Standard Pain Management Research Articles

Femoral Nerve Block versus Adductor Canal Block for Analgesia after Total Knee Arthroplasty.

Inadequate pain management after total knee arthroplasty (TKA) impedes recovery, increases the risk of postoperative complications, and results in patient dissatisfaction. Although the preemptive use of multimodal measures is currently considered the principle of pain management after TKA, no gold standard pain management protocol has been established. Peripheral nerve blocks have been used as part of a contemporary multimodal approach to pain control after TKA. Femoral nerve block (FNB) has excellent postoperative analgesia and is now a commonly used analgesic modality for TKA pain control. However, FNB leads to quadriceps muscle weakness, which impairs early mobilization and increases the risk of postoperative falls. In this context, emerging evidence suggests that adductor canal block (ACB) facilitates postoperative rehabilitation compared with FNB because it primarily provides a sensory nerve block with sparing of quadriceps strength. However, whether ACB is more appropriate for contemporary pain management after TKA remains controversial. The objective of this study was to review and summarize recent studies regarding practical issues for ACB and comparisons of analgesic efficacy and functional recovery between ACB and FNB in patients who have undergone TKA.

Repeated exposure to sucrose for procedural pain in mouse pups leads to long-term widespread brain alterations.

Oral sucrose is administered routinely to reduce pain of minor procedures in premature infants and is recommended as standard care in international guidelines. No human or animal studies on effects of early repeated sucrose exposure on long-term brain development have been done in the context of pain. We evaluated the effects of repeated neonatal sucrose treatment before an intervention on long-term brain structure in mouse pups. Neonatal C57Bl/6J mice (n = 109) were randomly assigned to one of 2 treatments (vehicle vs sucrose) and one of 3 interventions (handling, touch, or needle-prick). Mice received 10 interventions daily from postnatal day 1 to 6 (P1-6). A dose of vehicle or 24% sucrose was given orally 2 minutes before each intervention. At P85-95, brains were scanned using a multichannel 7.0 T MRI. Volumes of 159 independent brain regions were obtained. Early repetitive sucrose exposure in mice (after correcting for whole brain volume and multiple comparisons) lead to smaller white matter volumes in the corpus callosum, stria terminalis, and fimbria (P < 0.0001). Cortical and subcortical gray matter was also affected by sucrose with smaller volumes of hippocampus and cerebellum (P < 0.0001). These significant changes in adult brain were found irrespective of the type of intervention in the neonatal period. This study provides the first evidence of long-term adverse effects of repetitive sucrose exposure and raises concerns for the use of this standard pain management practice during a period of rapid brain development in very preterm infants.

Improving Pain Management and Long-Term Outcomes Following High-Energy Orthopaedic Trauma (Pain Study).

Poor pain control after orthopaedic trauma is a predictor of physical disability and numerous negative long-term outcomes. Despite increased awareness of the negative consequences of poorly controlled pain, analgesic therapy among hospitalized patients after orthopaedic trauma remains inconsistent and often inadequate. The Pain study is a 3 armed, prospective, double-blind, multicenter randomized trial designed to evaluate the effect of standard pain management versus standard pain management plus perioperative nonsteroidal anti-inflammatory drugs or pregabalin in patients of ages 18-85 with extremity fractures. The primary outcomes are chronic pain, opioid utilization during the 48 hours after definitive fixation and surgery for nonunion in the year after fixation. Secondary outcomes include preoperative and postoperative pain intensity, adverse events and complications, physical function, depression, and post-traumatic stress disorder. One year treatment costs are also compared between the groups.

MP89-20 TARGETED ROBOTIC ASSISTED MICROSURGICAL DENERVATION OF THE SPERMATIC CORD FOR THE TREATMENT OF CHRONIC SCROTAL CONTENT PAIN: SINGLE CENTER, LARGE SERIES REVIEW.

