral TAP blocks for post- operative pain management in patients undergoing total abdominal hysterectomy. Patients and Methods This study was a prospective randomised clinical study conducted in Ain Shams University Hospitals from October 2021 till October 2022 with a sample size of 100 patients undergoing total abdominal hysterectomy under general anaesthesia, divided into 2 groups, 50 patients each: Group A: Subcostal TAP Block group, Group B: lateral TAP Block group. Results These results demonstrated that performing postoperative bilateral subcostal TAP block in group (A) was associated with significant increase in heart rate, mean arterial blood pressure, pain scores and pethidine requirements postoperatively in comparison to bilateral lateral TAP block in group (B) which provided more effective analgesia than subcostal approach. Conclusion The quality of postoperative analgesia was more effective in patients received lateral TAP block than those received subcostal TAP block regarding hemodynamic changes, pain scores, doses of pethidine required for pain relief and postoperative mobilization.

Prevalence and risk factors for postpartum depression two months after cesarean delivery: a prospective multicenter study

BackgroundThe prevalence and risk factors of postpartum depression after cesarean delivery remain unclear. ObjectiveTo assess the prevalence of postpartum depression and its risk factors 2 months after cesarean delivery. MethodsProspective ancillary cohort study of the Tranexamic Acid for Preventing Postpartum Hemorrhage after Cesarean Delivery (TRAAP2) trial, conducted in 27 French hospitals in 2018-2020 and enrolling women undergoing cesarean delivery before or during labor at 34 or more weeks of gestation. After randomization, characteristics of the cesarean delivery, postpartum blood loss, and immediate postpartum period, including memories of delivery and postoperative pain, were prospectively collected. Women's characteristics, particularly any psychiatric history, were collected from medical records. Two months after childbirth, a postpartum depression provisional diagnosis was defined as a score of 13 or higher on the Edinburgh Postnatal Depression Scale, a validated self-administered questionnaire. The corrected prevalence of postpartum depression was calculated with the inverse probability weighting method to take nonrespondents into account. Multivariate logistic regression analyzed associations between potential risk factors and postpartum depression. A sensitivity analysis used an EPDS cutoff value of 11 or higher. ResultsThe questionnaire was returned by 2793/4431 women (63.0% response rate). The corrected prevalence of postpartum depression provisional diagnosis was 16.4% (95% confidence interval (CI), 14.9-18.0%) with an EPDS score of 13 or higher and 23.1% (95%CI, 21.4-24.9%) with a cutoff value of 11 or higher. Characteristics associated with a higher risk of postpartum depression were pre-pregnancy characteristics such as young age (aOR 0.83, 95%CI 0.74-0.93 for each 5-year increase in maternal age) and non-European country of birth (aOR 2.58, 95%CI 1.85-3.59 for North Africa; aOR 1.57, 95%CI 1.09-2.26 for Sub-Saharan Africa and aOR 1.99, 95%CI 1.28-3.10 for other country of birth; reference: Europe) and some aspects of the cesarean delivery, notably its timing and context, emergency before labor (aOR 1.70, 95%CI 1.15-2.50; reference: before labor without emergency) and during labor after induction of labor (aOR 1.36, 95%CI 1.03-1.84; reference: before labor without emergency). Also at higher risk were women reporting high intensity pain during the postpartum stay (aOR 1.73, 95%CI 1.32-2.26) and bad memories of delivery on day 2 postpartum (aOR 1.67, 95%CI 1.14-2.45). Conversely, women who had social support in the operating room had a lower risk of postpartum depression (aOR 0.73, 95%CI 0.53-0.97). ConclusionAround one woman in six had postpartum depression symptoms 2 months after cesarean delivery. Some cesarean-related obstetric factors may increase this risk: cesareans before labor for emergency situations or during labor after medically indicated induction of labor, severe postoperative pain and bad memories of delivery before discharge. Specific subgroups of at-risk women could benefit from early screening or intervention to reduce the onset of postpartum depression. Perinatal professionals should pay particular attention to postoperative pain management.

Ultrasound Guided Suprascapular Nerve Block Combined with Intra-Articular Injection of Bupivacaine versus Ultrasound-Guided Interscalene Nerve Block in Shoulder Arthroscopy

Abstract Background Severe intraoperative and postoperative pain associated with arthroscopic shoulder surgery has a high incidence reaching up to 45%; it is often significant enough to interfere with initial recovery and rehabilitation. This pain is difficult to manage without large doses of opioids. Objective To compare Interscalene nerve block ISNB with the suprascapular nerve and Intra- articular injection (SSNB+IAI) for postoperative analgesia after shoulder arthroscopic surgery guided with ultrasound. Patients and Methods This is a prospective, randomized, double-blinded study, that was carried out in Ain Shams University Educational Hospitals, through a period of six months. Results The ISNB and SSNB+IAI have the same efficacy for postoperative analgesia after shoulder arthroscopy done for different purposes. A non-significant difference in patient satisfaction assessed 24-hour post-operative, with p-value 0.054. There is a significant difference between the two groups regarding the reported complications, with a p-value of 0.017. Highly significant difference between the two groups regarding phrenic nerve paresis which is assessed using diaphragmatic ultrasound, with a p-value of 0.000. Based on our results we recommend further studies on larger patients and longer periods of follow-up to emphasize our conclusion. Conclusion ISNB and SSNB+IAI provided similar postoperative analgesia and patient satisfaction, but the higher rate of complications in ISNB made the SSNB+IAI superior for use in arthroscopic shoulder surgery.

Comparison between Anterior Approach and Posterior Approach of Suprascapular Nerve Block for Postoperative Analgesia in Shoulder Arthroscopy

Abstract Background Severe intraoperative and postoperative pain associated with arthroscopic shoulder surgery has high incidence reaching up to 45%, it is often significant enough to interfere with initial recovery and rehabilitation. This pain is difficult to manage without large-dose opioids. Aim of the Work compare between anterior approach and posterior approach of suprascapular nerve block for postoperative analgesia in shoulder arthroscopy. Patients and Methods The study was conducted in Ain Shams University Eldemerdash Hospitals after approval from the ethics committee of anesthesia, intensive care and pain management department and written patients‟ consent. It included a total of 72 adult patients aged 18-60 years, Scheduled for shoulder arthroscopic surgeries. Patients were randomly divided into two equal groups, 36 each, according to the inclusion and exclusion criteria. Results no statistically significant differences in pain scores at 6, 12, and 24 hours postoperatively between the anterior SSNB and posterior SSNB groups. Postoperative First analgesia request time/hour early in posterior approach comparing to anterior approach (6.03±0.74, 5.64±0.68).opioid requirements were statistically different between the two groups, with a benefit in favour of the anterior route in the recovery area and during the first 24 postoperative hours. Conclusion the main finding is the anterior approach of SSNB provided superior analgesia compared with posterior approach of SSNB in postoperative opioid consumption.

A Comparative Study between Ultrasound Guided Fascia Iliaca Block and Femoral Nerve Block for Postoperative Analgesia in Total Knee Arthroplasty

Abstract Background Total knee arthroplasty (TKA) are common surgical procedures for treatment of the degenerative disorders and traumatic diseases. However, a majority of patients often experience moderate to severe postoperative pain after TKA. Postoperative pain control has a significant impact on earlier ambulation, initiation of physiotherapy, and better functional recovery. In addition, effective pain control would lower the length of hospital stay and the risk of thrombotic events which improves patients’ satisfaction. Aim of the Work The aim of this study was to assess the efficacy and safety of FICB compared with FNB in patients undergoing total knee arthroplasty. Patients and Methods 74 patients were included in the study, and were divided into two groups. In FICB group: Patients (n = 37) of this group received ultrasound guided Fascia iliaca compartment block (FICB) after spinal anesthesia using 30-40 ml of 0.25% bupivacaine. While in FNB group: Patients (n = 37) of this group received ultrasound guided femoral nerve block (FNB) after spinal anesthesia using 15-20 ml of 0.25% bupivacaine. Results The present study showed that the Fascia iliaca compartment block (FICB) was more efficient than FNB regarding first request analgesic, total pethidine consumption, time of ambulation and kinetic visual Analogue scale. But no significant difference was detected in static Visual Analogue scale and Bromage score. The FNB group had higher kinetic pain scores and were the first to ask for rescue analgesia; therefore, they had highest total pethidine consumption in the first 24 hours postoperatively and needed more time to start to ambulate in comparison to patients of FICB group. But the FNB group have almost same values regarding pain measured by static visual analogue scale. And also, FNB group had close values regarding Bromage score in comparison to FICB group. Conclusion Fascia iliaca compartment block is more effective than FNB, for pain relief during the early post- operative period after total knee arthroplasty. Meanwhile, it can reduce the cumulative meperidine consumption.