You have accessJournal of UrologyInfertility: Therapy I1 Apr 2017MP89-20 TARGETED ROBOTIC ASSISTED MICROSURGICAL DENERVATION OF THE SPERMATIC CORD FOR THE TREATMENT OF CHRONIC SCROTAL CONTENT PAIN: SINGLE CENTER, LARGE SERIES REVIEW. Nahomy Calixte, Bayo Tojuola, Ibrahim Kartal, Ahmet Gudeloglu, Jamin Brahmbhatt, and Sijo Parekattil Nahomy CalixteNahomy Calixte More articles by this author , Bayo TojuolaBayo Tojuola More articles by this author , Ibrahim KartalIbrahim Kartal More articles by this author , Ahmet GudelogluAhmet Gudeloglu More articles by this author , Jamin BrahmbhattJamin Brahmbhatt More articles by this author , and Sijo ParekattilSijo Parekattil More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2818AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Microsurgical denervation of the spermatic cord (MDSC) is a treatment option for chronic scrotal content pain that is unresponsive to conservative treatments. A recent study has shown specific nerve fiber abnormalities (Wallerian degeneration) in the cord as a potential cause for this pain. Our goal was to assess outcomes of a more targeted technique in ablating only these abnormal nerves when performing MDSC: targeted robotic assisted microsurgical denervation of the spermatic cord (RMDSC). METHODS Retrospective review of 772 patients who underwent RMDSC by two fellowship trained microsurgeons from October 2008 to July 2016. Selection criteria were as follows: chronic testicular pain (>3 months), failed standard pain management treatments and negative urologic workup. Targeted ligation of tissues containing the trifecta location of nerves with Wallerian degeneration was performed: the cremasteric muscle fibers, the peri-vasal sheath and the posterior spermatic cord lipomatous tissues. The primary outcome measure was level of pain. Pain was assessed preoperatively and postoperatively using two assessment tools: a) the subjective visual analog scale (VAS) and b) an objective standardized externally validated pain assessment tool (PIQ-6, QualityMetric Inc., Lincoln, RI). RESULTS Median age was 41 years. Median operative duration (robot console time) was 20 minutes (15-80). Median follow up was 24 months. Subjective VAS patient pain outcomes: 84% significant reduction in pain (50% complete resolution – 425 patients, 34% reported a greater than 50% reduction in pain – 291 patients). Objective PIQ-6 outcomes: significant reduction in pain in 67% of patients at 6 months and 68% at 1 year post-op. CONCLUSIONS Targeted robotic assisted microsurgical denervation of the spermatic cord is a safe and viable treatment option for patients with chronic scrotal content pain refractory to conservative measures. Further studies are warranted. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1209 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Nahomy Calixte More articles by this author Bayo Tojuola More articles by this author Ibrahim Kartal More articles by this author Ahmet Gudeloglu More articles by this author Jamin Brahmbhatt More articles by this author Sijo Parekattil More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Comparative analysis of length of stay, hospitalization costs, opioid use, and discharge status among spine surgery patients with postoperative pain management including intravenous versus oral acetaminophen

Background: Recovery from spine surgery is oriented toward restoring functional health outcomes while reducing resource use. Optimal pain management is a key to reaching these objectives. We compared outcomes of spine surgery patients who received standard pain management including intravenous (IV) acetaminophen (APAP) vs. oral APAP.Methods: We performed a retrospective analysis of the Premier database (January 2012 to September 2015) comparing spine surgery patients who received pain management with IV APAP to those who received oral APAP, with no exclusions based on additional pain management. We performed multivariable logistic regression for the discharge and all cause 30-day readmission to the same hospital outcomes and instrumental variable regressions using the quarterly rate of IV APAP use for all hospitalizations by hospital as the instrument in two-stage least squares regressions for length of stay (LOS), hospitalization costs, and average daily morphine equivalent dose (MED) outcomes. Models adjusted for age, gender, race, admission type, 3M All Patient Refined Diagnosis Related Group severity of illness and risk of mortality, hospital size, and indicators for whether the hospital was an academic center and whether it was urban or rural.Results: We identified 112,586 spine surgery patients with 51,835 (46%) having received IV APAP. Subjects averaged 57 and 59 years of age respectively in the IV APAP and oral APAP cohorts and were predominantly non-Hispanic Caucasians and female. In our adjusted models, IV APAP was associated with 0.68 days shorter LOS (95% CI: −0.76 to −0.59, p < .0001), $1175 lower hospitalization costs (95% CI: −$1611 to −$739, p < .0001), 13 mg lower average daily MED (95% CI: −14 mg to −12 mg, p < .0001), 34% lower risk of discharge to a skilled nursing facility (95% CI: 0.63 to 0.69, p < .0001), and 13% less risk of 30-day readmission (95% CI: 0.73 to 1.03).Conclusions: Compared to oral APAP, managing post-spine-surgery pain with IV APAP is associated with less resource use, lower costs, lower doses of opioids, and improved discharge status.