Effect of low-volume ropivacaine in ultrasound-guided superior trunk block on diaphragmatic movement in patients undergoing shoulder arthroscopy: a randomized controlled trial

ObjectivesThe incidence of hemidiaphragmatic paresis (HDP) in superior trunk block (STB) usually depends on the dose of local anesthetic. This study aimed to further evaluate the impact of a lower volume (10 mL) of the same low concentration (0.25%) ropivacaine compared to a conventional volume (15 mL), on diaphragmatic function and analgesic efficacy under a multimodal analgesia regimen for shoulder arthroscopy.MethodsPatients scheduled to undergo shoulder arthroscopy were randomized allocated to receive either 10 mL or 15 mL of 0.25% ropivacaine in the STB under ultrasound guidance prior to general anesthesia. The primary outcome was the percentage reduction in diaphragm excursion (ΔDE) between baseline and 30 min after block. Secondary outcomes included DE and diaphragm thickening fraction (DTF) before and after block, incidence of HDP, onset of sensory/motor block, duration of analgesia/motor block, dermatomal coverage area of the block, postoperative pain severity, pre- and post-block respiratory function and intraoperative hemodynamic parameters, the use of other anesthetic and analgesic drugs, post-block complications, and adverse events post-surgery.ResultsCompared with 15 mL volume, 10 mL ropivacaine significantly reduced the incidence of post-block HDP (as measured by ΔDE: 39.47% vs. 64.10%; and by post-block DTF: 13.16% vs. 33.33%). There was no significant difference in onset of sensory block, duration of analgesia/motor block, dermatomal coverage area of the block, postoperative pain severity between the two groups, except that the onset of motor block was significantly slower in the 10 mL group than in the 15 mL group. Pre- and post-block respiratory function and intraoperative hemodynamic parameters, the use of other anesthetic and analgesic drugs, post-block complications, or postoperative adverse events were not significantly different between the two groups.ConclusionIn shoulder arthroscopy, STB with 10 mL of ropivacaine can reduce the incidence of HDP with no significant difference in analgesic effects under a multimodal analgesia regimen compared with 15 mL.Trial registration: We registered the study at chictr.org (ChiCTR2200057543 , 14/03/2022.https://www.chictr.ogr.cn

Application of placing the anterior end of endotracheal tube at the glottis in laryngeal mask airway positive ventilation during general anesthesia: A prospective, randomized, controlled trial.

Glottic contraction and closure causes ventilation obstruction and laryngeal mask airway (LMA) leakage during positive pressure ventilation using LMA. This study aimed to assess the effect of placing the anterior end of the endotracheal tube (ET) at the glottis through the LMA ventilation conduit on treating LMA leakage following glottic contraction and closure. In this prospective, randomized, controlled trial, patients with non-minor surgery using LMA ventilation were randomly allocated to the i-gel group (group L) and the i-gel combined with ET group (group LE). The tip of ET was placed 2 cm under glottis guided by fiberoptic bronchoscope through i-gel ventilation conduit in group LE. The perioperative incidence of i-gel leakage, the changes of systolic blood pressure (SBP) and heart rate (HR) following artificial airway insertion, and adverse events were recorded. Perioperative i-gel leakage was observed in 7 of 48 patients (14.6%) in group L and 1 of 49 patients (2.0%) in group LE. There was significant difference in the incidence of leakage between the 2 groups (P = .031). SBP and HR after ET insertion in group LE increased significantly compared to those in group L (P < .05/5). The values of both SBP and HR after ET insertion did not exceed the basic values in group LE (P > .05/4). There were no significant differences in the incidence and severity of postoperative sore pain and hoarseness, cough during i-gel and ET removal between the 2 groups (P > .05). Placing the anterior end of ET at the glottis reduced LMA air leakage related to glottic contraction and closure in non-minor surgery. The ET placing had low stress response and did not significantly increase postoperative complications.

Peri-operative pain management in adults: a multidisciplinary consensus statement from the Association of Anaesthetists and the British Pain Society.

Nearly half of adult patients undergoing surgery experience moderate or severe postoperative pain. Inadequate pain management hampers postoperative recovery and function and may be associated with adverse outcomes. This multidisciplinary consensus statement provides principles that might aid postoperative recovery, and which should be applied throughout the entire peri-operative pathway by healthcare professionals, institutions and patients. We conducted a directed literature review followed by a four-round modified Delphi process to formulate recommendations for organisations and individuals. We make recommendations for the entire peri-operative period, covering pre-admission; admission; intra-operative; post-anaesthetic care unit; ward; intensive care unit; preparation for discharge; and post-discharge phases of care. We also provide generic principles of peri-operative pain management that clinicians should consider throughout the peri-operative pathway, including: assessing pain to facilitate function; use of multimodal analgesia, including regional anaesthesia; non-pharmacological strategies; safe use of opioids; and use of protocols and training for staff in caring for patients with postoperative pain. We hope that with attention to these principles and their implementation, outcomes for adult patients having surgery might be improved.

Pre-emptive Nebulized Ketamine Versus Lidocaine for Post-tonsillectomy Pain Management in Children: A Comparative Study.

Background Tonsillectomy is associated with significant pain, and postoperative pain control is often unsatisfactory. There have been several methods adopted to treat postoperative pain, but none of the methods were effective, with patients continuing to undergo severe postoperative pain. Hence, our study aimed to compare the efficacy of pre-emptive nebulized ketamine versus pre-emptive nebulized lidocaine with a control group receiving nebulized saline for pain control in children undergoing tonsillectomy. Methods In this prospective randomized clinical trial, 105 patients with American Society of Anesthesiologists(ASA) Ⅰ and Ⅱ undergoing tonsillectomy were enrolled and randomized into three groups, group K, group L, and group C, with 35 patients in each group, wherein pre-emptive nebulized ketamine, lidocaine, and saline were given to each group of patients, respectively. Faces Pain Scale-Revised (FPS-R), sedation scale scores, and the usage of rescue analgesia were noted postoperatively for the first six hours. Hemodynamic parameters were noted before and after nebulization.The primary objective was to determine the number of patients requiring rescue analgesia as an indicator of postoperative pain control. Results In this randomized clinical trial, pre-emptive nebulized ketamine significantly reduced the need for rescue analgesia compared to lidocaine and saline (p<0.05). Only 14.3% (n=5) of patients in the ketamine group required rescue analgesiacompared to 85.7% (n=30) in the lidocaine group and 91.4% (n=32) in the control group. Nebulized ketamine given pre-emptively is an effective strategy for reducing postoperative pain in pediatric tonsillectomy. Conclusion Pre-emptive nebulized ketamine was found to be effectivewhen compared with lidocaine nebulization in reducing postoperative pain in children undergoing tonsillectomy.

Comparison of the effect of warm saline irrigation versus negative gas suction on reduction of postoperative pain in patients of laparoscopic cholecystectomy

ABSTRACT OBJECTIVE: To compare warm saline irrigation and negative gas suction in terms of frequency of severe postoperative pain in patients of laparoscopic cholecystectomy. PATIENTS AND METHODS: A comparative clinical trial was conducted in the Department of General Surgery, Pakistan Institute of Medical Sciences, Islamabad over a period of six months. After ethical approval from the hospital ethics committee, all patients who had laparoscopic cholecystectomy for gallstones were enrolled in the study. Patients were randomly divided into two equal groups by lottery methods. One group had warm saline irrigation of the operative field while the other group had negative gas suction at the end of the procedure. The pain score was recorded postoperatively by visual analog score. SPSS version 21 was used for descriptive analysis of the variables. RESULTS: A total of 102 patients were included according to the study's inclusion criteria. All the patients were observed for 24 hours for severe postoperative pain. The mean age (years) of the patients was 40.40+11.55 years. There were 28 (27.5%) male and 74 (72.5%) female patients in the study. The frequency of severe postoperative pain in patients of laparoscopic cholecystectomy among warm saline irrigation and negative gas suction was 33 (64.7%) and 14 (24.5%) respectively which was statistically significant (p-value ˂0.001). CONCLUSION: Patients in the negative gas suction group have better modalities in reducing severe postoperative pain after laparoscopic cholecystectomy. This helps in early pain relief that reduces the agony of the patients and shortens the post-operative hospital stay. KEYWORDS: Cholelithiasis, Laparoscopic Cholecystectomy, Postoperative Pain