Application effect of multi-dimension evaluation on the nasal septum injuries of prematures treated with NCPAP

Objective To improve the nursing quality and optimize services by shortening the treatment time of nasal continuous positive airway pressure (NCPAP) , and decreasing the incidence of nasal septum injury. Methods Totally 72 prematures treated with NCPAP in neonate department from February 2014 to September 2016 were selected and divided into the observation group and the control group, with 26 cases in each group. Patients in the control group received routine nursing method, while patients in the observation group received multi-dimension evaluation intervention. We used quality control circle to improve the quality, used cause-and-effect diagram to analyze the cause of nasal septum injury of prematures under the treatment of NCPAP, and used correlation analysis and clinical examination to find out the root cause. Targeted at 5 root causes, the improvement project was made. The treatment time of prematures, the number of cases of nasal septum injury and its degree, the average hospitalization time, the decannulation rate under the duty nurses' intervention, the increasing situation of prematures' weight in two groups before and after the application of multi-dimension evaluation were compared. Results Early machine withdrawal standard process and pain management plan were made, and hydrocolloid dressing combined with piping belt fixation method was used. The treatment time of NCPAP in prematures decreased from (44.2±18.4) h to (32.3±11.7) h (t=2.173, P=0.003) ; the incidence rate of Ι skin injury decreased from 41.7% to 11.1% (χ2=-3.092, P=0.003) ; the incidence rate of Ⅱ skin injury decreased from 16.7% to 2.8% (χ2=-2.017, P=0.048) ; the machine withdrawal rate under nurses' intervention decreased from 58.3% to 13.9% (χ2=4.366, P=0.000) ; the average hospitalization time decreased from (189.1±52.8) h to (170.9±42.4) h (t=3.014, P=0.003) ; the increasing weight of prematures reduced from 58.3% to 88.9% (χ2=3.092, P=0.003) ; and the comparison between two groups had significant difference (P<0.05) . Conclusions Multi-dimension evaluation can significantly decrease the occurrence of premature's nasal septum injuries. Key words: Infant, premature; Multi-dimension evaluation; Nasal continuous positive airway pressure; Nasal septum injury

Abstract No. 104 - A prospective, double-blind, randomized controlled study evaluating the effects of two new IV medications, IV acetaminophen and/or IV ibuprofen, on standard of care pain and antiemetic management in uterine fibroid embolization patients

Abstract No. 104 - A prospective, double-blind, randomized controlled study evaluating the effects of two new IV medications, IV acetaminophen and/or IV ibuprofen, on standard of care pain and antiemetic management in uterine fibroid embolization patients

Designing a pain management protocol for craniotomy: A narrative review and consideration of promising practices.