Effect of adductor canal block combined with infiltration between the popliteal artery and posterior capsular of the knee on chronic pain after total knee arthroplasty: a prospective, randomized, double-blind, placebo-controlled trial

IntroductionTotal knee arthroplasty (TKA) is accompanied by severe postoperative pain, which is reported to be an important cause of chronic pain. Ultrasound-guided adductor canal block (ACB) combined with infiltration between the popliteal artery and posterior capsular of the knee (IPACK) has been proven to have a better effect on relieving acute pain after TKA. However, whether it has a significant effect on the incidence of chronic pain after TKA has not been reported. This trial was designed to investigate the effect of ultrasound-guided ACB combined with IPACK on the incidence and intensity of chronic pain after TKA.MethodsIn this prospective, randomized, double-blind, placebo-controlled study, 100 subjects scheduled for TKA were randomly (1:1) divided into two groups: the ropivacaine group and the placebo group. Patients in each group received ultrasound-guided ACB + IPACK procedures with 0.25% ropivacaine or equal volume normal saline. All patients received multimodal analgesia. Pain intensity was assessed using the Numerical Rating Scale (NRS). The primary outcome was the incidence of chronic pain at 3 months after TKA by telephone follow-up. In addition, pain intensity in early resting and mobilized states, chronic pain intensity, the time to first rescue analgesia; opioid consumption; CRP and IL-6 after the operation; length of postoperative hospital stay; and cost of hospitalization and postoperative complications; as well as the function of the knee in the early stage after the operation, were recorded.ResultsNinety-one participants were included in the final analysis. At 3 months, the incidence of chronic pain was 30.4% in the ropivacaine group, significantly lower than 51.1% in the placebo group. Compared with the placebo group, the ACB + IPACK with ropivacaine group had significantly lower pain scores at 4 hours, 8 hours, 16 hours, and 24 hours after the operation; increased the knee range of motion at 8 hours and 24 hours after the operation; and a significantly decreased incidence of chronic pain at 3 months after the operation. During the follow-up period, there were no nerve block-related complications in either group.ConclusionIn the context of multimodal analgesia protocols, ACB combined with IPACK before surgery decreases the incidence and intensity of chronic pain 3 months after TKA compared with placebo injection. In addition, it reduces the NRS scores, whether at rest or during mobilization, and improves knee function within 24 hours after TKA.Trial registrationThis trial was registered in the China Clinical Trial Center (registration number ChiCTR2200065300) on November 1, 2022.

Effect of the intraoperative head hypsokinesis on sore throat after thyroid surgery: a randomized controlled trial.

Postoperative sore throat (POST) after thyroidectomy is a major concern.A roll is typically inserted under the shoulder to achieve head hypsokinesis and neck extension to better expose the surgical site during thyroid surgery. However, POST and impaired voice function have been attributed to neck overextension. This study aimed to explore the rational angle of head hypsokinesis that both reduced sore throat intensity and protects voice function after thyroid surgery. A total of 210 patients who underwent thyroidectomy were enrolled and randomized into high-tilt (Group H) and low-tilt angle groups (Group L). The primary outcome was the incidence of POST 6 h after surgery. Secondary outcomes included the severity of postoperative pharyngeal pain, voice function, swallowing pain, and coughing. The incidence of POST 6 h after thyroidectomy was significantly lower in Group L than that in Group H. In addition, the intensity of postoperative sore throat and swallowing pain was more severe in Group H. A lower degree of head hypsokinesis in Group L prevented transient postoperative voice injury. A lower degree of head hypsokinesis effectively mitigated sore throat severity after thyroidectomy and improved postoperative voice function. The trial was registered in the Chinese Clinical Trial Registry on 21 June 2022 (ChiCTR2200061329). The trial is registered at https://www.chictr.org.cn/showproj.html?proj=166254 .

Interpersonal differences in postoperative pain scores after bariatric surgery: a systematic review

Background: Despite intensive and better multimodal pain management schemes during bariatric surgery, many obese patients still experience severe early postoperative pain. Furthermore, postoperative pain varies considerably between patients who undergo the same kind of surgery. The main purpose of this study is to investigate psychological and demographic predictors for interpersonal differences of acute postoperative pain after laparoscopic bariatric surgery. Methods: A search of Pubmed, Web of Science, Cochrane database, PsycARTICLES, Google Scholar from 2008 to 2023 was conducted with the following search criteria: psychological, psychometric, catastrophizing, anxiety, pain, fear, stress, depression, vulnerability, self-efficacy, somatization, perception, bariatric surgery and postoperative pain. Results: Younger age, higher ASA physical status, higher educational level, pre-existing anxiety, pre-existing depression and pre-existing alexithymia may contribute to interpersonal differences in acute postoperative pain scores after bariatric surgery. Conclusion: Limited evidence exists on demographic and psychological factors. Further research is warranted to clarify these demographic and psychological predictors of acute postoperative pain in bariatric surgery to provide a more effective intervention and perioperative care.

290. EVALUATION OF THE POST-OPERATIVE GERD AND RESIDUAL CHEST PAIN AFTER POEM

Abstract Background Per-oral endoscopic myotomy (POEM) for esophageal achalasia has increasingly become a mainstream procedure worldwide, and its short and middle term efficacy and safety are more and more recognized. However, the long-term outcomes are still unclear and we sometimes experience the cases with severe post-operative GERD and residual chest pain. Methods We retrospectively reviewed 241 cases who were performed POEM in our center from Apr 2015 to Feb 2022 and evaluate their post-operative GERD and residual chest pain. Results Before POEM, 126 cases (54.8%) had chest pain. Residual chest pain 2 months after POEM was observed in 28 patients (23.1%). 78.2% had complete remission of chest pain after 1 year. Severe GERD (LA Grade C or D) 2 months and 1 year after POEM was observed in 5.1%, 8.2%, respectively. All of them except one patient were improved by PPIs. On univariable analysis, younger patients and pre-treatment were at risk for residual chest pain (p=0.02, p=0.04, respectively). Higher BMI was risk for severe GERD after 2 months (p=0.02), however it was not associate with that after 1 year (p=0.04). Conclusion Younger age and pre-treatment were at risk for residual chest pain after POEM and post-operative severe GERD was related to higher BMI, however almost all of them was controlled by PPIs. The number of cases was small, so it is necessary to accumulate more cases.

TO ASSESS THE ROLE OF NASAL TAPENTADOL AS PRE-EMPTIVE ANALGESIA, IN BREAST SURGERY PATIENTS

Patients undergoes moderate to severe postoperative pain after surgery, which is troublesome during the postoperative period. Inadequately treated acute post operative pain causes prolonged morbidity to patients. Pre-emptive analgesic minimises the pain in perioperative period by central neuro sensitization. We assessed the role of Nasal Tapentadol in breast surgery patients, as a pre-emptive analgesic, in the reduction of post-operative analgesic requirement. In a double blinded prospective randomized control study, sixty breast surgery patients, received nasal spray of tapentadol (Group A) or saline Spray (Group B), 30 minutes prior to general anaesthesia. Perioperative analgesic requirement, time taken for first analgesic requirement in post operative period, post operative pain and sedation scores, we compared the following parameters in the first 24h during the postoperative period in all patients: Analgesic requirement during perioperative period, time taken for first post operative analgesic dose, pain score and sedation score in postoperative period.Data Of all sixty patients were analysed. Patients in Tapentadol Group A had significantly lower requirement of analgesics and lower Visual analog scale (VAS) than Saline group in the post operative period. However, Ramsay sedation score was more in Tapentadol group, immediately after shifting the patient to the postanaesthetic care unit. Single Pre-emptive nasal spray of tapentadol (45mg) is an effective intervention to, reduce the surgical pain and lesser requirement of analgesics, in post operative period, without added side effects.

High frequency variability index in predicting postoperative pain in video/robotic-assisted thoracoscopic surgery under combined general anesthesia and peripheral nerve block: an observational study.

The high frequency variability index (HFVI)/analgesia nociception index (ANI) is purported to assess the balance between nociception and analgesia in patients under general anesthesia. This observational study investigated whether intraoperative HFVI/ANI correlates with postoperative pain in patients performed with nerve block under general anesthesia in video/robotic-assisted thoracoscopic surgery (VATS/RATS). We investigated whether maximum postoperative pain at rest and postoperative morphine consumption are associated with HFVI/ANI just before extubation, mean HFVI/ANI during anesthesia, the difference in HFVI/ANI between before and 5min after the start of surgery, and the difference in HFVI/ANI between before and 5min after the nerve block. Data obtained from 48 patients were analyzed. We found no significant association between HFVI/ANI just before extubation and postoperative Numerical Rating Scale (NRS) score. Receiver operating characteristic curve analysis revealed that moderate (NRS > 3) or severe (NRS > 7) postoperative pain could not be predicted by HFVI/ANI just before extubation. In addition, there were no associations between postoperative morphine consumption and HFVI/ANI at any time points. The present study demonstrated that it is difficult to predict the degree of postoperative pain in patients undergoing VATS/RATS under general anesthesia combined with peripheral nerve block, by using HFVI/ANI obtained at multiple time points during general anesthesia.