Background:Craniotomy is a relatively common surgical procedure with a high incidence of postoperative pain. Development of standardized pain management and enhanced recovery after surgery (ERAS) protocols are necessary and crucial to optimize outcomes and patient satisfaction and reduce health care costs.Methods:This work is based upon a literature search of published manuscripts (between 1996 and 2017) from Pubmed, Cochrane Central Register, and Google Scholar. It seeks to both synthesize and review our current scientific understanding of postcraniotomy pain and its part in neurosurgical ERAS protocols.Results:Strategies to ameliorate craniotomy pain demand interventions during all phases of patient care: preoperative, intraoperative, and postoperative interventions. Pain management should begin in the perioperative period with risk assessment, patient education, and premedication. In the intraoperative period, modifications in anesthesia technique, choice of opioids, acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), regional techniques, dexmedetomidine, ketamine, lidocaine, corticosteroids, and interdisciplinary communication are all strategies to consider and possibly deploy. Opioids remain the mainstay for pain relief, but patient-controlled analgesia, NSAIDs, standardization of pain management, bio/behavioral interventions, modification of head dressings as well as patient-centric management are useful opportunities that potentially improve patient care.Conclusions:Future research on mechanisms, predictors, treatments, and pain management pathways will help define the combinations of interventions that optimize pain outcomes.

Can consistent benchmarking within a standardized pain management concept decrease postoperative pain after total hip arthroplasty? A prospective cohort study including 367 patients.

BackgroundThe number of total hip replacement surgeries has steadily increased over recent years. Reduction in postoperative pain increases patient satisfaction and enables better mobilization. Thus, pain management needs to be continuously improved. Problems are often caused not only by medical issues but also by organization and hospital structure. The present study shows how the quality of pain management can be increased by implementing a standardized pain concept and simple, consistent, benchmarking.MethodsAll patients included in the study had undergone total hip arthroplasty (THA). Outcome parameters were analyzed 24 hours after surgery by means of the questionnaires from the German-wide project “Quality Improvement in Postoperative Pain Management” (QUIPS). A pain nurse interviewed patients and continuously assessed outcome quality parameters. A multidisciplinary team of anesthetists, orthopedic surgeons, and nurses implemented a regular procedure of data analysis and internal benchmarking. The health care team was informed of any results, and suggested improvements. Every staff member involved in pain management participated in educational lessons, and a special pain nurse was trained in each ward.ResultsFrom 2014 to 2015, 367 patients were included. The mean maximal pain score 24 hours after surgery was 4.0 (±3.0) on an 11-point numeric rating scale, and patient satisfaction was 9.0 (±1.2). Over time, the maximum pain score decreased (mean 3.0, ±2.0), whereas patient satisfaction significantly increased (mean 9.8, ±0.4; p<0.05). Among 49 anonymized hospitals, our clinic stayed on first rank in terms of lowest maximum pain and patient satisfaction over the period.ConclusionResults were already acceptable at the beginning of benchmarking a standardized pain management concept. But regular benchmarking, implementation of feedback mechanisms, and staff education made the pain management concept even more successful. Multidisciplinary teamwork and flexibility in adapting processes seem to be highly important for successful pain management.

Choosing Opioid Policies Our Patients Can Live With.

In 1997, the American Academy of Pain Medicine and the American Pain Society jointly issued recommendations regarding the care of patients with chronic pain.(1) Several years later, the Joint Commission on Accreditation of Healthcare Organizations issued pain management standards "recommending" that hospitals identify patients with pain upon initial screening and collect data to monitor the effectiveness of pain management.(2) Nearly two decades later, we find ourselves in the midst of a opioid epidemic triggered, in part, by excessive utilization of opioid pain medications.(3) We now find ourselves playing "catch up," as we try to undo some of the practices of the past, and change the culture to better balance benefit and risk. This article is protected by copyright. All rights reserved.This article is protected by copyright. All rights reserved. Language: en

Effectiveness research on network informatization postoperative pain management

Objective Through the network informatization management, postoperative pain assessment, nursing records, process the results into the network electronic medical records, more standardized postoperative pain management, improve the effectiveness of postoperative analgesia. Methods A total of 3 680 patients after the operation from November to December in 2015 were selected and divided into control group and observation group according to the operation time. In November for the traditional postoperative pain management in control group (1 850 cases), in December as observation group (1 830 cases), with Hospital Information System and Anesthesia Information System, all of the records in the postoperative pain management content network electronic information management, according to the degree of pain and analgesia method to select a different form, data sharing, wrong alarm to remind, handle in time. To establish a network of WeChat public platform to perform health education and information communication. The analgesia effect and patient's satisfaction were compared between two groups. Results The incidence of incomplete pain was 12.5%(231/1 850) in control group and 4.2% (77/1 830) in observation group, and there was significant difference between two groups(χ2= 82.22, P< 0.01). The satisfaction score was (5.9±3.7) points in observation group and (4.4±2.6) points in control group, and there was significant difference between two groups(t = 2.10, P<0.05). Conclusions Postoperative pain management network informatization can effectively improve the effect of postoperative analgesia, improve work efficiency. Key words: Network informatization; Electronic medical record; Postoperative analgesia; Management

Operation practice of the pain nursing team as main of pain resource nurses

Objective To explore the effect of pain management by pain resource nurse (PRN) attending pain nursing group, and to know the patient's satisfaction. Methods Advanced practice nurse as the lead of the group. The selection of PRN members in the group was made on merit which all have definite responsibility and like pain nursing, established pain management quality control system in group and training, standardized pain management processes and the regulations, educated knowledge and skills of pain management for PRN. Results Patient satisfaction with pain management increased significantly from 82.0% (496/605) to 97.1%(572/589) (P < 0.05). Moderate and serious pain rate of patients decreased significantly from 60.0% to 20.0% (P <0.01). The qualified rate of pain assessment increased from 84.9% (514/605) to 95.1% (560/589) (P <0.05). Conclusions The establishment of pain nursing group can not only improve pain management quality and patients satisfaction, but also improve of PRN's professional behaviors and development of clinical pain nursing . Key words: Pain; Quality control; Management; Satisfaction

Management of postoperative pain in 164 hospitals in Shandong Province

Objective To investigate current situation of postoperative pain mamagement in 164 hospitals in Shandong Province. Methods A questionnaire was developed on the basis of guidelines of acute pain and pain quality assessment. The questionnaire was used to obtain information regarding the nature and scale of the medical institution, the structure of pain management organization, the structure of acute pain service(APS), the model of APS, the implementation of pain assessment, and the analgesic techniques and processes used in clinical practice. A multi-stage stratified and cluster sampling method were employed to investigate the current situation of postoperative pain management in 164 medical institutions in Shandong Province. Results For APS, 32.9% of the hospitals established postoperative pain management organizations similar to APS. For pain evaluation, 58.5% of the hospitals evaluated pain as the fifth vital sign, and 42.7% of the hospitals evaluated pain at rest and during activity. Furthermore, 44.5% of the surveyed hospitals employed patient-controlled analgesia mode, of which hospitals employing brachial plexus block, lumbar plexus block, and femoral nerve block analgesia accounted for 4.9%, 1.2%, and 4.3%, respectively. The survey revealed that 52.4% of the hospitals educated patients about pain and pain management, of which patients were postoperatively educated by ward nurses in 11.0% and patients were educated by APS during ward rounds in 1.2%. Conclusions There is a lack of standardized postoperative pain management. The involvement of nurses in pain management is scarce, and the pain assessment and education and application of advanced analgesic management techniques were found to be inadequate in medical institutions in Shandong Province. Proposed Establish specification evaluation system and postoperative pain management in order to improve the postoperative pain management. Key words: Medical institution; Pain management; Acute pain service