Analgesic efficacy of ultrasound-guided bilateral sphenopalatine ganglion block as a sole analgesic in fess surgeries and reconstructive nasal surgeries

: Severe postoperative pain is the most common complaint following Functional endoscopic sinus surgeries (FESS) and reconstructive nasal surgeries. Sensory, autonomic nerves supplying paranasal sinuses, nasal cavity, and palate relay in sphenopalatine ganglion. Bilateral Sphenopalatine ganglion block can be an effective regional anaesthetic technique for post-operative analgesia. We conducted a study with ultrasound-guided bilateral sphenopalatine ganglion block as the sole analgesic compared to Fentanyl in patients undergoing FESS &amp; reconstructive nasal surgeries performed under general anaesthesia. The primary objective of our study was to assess the analgesic effect, quality, and duration of analgesia of ultrasound guided bilateral sphenopalatine ganglion block as a sole analgesic. In addition, the secondary aim was to further evaluate the adverse effects.With Institutional ethical committee approval and written informed consent, we conducted this study with two groups of 30 patients each. The surgical procedure was performed under general anaesthesia. At the end of the surgery and before the reversal of neuromuscular blockade, bilateral sphenopalatine plexus block was performed under ultrasound guidance in interventional Group (A) with a mixture of 0.25% Ropivacaine, Dexamethasone 4mg 7.5ml each side, whereas the control Group (B) received fentanyl 2ug/kg intraoperatively. Visual analogue scale (VAS) scores were evaluated soon after extubating (0hrs) and up to 48 hrs postoperatively in all patients.There was no significant difference in VAS scores at 0hrs, 2hrs between both groups. Interventional group(A) had statistically significant lower scores (P &amp;#60;0.00) 4hrs onwards till 48hrs than in control group(B). No adverse events were noted with minimal postoperative analgesic requirement in group(A) (P &amp;#60;0.000).: We conclude, that ultrasound-guided bilateral sphenopalatine block is a safe and effective procedure that provides sustained and superior quality of analgesia when compared to fentanyl

Risk factors for postoperative urinary retention in patients underwent surgery for benign anorectal diseases: a nested case–control study

BackgroundPostoperative urinary retention (POUR) is a common complication of anorectal surgery. This study was to determine the incidence of POUR in anorectal surgery for benign anorectal diseases, identify its risk factors, and establish a nomogram for prediction of POUR.MethodsA nested case–control study was conducted. The clinical data of patients were collected, and the incidence of POUR was analyzed. Univariate analysis was used to identify the risk factors associated with POUR, and multivariate logistic regression analysis was used to determine independent risk factors for POUR. A nomogram for the preoperative prediction of POUR using a logistic regression model was developed (n = 609).ResultsThe incidence of POUR after anorectal surgery for benign anorectal diseases was 19.05%. The independent risk factors for POUR were: female (P = 0.007); male with benign prostatic hyperplasia (BPH) (P = 0.001); postoperative visual analogue scale (VAS) score > 6 (P = 0.002); patient-controlled epidural analgesia (PCEA) (P = 0.016); and a surgery time > 30 min (P = 0.039). In the nomogram, BPH is the most important factor affecting the occurrence of POUR, followed by a postoperative VAS score > 6, PCEA, surgery time > 30 min, and sex has the least influence.ConclusionFor patients undergoing anorectal surgery for benign anorectal diseases, preventive measures can be taken to reduce the risk of POUR, taking into account the following risk factors: female or male with BPH, severe postoperative pain, PCEA, and surgery time > 30 min. Furthermore, we developed and validated an easy-to-use nomogram for preoperative prediction of POUR in anorectal surgery for benign anorectal diseases.Trial registrationChina Clinical Trial Registry: ChiCTR2000039684, 05/11/2020.