Pain assessment of severely injured patients 2 years after trauma

Trauma patients often suffer from persisting pain even years after injury, and data on long-term pain management is lacking. The aim of this study was to evaluate the frequency of persisting pain and health-related quality of life (HrQoL) among trauma victims 2 years after injury. Furthermore, the frequency of pain specialist consultation and the quality of outpatient pain management, including phamacological management, was assessed. We analyzed prospectively collected data on severely injured adult patients treated between 2008-2011 at the Cologne Merheim Medical Center (CMMC)/Germany.Data included the 'Polytrauma Outcome Profile' and a standardized questionnaire onoutpatient pain management. Exclusion criteria were death, inability to answer the questionnaire due to cognitive disabilities and lack of language knowledge. 207/391 (53 %) data sets were available for analysis, presenting a typical trauma collective with injury severity of ISS19, predominantly male and a mean age of 44years. 2 years after trauma 59 % still reported that they suffered from severe persisting pain; 53 % of these patients were under pharmacological pain medication. Only 1/5 of the patients with severe persisting pain was treated by a pain specialist. Successful treatment options do exist; improvement of treatment is required.

Adjunctive cognitive behavioural treatment for chronic pain couples improves marital satisfaction but not pain management outcomes.

Data have consistently shown that patient coping with chronic pain can be affected by various factors associated with the primary relationship, and hence efforts to include the patient's partner in the treatment process have merit. This study evaluated the benefit of adding an adjunctive, couples-based, cognitive behavioural treatment (CBT) for chronic pain to a standard cognitive behavioural pain management programme. Forty-five couples were randomly assigned to either an adjunctive couples intervention (n=19) or the pain programme only (n=26). All patient participants completed a 3-week multi-disciplinary pain management programme, to which their partners were invited to attend one full day. In addition, partners in the adjunctive condition received four, one hour treatment sessions focusing on pain education, patient-partner communication, operant behavioural principles and relapse prevention strategies. Partner sessions for the adjunctive intervention were provided over the telephone. By the completion of the pain programme the adjunctive couples intervention demonstrated significant improvements in maritalsatisfaction for the spouses over and above attendance at the pain management programme alone (p=0.003). However, spouse involvement did not facilitate any additional response to treatment for pain patients on marital satisfaction, pain, disability or any indices of distress. All treatment gains were maintained at 1month follow-up. These data demonstrate that a brief CBT intervention can significantly improve marital satisfaction for spouses of chronic pain patients, but the treatment does not translate to improvements in function on any outcomes, including marital satisfaction, for patients of chronic pain. WHAT DOES THIS STUDY ADD?: A brief, telephone-based intervention for couples living with chronic pain is an acceptable format for intervention. This intervention can significantly improve marital satisfaction for partners of chronic pain patients. Patients who are already participating in a multidisciplinary pain programme will not obtain further benefit.

Acupuncture for postoperative pain, a literature review

There is evidence that acupuncture may relieve pain. To assess the evidence about the effectiveness of acupuncture to relieve postoperative pain. A systematic review of the literature selecting controlled clinical trials and systematic reviews comparing acupuncture with standard pain management. The value and quality of reports were evaluated using Jadad scale and STRICTA protocol. Pain intensity and analgesic consumption were the primary endpoints sought. Five controlled trials and two systematic reviews were selected. A meta-analysis was not feasible due to the heterogeneity of studies. In the postoperative period of tonsillectomy, acupuncture reduced pain by 36 and 22% at 20 minutes and two hours, respectively. In knee replacement, acupuncture reduced pain by 2% and analgesic consumption by 42%. In the postoperative period of dental interventions, acupuncture reduced pain by 24% at two hours. Acupuncture may be useful to manage postoperative pain, but more controlled studies are required.

Applying healthcare failure mode and effect analysis to patient pain management in the anesthesia recovery period

Abstract Objective To standardize pain management in the anesthesia recovery period and improve the effects of analgesia on acute postoperative pain. Methods Using healthcare failure mode and effect analysis (HFMEA), we analyzed the primary cause of patients' pain and subsequently determined the process and risk priority number (RPN). Results Actions were taken to improve patients' pain. After using HFMEA, the experimental group's visual analog scale (VAS) scores were lower than those of the control group at 1 h and at discharge from the post-anesthetic intensive care unit (PAICU). The differences were statistically significant (P Conclusions The application of failure mode and effect analysis can relieve pain and improve the quality of nursing.

Assessing Pain in the ED Including the Use of Pain Scales (Such as OSBD, FLACC, VRS, NRS, CRS, and Oucher)

Pain is a common presenting complaint in pediatric emergency departments (EDs). In 2001 the Joint Commission for Healthcare Organizations (JCAHO) set standards for pain assessment and management that have become important quality indicators. These Joint Commission standards led EDs to treat pain as a “fifth vital sign” to be measured and addressed. JCAHO left the details of pain assessment metrics to the facilities, thus no single scale has been recommended as the standard of care in pediatrics. Self-reported pain severity scales are considered ideal, but young and cognitively impaired children are unable to effectively use these tools. Other observational scales have been developed to reliably measure pain in these populations. Debate about the value of pain metrics persists in the medical literature despite the near-universal institutionalization of pain measurement in US EDs.

Percutaneous freezing of sensory nerves prior to total knee arthroplasty

BackgroundTotal knee arthroplasty (TKA) is a common procedure resulting in significant post-operative pain. Percutaneous cryoneurolysis targeting the infrapatellar branch of the saphenous nerve and anterior femoral cutaneous nerve could relieve post-operative knee pain by temporarily blocking sensory nerve conduction. MethodsA retrospective chart review of 100 patients who underwent TKA was conducted to assess the value of adding perioperative cryoneurolysis to a multimodal pain management program. The treatment group consisted of the first 50 patients consecutively treated after the practice introduced perioperative (five days prior to surgery) cryoneurolysis as part of its standard pain management protocol. The control group consisted of the 50 patients treated before cryoneurolysis was introduced. Outcomes included hospital length of stay (LOS), post-operative opioid requirements, and patient-reported outcomes of pain and function. ResultsA significantly lower proportion of patients in the treatment group had a LOS of ≥2days compared with the control group (6% vs. 67%, p<0.0001) and required 45% less opioids during the first 12weeks after surgery. The treatment group reported a statistically significant reduction in symptoms at the six- and 12-week follow-up compared with the control group and within-group significant reductions in pain intensity and pain interference at two- and six-week follow-up, respectively. ConclusionsPerioperative cryoneurolysis in combination with multimodal pain management may significantly improve outcomes in patients undergoing TKA. Promising results from this preliminary retrospective study warrant further investigation of this novel treatment in prospective, randomized trials. Level of evidenceIII

Management of Postoperative Pain in Medical Institutions in Shandong Province in China.

The aim of the study was to investigate current situation of postoperative pain management in medical institutions in Shandong Province.A questionnaire was developed on the basis of guidelines of acute pain and pain quality assessment scale. The questionnaire was used to obtain information regarding the nature and scale of the medical institution, structure of pain management organization, implementation of pain assessment, and analgesic techniques and processes used in clinical practice. A multistage stratified and cluster sampling method was employed to investigate the current situation of postoperative pain management in 168 medical institutions in Shandong Province.For acute pain service (APS), 32% of the hospitals established postoperative pain management organizations similar to APS. For pain evaluation, 57.1% of the hospitals evaluated pain as the fifth vital sign, and 47.0% of the hospitals evaluated pain at rest and during activity. Furthermore, 43.0% of the surveyed hospitals employed patient-controlled analgesia mode, of which hospitals employing brachial plexus block, lumbar plexus block, and femoral nerve block analgesia accounted for 5.0%, 1.0%, and 4.0%, respectively. The survey revealed that 51.0% of the hospitals educated patients about pain and pain management, of which patients were postoperatively educated by ward nurses in 5.0% and patients were educated by APS during ward rounds in 2.0%.There is a lack of standardized postoperative pain management, the involvement of nurses in pain management is scarce, and the pain assessment and education and application of advanced analgesic management techniques were found to be inadequate in medical institutions in Shandong Province.